Critics of 'me-too' innovation often argue that follow-on drugs offer little incremental clinical value over existing pioneer products, while at the same time increasing health care costs. This study examines whether consumers view follow-on and pioneer drugs as close substitutes or distinct clinical therapies. For five major classes of drugs, it found that large reductions in the price of pioneer molecules after patent expiration – which would typically lead to decreased consumption of strong substitutes – have no effect on the trend in demand for follow-on drugs. The findings are likely unaffected by health insurance, competitive pricing of me-toos, marketing, and switching costs.
Health equity in economic and trade policies
Conditionalities attached to loans from the World Bank and IMF were among the key negative influences on health and its social determinants between 1980 and 2000 in many of the more than 75 low- and middle-income countries in which they were applied. Best available evidence suggests that this 'neoliberal epidemics' era is not over. In the future, neoliberalism is likely to reflect the erosion of territorial divisions between core and periphery, or the global North and the global South, in the world economy. The authors write that the success of efforts to fight neoliberal epidemics and reduce health inequalities will depend on blurring boundaries: between the global and local frames of reference, and between public health practice and the politics of health. This last blurring means a return to the wisdom of Rudolf Virchow, to the effect that ‘medicine is a social science, and politics is nothing else but medicine on a large scale’. As Martin McKee and colleagues wrote in a 2012 commentary on the failure of austerity policies, ‘Virchow’s words are as relevant today as they ever were’. Understanding how to translate that insight into political action will require the development of a comparative political science of health inequalities – a critically important project that remains in its infancy.
The report asserts that in South Africa, as in other jurisdictions, “Big Food” (large commercial entities that dominate the food and beverage environment) is becoming more widespread and is implicated in unhealthy eating. “Small food” remains significant in the food environment in South Africa, and it is both linked with, and threatened by, Big Food. Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe. These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa; they have also developed a range of “health and wellness” initiatives. Whether these initiatives have had a net positive or net negative impact is not clear. The authors argue that the South African government should act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.