Intended for healthcare professionals


Post-marketing observational trials and catastrophic health expenditure

BMJ 2012; 344 doi: (Published 12 June 2012) Cite this as: BMJ 2012;344:e3987
  1. John S Yudkin, emeritus professor of medicine
  1. 1Department of Medicine, University College London, London WC1E 6BT, UK
  1. j.yudkin{at}

Over the past decade, one of the world’s largest insulin manufacturers, Novo Nordisk, has worked hard on its social responsibility profile. In 2001, the company launched an equity pricing scheme for its insulins in 50 of the world’s poorest countries.1 This might have been triggered by the unease felt across Denmark at the company’s participation, with 38 other pharmaceutical companies, in an infamous court case in South Africa attempting to use trade agreements to block the government’s use of generic antiretroviral drugs.2 Nevertheless, by 2008, in the Access to Medicines Index, a ranking of the world’s largest drug companies on their efforts to increase access to medicine, Novo Nordisk came second, with an aggregate score of 3.9 out of 5.3

In 2010, however, Novo Nordisk invoked negative headlines by threatening to withdraw all its products from Greece because of a governmental order to cut all drug prices by 25%.4 In the UK, Novo Nordisk has faced protests about its withdrawal of its Mixtard insulin formulation, still used by 90 000 people.5 In the 2010 update of the Access to …

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