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Miles White, CEO of Abbott Labs, describes the approach based on 4 P's- people, product, presence and perseverance- that will work best for emerging markets. The idea is to become a citizen of that country or region, with the right mix of local people, product customized for regional preferences, local infrastructure, and perseverance for the long haul. The stakes are huge, as emerging markets are growing rapidly. The pharmaceutical market in India is expected to quadruple from $12 billion today to $50 billion by 2020.

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A series of voicemails and emails in court documents now disclosed, show that AstraZeneca tried to suppress findings about diabetes after effects in taking its psychiatric drug Seroquel. In an August 15, 2005, voicemail sent to company salespeople an employee Christine Ney, followed up on a"weight and diabetes sell sheet" they had recently sent. It said that the salespeople should assuage doctors' fears about their patients' weight gains, telling them that the data did not show any causal link between diabetes and the drug. "Our objective is to neutralize customer objections to Seroquel's weight and diabetes profile", Ms Ney said in the voice mail message. She instructed representatives to "refocus the call" away from diabetes to the drug's tolerability. While all this was going on and years before this, Astra Zeneca concealed a drug safety expert's own assessment of Seroquel's relation to diabetes. In a 2000 position paper about the safety of Seroquel sent to Dutch regulatory authorites, an AstraZeneca doctor named Wayne Geller wote that there was a relationship between the drug and diabetes. He wrote " there is reasonable evidence to suggest that Seroquel therapy can cause impaired glucose regulation including diabetes melliutus in certain individuals."...

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EpiPen's price has jumped 550% over 8 years. Mylan Pharmaceuticals is dominant in the $1 billion market for treating serious allergic reactions. Mylan acquired reights to sell EPiPen in late 2007. A pack of two list price is now $608.61. Last Nov. Sanofi's competing product Auvi-Q was recalled giving Mylan price dominance. A problem for consumers is that EpiPen expires in one year. Mylan launched a campaign to make parents aware of the product for children with peanut and other allergies, and also lobbied the governments to make ready supply of EpiPens available in schools and other public places. Now the controversy over price increases, with Hillary Clinton citing this as an example of exorbitant pharmaceutical pricing, is likely to change the environment around EpiPen and other overpriced drugs or healthcare products.

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Foreign institutional investment in India declined to a mere $172 million in April 2012, from $5 billion in February. Foreign direct investment in India is falling. It was down to $27.5 billion in 2011, with only $4.2 billion in Jan-Feb. 2012.

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Copies with slight changes to extend drug life with new brand names- Clarinex for Claritin, Nexium for Prilosec, Paliperidone for Risperdal being the latest in this new marketing strategy of drug companies to extend the life and sales of a successful drug. The drug companies try to market the copy drug as a significant improvement, which is what J&J is doing with Paliperidone. Experts are skeptical. Pricing of the generic versions of Risperdal or its copy will be much less expensive. Cost is a sensitive issue. About 15% of Risperdal's $1.35 billion sales were from Medicaid, generic substitutions offer potentially large savings. Meantime J&J did not do clinical tests between Risperdal and Paliperidone, the tests with 1600 patients compared Risperdal with a sugar pill. A psychiatry Professor at Duke and another professor at NYU are skeptical of J&J claims for Paliperidone. United Health shows savings of $150 million by using generics instead of Nexium, so managed care payors will tread carefully....

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About $710 million of the $3 billion fine Glaxo is paying the U.S. government and states is for the Justice Department's claims about the improper marketing of the asthma combination inhaler Advair.

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Vikram Pandit's style at Citigroup after 4 months, thoughful, asking lots of questions, fixing the little things that actually matter a lot, like the unwillingness of some heads of divisions to sit together in the same room, some hiring decisions and new lines of reporting and responsibiity and interaction in the organization structure that call for teamwork, discussion and collaboration. The oldtimers like Krawcheck used to clear lines of reporting are now getting used to the new culture of collaborative working. His style is first to come to grips with issues and not to come to snap decisions based on intuition, such as interviewing at length and asking tough questions at length to Ajay Banga, head of Citi's international group about the extensive defaults in Citi's consumer loan business in Japan. One of his views is that only if you get the foundation right can you talk about vision. Regarding pettiness in management and small grudges, its either going to be a partnership or you're not going to be here. some of his colleagues like James Forense say that they would take substance over form, judgement over form, any day of the week. And while he does not shy away from details like expecting lower level employees to pay for sporting event tickets Citigroup earlier gave out free, and he himself rides the subway sometimes, he has made some of the bigger decisions. Among these, getting capital from outside sources by travelling extensively abroad, urging Citigroup's board to slash the dividend for the first time in 20 years, selling off 2 peripheral units that did not belong and a third Primerica on sale also. And urged by his mentor former Treasury secretary Rubin who also used a note pad and a thinking thoughtful style like Pandit's at Treasury during the Asian banking crisis and the Mexican financial crisis, Pandit has been direct and realistic. He tells Wall Street that the fate of Citigroup is going to be decided to some extent by the duration of the environment we are going through, the twin perils of the debt-market crisis and the sluggish US economy. And that for now issues like these are going to overwhelm our actions. Pandit's father was a senior executive of one of India's leading pharmaceutical companies when the family moved to New York, so he has grown up around business, and is able to ask the question quite sincerely and matter of factly of his managers at the beginning of every meeting. "What are you doing with the shareholder's money?" After which come the torrent of well thought out questions, probing deeper each time, especiually where issues are festering for a long time, and remain unresolved. ...

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Blue Dog or corporate shills, who are they, asks Thomas Frank. He reminds readers that Illinois Senator Paul Douglas advised people in 1932 not to expect much from the Democratic party. Douglas said the Democratic party was more like alifeboat for business interests, when the going got tough with the Republicans, business interests simmply used this lifeboat to get away. So he says call these Blue Dogs caucus the Lifeboat caucus, and you get closer to the mark. He points out that the Blue Dogs are some of the leading fundraisers in Congress. See the link to Max Baucus in the Senate, who the NYT describes as a leading fundraiser from Montana.

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Generic version of Zocor by Merck to reduce bad cholesterol is now available and can substitute for Lipitor which costs $2 to $3 per day. This generic can be bought at Costco at 10 cents per day. Generics can have a huge impact on cost for patients and for the country's medical bill and for affordable health care its very important to achieve affordable health care.

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New code of marketing for the Drug Industry.

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Genentech's Levinson at a turning point looks at autoimmune diseases to find new drugs and cures.

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Samuelson points to the risks to the American economic growth from excessive health care costs. This is hurting take home pay and shows up in consumer spending. It is hurting government spending in other areas such as needed infrastructure spending and efforts to reduce the deficit. This hurts private capital investment to create jobs because of lower demand from constricted consumer spending. The U.S. budget has as its largest single expense 27% on health care compared to 20% on defense the next largest expense, with growth in health care spending taking this to one third of the budget in coming years. Without addressing health care, says Samuelson, the Supercommitte in Congress even if successful at deficit reduction will basically have failed to do its job, and it did not have the time, resources or conviction to do this. According to a new study from the Organization for Economic Cooperation and Development (OECD), U.S. healthcare spending per person is $7,960 per person in 2009. This compares with Norway $5,352, Britain $3,487, France $3, 978, an OECD average of $3,233. Life expectancy in the U.S. is 78.2 years, compared to Japan 83 years, OECD average of 79.5 years. Chile and the Czech Republic have life expectancy equal to the U.S. Except for cancer care where the five year survival rate is 89.3% in the U.S. and the OECD average is 83.5%, the U.S. lags far behind in much needed critical areas such as diabetes and asthma. Rates of emergency hospitalization for asthma are 3 times that in France and 6 times that in Germany and Italy. The U.S. has fewer doctors per thousand population and higher cost per medical procedure- with more frequent use of the costliest procedures- creating a supply shortage that induces higher prices, and less preventive and early action care through physician visits. The number of practicing U.S. doctors is 2.4 per thousand population in the U.S. compared to 3.1 per thousand for the OECD average; and number of annual doctor consultations 3.9 per capita in the U.S. versus 6.5 for the OECD average. Appendectomy cost $7,962 in the U.S., $5,004 in Canada and $2,943 in Germany. Coronary angioplasty cost $14,378 in the U.S., compared to $9,296 in Sweden, and $7,027 in France. Knee replacement cost $14,946 in the U.S., $12,424 in France, and $9,910 in Canada. Knee replacements, angioplasties and MRI exams are twice as common in the U.S. compared to the OECD countries. ...

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On industry ties of groups advocating certain drugs. And the media publication of criticism of these industry ties.

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The CEO of Little Bird Company, Marshall Kirkpatrick, on why startups should move to Portland, and the Oregon area.

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Glaxo's ad campaign behind Alli its over the counter weight control drug. Details about a novel internet program designed by Glaxo for Alli and now in use by many customers.

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The reasons Exubera was conceived by Pfizer, the events leading to the persistance with backing Exubera with large investments in manufacturing and marketing and buying out Sanofi's stake in the face of repeated setbacks, the difficulties posed by a insulin inhaler from the very beginning. Bulkiness the size of a flashlight this inhaler was embarrassing to use in public, it required regular lung exams because the FDA placed a warning on theproduct because only 10% of the product went where it was intended and 90% was inhaled into the lungs and who knows what that could do especially for asthmatics but also for others. It cost twice as much instead of $2 or 3 it cost $5 per day. And the 3 milligram packet had to be loaded into the inhaler which required instructions on how to use, one doctor saying it woul take an hour to educate a patient compared to 5 minutes for an insulin pen. Abbott and Lilly have insulin inhalers that they are bringing to market in 2009. Abbott's uses aerosol insulin instead of powder, Lilly's is the size of a cellphone. Will they work for customers? Pfizer attributed as key cause of the failure to the need for regular lung exams because of the regulator's warnings for insulin inhaled into the lungs. Are Lilly and Abbott taking this problem seriously?...