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Drugs essential to basic health care have been priced out of the reach of Malaysia's poor, highlighting the importance of mechanisms to prevent manufacturers from raising prices too high, say researchers.

Research published in PLoS Medicine this week (27 March) has implications for health policy in other parts of the developing world.

An international team of researchers looked at the cost of 48 key drugs in private and government-run pharmacies and dispensing doctor's surgeries in four regions of western Malaysia.

Twenty-eight of these drugs are on a core list of 'essential' drugs published by the World Health Organization, based on disease burden. The remaining 20 are important for health care needs specific to Malaysia.

Prices of patented and generic drugs were compared and average local wages assessed to calculate the affordability of drugs.

They found that the prices of both patented and generic drugs were on average 16 times higher than international reference prices, and that some dispensing doctors are selling generic drugs at 310 times their real cost.

Buying a month's supply of a commonly prescribed stomach ulcer pill in Malaysia would cost a low-paid government worker the equivalent of three days' wages, for example.

Malaysia allows market forces to determine drugs prices, and the study questions the government's failure to cushion the poorest of its people against the effects of its commitment to the free market under the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) as part of the World Trade Organization.

This agreement allows countries to secure cheap drugs for themselves by allowing people to sell generic versions of the original patented drugs.

But the study points out that drug prices in Malaysia are much higher than in India and Sri Lanka, for example, where government measures make medicines more affordable.

Malaysia, wooed by United States, has entered into bilateral free trade agreements on drugs, which have been criticised for disabling the country's rights to procure cheaper drugs.

The authors call for more effective price-control policies to be put in place, and increased or better-targeted public spending on essential medicines.

In India ― also a signatory of TRIPS ― the multinational drug company Novartis has been claiming rights of exclusivity over newer versions of the leukaemia drug Gleevec, which costs 12 times more than its Indian generic version.

Meera Shiva, a health rights activist in India, said, "Drug prices in developing countries in the post TRIPS scenario reflect the reality of big firms seeking to monopolise drugs and keep out cheaper versions."

"[The issues in the study] are also about people having to pay for most of the drugs from their own pockets with little government aid. So keeping the drugs cheap is life-giving in a number of ways," she added.

Shiva gave the example of France, where more than 80 per cent of drugs are paid for by the health system, making prices less of a concern.

Suzanne Hill, clinical pharmacologist based in Ferney-Voltaire, France, advised caution about the results of the study. She said it is important not to over-interpret the results, as they are based on surveys of small samples of facilities, and may not be applicable to the entire country.

Link to full article/paper in PLoS Medicine

Reference: PLoS Medicine 4(3) 2007