Defying patents: India forces debate on generic drugs

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Generic drugs should be any health worker’s favorite tools. Unfortunately, the world of medical aid missions is not resistant to the politics of drug pricing and distribution. Medical R&D practices have multiplied the world over, giving rise to affordable science. From the primordial knowledge soup of advanced medical technologies, no exclusive R&D results arise.


Stiff market competition among purveyors of high-demand drugs was the status quo until the advent of patents. Even then, emerging economies, such as India, are persisting with generic drugs production, naturally rankling huge pharmaceuticals. India offers some of the cheapest medicines in the world against cancer, tuberculosis, and AIDS. Its homegrown pharmaceutical industries were collectively worth USD 11 billion, and according to Le Monde diplomatique, it is set to inflate to USD 30 billion by 2020.

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The medical profession isn’t homogeneous in its hawkishness, and humanitarian doctors have stepped up to the plate in the promotion of generic drugs. For instance, New York-based nephrologist Paul Frymoyer and Deane Marchbein of Doctors Without Borders, whose experience in giving medical aid in African missions opens to them the realities of epidemics and pandemics, could find recourse in generic drugs to push aid distribution far.

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The reality is that the pharmaceutical industry is divided by its quest for profits and mission to equip the world with advanced medical solutions. India’s local, healthier pharmaceutical competitive market has evened out this contradiction, yet it remains at the behest of international trade agreements. The European Union, headed by President Juan Manuel Barroso, denounced India’s cheap drug exports, and resorted to supply seizures in what the World Health Organization considered as an abuse of counterfeit laws.


As a prominent nephrologist, Dr. Paul Frymoyer is especially concerned about new medical trends. Visit this Facebook page for more information.

Reblog: Decoding Cancer: Scientists Release 520 Tumor Genomes from Pediatric Patients

Time.com reports on advancements in research on cancer and ways to cure the disease:

Could the answer to cancer lie within our own DNA?

Childhood cancer experts are hoping that at least some of what drives pediatric cancers can be gleaned from the genomes of patients and their tumors. That’s the thinking behind the Pediatric Cancer Genome Project (PCGP), a three-year, $65 million effort to sequence major pediatric cancers.

The latest release of data from the PCGP, published in the journal Nature Genetics, includes 520 genome sequences from childhood cancer patients; half of the genetic material comes from their tumors, and half from their healthy tissues. By matching the tumor genomes to those of normal cells from the same patients, researchers hope to pinpoint the differences and get a better idea of where the cancer cells went awry. These discrepancies in the genetic code are also likely to be the richest targets yet for potential new therapies.

“We knew that if we only sequenced the tumor, and not normal non-tumor DNA from the patient, we would end up with thousands to hundreds of thousands of potential mutations, and no way to sort through which ones were important to cancer,” says Dr. James Downing, scientific director and leader of the PCGP at St. Jude Children’s Research Hospital, which partnered with Washington University for the project.

Ultimately, the researchers aim to use the genetic information to help develop new, more effective cancer treatments. Despite the fact that survival rates of many childhood cancers has improved to reach 80% to 90% in recent years, much of this benefit is due to early detection and quick intervention with conventional treatment, including surgery, chemotherapy and radiation therapies. There have been no new drugs to treat pediatric cancers in nearly two decades, and the rates of recurrent and new cancers among survivors remains high.

It’s hard to argue that the genetic information collected by PCGP won’t be useful, but can it change patients’ lives now? Will it help guide doctors to better treatments for childhood cancers? A recent study showed that despite the excitement over applying genetic information in improving health outcomes, adding genetic testing did not improve doctors’ ability to predict diseases such as breast cancer, diabetes or rheumatoid arthritis.

Downing acknowledges that the current depot of genetic information is but the first step. Doctors still need to be able to interpret and apply all the information gleaned from patients’ tumors and healthy cells to make smarter treatment decisions that improve survival — and perhaps even cure their cancer. “All the knowledge gained from direct analysis of DNA sequences will help as we start to apply them to personalized medicine and clinical genomics,” Downing says. “There is a lot of genetic testing going on, but does it really help? A lot of it doesn’t; there is a lot less specificity than we would ultimately need for a physician to use that sequencing information in caring for patients. But we are making good progress in interpreting the data and figuring out which mutation are important.”

Already, genetic information has provided some important clues about how best to treat certain childhood cancers: decoding the tumor genomes of a form of acute lymphoblastic leukemia (ALL), for example, showed that doctors were treating this cancer the wrong way; instead of being similar to other lymphoblastic leukemias, these tumors had more in common with acute myeloid leukemia (AML), another cancer of the bone marrow and blood cells, which is treated very differently. “So immediately we saw that we needed to modify the therapeutic approaches for patients with ALL,” says Downing.

Trials to treat patients who have relapsed on all available treatments for ALL with AML-based therapies are just beginning to launch, to establish whether the gene-based intelligence can make a difference in survival for these patients.

There are other examples, as well, in which a childhood eye cancer was traced to a mutation for which a targeted anti-cancer drug already exists.

The idea, says Downing, is to collate all the genetic information on childhood cancers into one place, so that researchers, clinicians, biologists and drug developers can analyze the data and start connecting dots toward more effective treatments. The database is currently available through the European Bioinformatics Institute portal.

While the effort was privately funded by St. Jude Children’s Research Hospital and Kay Jewelers, the PCGP will make access to the database free to researchers, as long as they use the information for research and agree to hold any publications for nine months after the data is uploaded to ensure time for any modifications to verify the sequences.

Because the final goal of the PCGP is to make DNA information useful in the clinic, Downing says that most of the project’s publications include some interpretation of the genetic material to help scientists apply it to effective clinical treatment. PCGP researchers attempt to provide background information on how the mutations identified might contribute to tumor formation, and whether there exist any studies linking mutations to bad or good outcomes for patients.

Downing acknowledges that scientists are still a long way from directly applying genomic information to cancer care, but the more samples and the more tumor DNA that is layered into the PCGP, the more easily researchers can start to pick out genetic patterns and read the hidden language of cancer cells.

“There is a wealth of information that we are generating and it will take years to extract all the valuable information,” he says. “But we need to start by getting it out into the hands of everybody in the scientific field — not only those in cancer research — so they can use it both as reference and as a discovery tool, and find new things that we have yet to find.”

Article source: http://healthland.time.com/2012/05/30/decoding-cancer-scientists-release-520-tumor-genomes-from-pediatric-patients

Paul Frymoyer on infection and antimicrobial resistance

Dr. Paul Frymoyer is board-certified in internal medicine and nephrology. He went to Malawi, Africa two years ago to provide medical assistance to the natives. As a nephrologist, the fervent doctor provides critical care for kidney diseases and conditions through efficacious interventions, particularly antibiotic treatment.

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That being said, the New York-based doctor, along with other physicians across different practices, would have been alarmed with the current influx of antimicrobial resistance. Antimicrobial resistance (AMR) happens when microorganisms like bacteria, parasites, and viruses are able to survive exposure to an antibiotic to which they are previously sensitive. AMR is mostly likely due to spontaneous or induced mutation in the DNA of the bacteria and to the transfer of resistant genes from one bacterium to another.

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Dr. Paul Frymoyer would believe that AMR is the major consequence of misuse or overuse of antibiotics. Simply put, the more people use antibiotics, the more drug resistance they’ll get. Normally, antimicrobial medicines stave off infection either by directly killing microorganisms (bacteriocidal process) or by hampering the growth of microorganisms (bacteriostatic process). The overuse of drugs allows microorganisms to get used to the way antimicrobial medicines work and pick up some drug-fighting actions such as hindering the medicine from reaching its target, changing its target so that antibiotics can no longer distinguish it, and destroying the medicine itself.

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According to the World Health Organization, approximately 440,ooo cases of AMR, including drug-resistant tuberculosis (XDR-TB), appear each year, accounting for at least 150,ooo deaths.

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Weighing in: Dr. Paul Frymoyer and obesity in children

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Dr. Paul Frymoyer is a New York-based nephrologist. Two years ago, he visited Malawi in Africa, and helped tend to the medical needs of hundreds of children afflicted with a variety of conditions, including malaria, diarrhea, and HIV.


Obesity in children has been under scrutiny for over decades. Concern for children’s diets and the effects of these on their general health has steadily increased in recent years. Causes for obesity have been identified, and while most of these are dietary in nature, it appears now that there may be other reasons why some children have a propensity to be overweight.

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Children’s doctors, like Dr. Paul Frymoyer, have identified food and lifestyle as among the top factors to consider when dealing with obesity. Recently, a report in TIME detailed the dire effects of excessive consumption of bottled sodas, and how cutting back on these drinks lessened the risk of excess weight among children. Drinking water in place of a can of soda, for instance, leads to less fat deposits and, eventually, weight loss.


Researchers, however, have now also found that some children are more predisposed toward obesity than others. A pregnant woman’s exposure to pollution, for instance, may have an effect to her child’s weight because of the endocrine disruptors or environmental chemicals found in polluted areas. Polycyclic aromatic hydrocarbons (PAHs) are among these chemicals, which may be found in cigarette smoke and car exhaust. The presence of these endocrine disruptors in the child’s body could lead to a higher possibility of obesity.

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From words to works: Paul Frymoyer and the path he leads

“Lead, follow or get out of the way.”

Dr. Paul Frymoyer, a Manlius, New York-based nephrologist admires this passage from Thomas Paine. It is his favorite quote—the sequence of words that defines his life’s perspective, adhering to which has led him to undergo a compelling journey to a distant territory, in the company of a foreign people.

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That a man such as Dr. Frymoyer would adopt a perspective such as Thomas Paine’s is not at all strange. If given the opportunity, he would have enjoyed shaking the hand of men like Barrack Obama, Franklin Roosevelt, and Winston Churchill—leaders all. On the other hand, Paine may not have been a leader in terms of political position, but some of his works influenced his people to work toward ushering change and freedom through the American Revolution.

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Similarly, Dr. Paul Frymoyer holds no political post, but his journey to Africa would have made any great leader proud. Some time ago, he travelled to Malawi for the second time with his wife, and practiced his profession among natives who often lacked the resources to afford medical attention. His skills and expertise came to great use, especially in the diagnosis of conditions like malaria and diabetes, and in the treatment of a large number of diseases among children and adults alike.

Indeed, Dr. Frymoyer did not lead people to war, or lift economies from upheavals, but he acted the way any leader would have and effected change in his own way.

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Dr. Paul Frymoyer: A children's doctor

Dr. Paul Frymoyer appears to have a soft spot for children. The Manlius, New York-based physician specializes in pediatric nephrology, the study of renal disorders among children. Because the kidneys work as a filter for the body, it is imperative that they work well in children. Kidney problems diagnosed in children are often more traumatic to the body than in adults, as younger bodies, while stronger, are not yet fully capable of repair and regeneration.

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Disorders in organs of the body inadvertently affect other parts of the body. General nephrology necessitates an understanding of internal medicine, or diseases in adults, thus requiring, on the doctor’s part, an in-depth understanding of diseases affecting both children and adults. Dr. Paul Frymoyer has put this specialization to good use when he visited the African country of Malawi, where adults and children alike are afflicted with the most serious illnesses known.

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The physician travelled with his wife to the impoverished continent for two purposes -- to practice medicine in the capital’s hospitals and to immerse themselves in the local culture. The doctor’s first stop was the Crisis Nursery in Lilongwe, Malawi’s capital. He marvelled at how, despite very limited resources and in the absence of state-of-the-art facilities, all the children in the hospital, including the 22 orphans left there, appeared to be well-cared for and comfortable.

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Later in his trip, Dr. Frymoyer visited two hospitals in the brush, where hundreds upon hundreds of patients came to avail of his team’s services. A good number of them were children, all afflicted with malaria, diarrhea, parasitic infections, and HIV.  

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Dr. Paul Frymoyer: A significant drop in the bucket

Dr. Paul Frymoyer is but one of thousands of doctors who, at a time in their careers, have dedicated time, energy, and professional expertise to the people of Africa. Several international organizations, among them the United Nations and Doctors without Borders, send several hundred doctors to various parts of Africa every year. Despite this influx, however, it appears that Africa’s health woes are multiplying as time goes by.

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It appears, however, that others bask more in recognition of their charity than the doctors who postpone lucrative careers in cities in order to practice their noble professions. For many doctors who go to Africa, being a doctor is a job akin to that of a peacekeeper. Dr. Paul Frymoyer has been in that situation before. Luckily for the doctor, however, he did not encounter anything potentially fatal. In restive areas, the danger of death hangs over every hospital and clinic. Medical entities are often caught in the crossfire of fighting forces, especially when they respond to the call of duty and try to extend assistance to wounded combatants on either side. This happens every so often, and no small number of doctors’ lives has been lost under these circumstances.

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Regardless of how long they stay, the doctors who come to Africa contribute significantly to saving lives in that troubled part of the world. Ironically, rarely are they recognized for these acts in the same way as celebrities who dole out cash donations for causes are hailed. Yet doctors continue to flow into the continent—one could only surmise that living by their oaths is rewarding enough.

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Paul Frymoyer: Phenomenal work in the Lilongwe Crisis Nursery

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There are many things which Dr. Paul Frymoyer found memorable during his trips to Africa for his medical practice. Some were part of his work, like the visits to some extraordinary hospitals in Lilongwe; the others were part of his leisure time, like his African safari expedition.

Among the things that he found most memorable was the work done by the caregivers in the Crisis Nursery in Lilongwe, which was his group’s first stop. At the time of the doctor’s visit, the nursery had about 22 orphans below 2 years of age in its care.

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What made the Lilongwe Crisis Nursery stand out for the doctor was the exemplary work that its staff members had been doing and continues to do.

Dr. Paul Frymoyer noted in his journal how amazingly good the children looked as he examined them, which was particularly amazing considering how sick they were when they were first admitted to the nursery. During his visit, there was a child whose tests for HIV were still pending and there was one who was thought to have malaria. In spite of their conditions, however, they still looked pretty healthy.

Another thing that Dr. Frymoyer considered praiseworthy was how adept the nursery’s staff was in managing the limited resources available to them. The doctor noted that such a feat would not be possible had there been a lack of dedication and of the huge amount of love that the caregivers had for the children under their care.

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Paul Frymoyer on his experience of South African townships

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Paul Frymoyer, M.D., is a physician from Manilus, New York who travelled to Malawi to practice medicine. He has previously talked about his many experiences in Africa, from the rich culture of the Africans to his African safari adventure with his wife Carolyn. As he was there not merely as a tourist but primarily as a professional who was out to share his expertise, Dr. Frymoyer also witnessed what it was like for people living in Africa’s townships.

South Africa was famous for its townships but Dr. Frymoyer confessed that he and his wife did not actually see one on their trips to Johannesburg. Dr. Paul Frymoyer had heard quite a lot about the concept but it was not until he arrived in Cape Town that he was able to see a massive township, which was just around the airport.

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The term township and location are usually used to refer to often underdeveloped urban living areas that were reserved for non-whites (meaning: black Africans, Coloreds, and Indians) from the late 19th century until the end of Apartheid.

 Dr. Frymoyer shared that the townships he saw consisted of small shanties, placed on top of each other, located on unoccupied land. They were, he said, huge and went as far as the eyes can see in some cases and still somehow provided a sort of contrast with the rural poverty that he and his wife saw in Malawi.

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Fortunately, the South African government was doing a lot to try and replace townships with sturdier housing and it seems that there has been good progress on that end.  

Visit Dr. Paul Frymoyer’s Facebook page for more stories about his work in Africa.

Paul Frymoyer "gets down to work" in Africa

Paul Frymoyer is a physician based in Manilus, New York, and an alumnus of the Rensselaer Polytechnic Institute. He traveled to Africa twice to propagate better health practices and to treat the disease-stricken natives of Malawi.

From Paul Frymoyer

Together with his wife, Carolyn, he visited the Crisis Nursery in Lilongwe, home to 22 orphans under the age of two, most of who tested positive for HIV and malaria. Dr. Frymoyer, with his expertise in pediatric nephrology, helped the children get healed. He also visited the different villages of Lilongwe, where he was faced with numerous cases of malaria and parasitic infections. The people of Lilongwe were very grateful for his aid, as they have not seen a doctor in many months, because the villages become inaccessible during the rainy season.

From Paul Frymoyer

Paul Frymoyer also treated a lot of patients with diarrhea and pneumonia. Despite being exposed to the risk of contracting malaria, he and his wife remained steadfast in their mission to promote health, and took precautions through prophylactic medications and sleeping under a mosquito net. Cases of diabetes, hypertension, and heart disease are also rampant in the area, though not as bad as in the United States.

From Paul Frymoyer

Paul Frymoyer has nothing but wonderful words about his Malawi trip, because the people were “truly wonderful and extraordinarily grateful” to have them there. More about his trip to Africa and his professional experience can be found on his Facebook page.