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The drug industry is a barrier to diabetes care in poor countries

BMJ 2012; 344 doi: (Published 25 May 2012) Cite this as: BMJ 2012;344:e3018
  1. John S Yudkin, emeritus professor of medicine, University College London, UK
  1. j.yudkin{at}

In many parts of the world, people with type 1 diabetes (whether or not the condition is diagnosed) still die for want of insulin, and those with type 2 diabetes go without treatments that prolong life at minimal cost—metformin, antihypertensives, and statins.1 The UN High-level Meeting on Non-communicable Diseases (NCDs) in New York in 2011 emphasised the importance of accessibility to and affordability of effective treatment, but concerns have been expressed that including the food, tobacco, and pharmaceutical industries in deliberations could undermine the development of sound policy.2 There was a vital role for novel patented medicines to tackle HIV/AIDS a decade ago, but it is questionable whether the same applies to management of NCDs.

I argue that the approaches to management that are so heavily advocated by the research based drug industry are not just irrelevant to diabetes care in low income countries, but are actually counterproductive.

One of the important needs addressed by the UN meeting was ensuring universal access to affordable high quality essential medicines for NCDs. All four diabetes drugs on the 2011 WHO essential medicines list,3 and those recommended as first line agents by the National Institute for Health and Clinical Excellence,4 are available at low cost from generic manufacturers. A decade ago, tackling World Trade Organization agreements on intellectual property was integral to improving the global availability and affordability of antiretroviral drugs, but drugs still under patent protection are unnecessary for …

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