A patient waits for medical assistance in a Bishkek state-run hospital in Kyrgyzstan, where the health and medical industry has been under fire due to accusations of low-quality medicines, corruption and conflicts of interest. At the center of the controversy is how pharmaceutical firms supply Kyrgyz hospitals through what some oversight organizations, media, and politicians claim are dubious practices, including bribery. (Photo: Dean C.K. Cox)

Kyrgyz media outlets have been full of accusations and counter-claims about low-quality medicines, corruption and conflicts of interest, raising concerns about government oversight of the lucrative pharmaceuticals sector.

Central to the simmering controversy is Repretin, a generic drug designed to treat anemia. It is manufactured in Egypt and sold by Rotapharm Ltd., a British-registered company that won tenders to supply several large state-run hospitals last year.

Rotapharm’s critics, including kidney-dialysis patients who claim the drug is ineffective, have questioned the tactics used by the company to win government tenders. Rotapharm has denied wrongdoing, and responded by suing its critics and accusing them of representing the company’s better-known competitors.

Though it styles itself a British company, a March 4 investigation by London’s The Guardian newspaper reported that Rotapharm is registered in the British Virgin Islands, a tax haven, and its UK ties are limited to a single office that, the paper said after visiting, “seemed to have no employees.” Repretin, which entered the Kyrgyz market in 2009, is sold largely in the former Soviet Union.

Uroz Monolov, 56, who suffered dual kidney failure two years ago, contends the drug simply does not work. Monolov’s distrust in public healthcare grew when the state-run hospital where he was receiving treatment switched from administering him Recormon, produced by Basel-based Hoffmann-La Roche AG, to Repretin, last July.

“I’m not complaining about side-effects, but non-effects,” he says of Repretin, claiming that his hemoglobin fell to dangerous levels while he was taking the drug.

After two months, Monolov moved back on to Recormon at his own expense – a monthly dose costs 1,200 soms, about $25. His hemoglobin levels have stabilized. But he says that others lacking the money to make the switch have experienced trouble. On March 5, MP Shirin Aitmatova wrote on her Facebook page that nine of 30 dialysis patients receiving Repretin at the Chui Oblast Hospital had died in the previous month. “We need to investigate urgently,” she said, in comments reprinted by the local press.

The Health Ministry has denied the deaths were related to anemia. Minister Dinara Sagynbaeva went even further, dismissing all opposition to the drug as “lobbying on behalf of one company,” an apparent reference to Hoffmann-La Roche, in a March 13 interview with news outlet 24.kg. Aitmatova, the MP, denies she is defending the Swiss company’s interests by raising concerns about Repretin.

When contacted by email for comment, Fuad Rafailov, an Istanbul-based Rotapharm representative, said the deaths at the Chui Oblast Hospital were unrelated to Repretin. Adding that the company’s success was due to the drug’s “high quality and reasonable price,” Rafailov noted Rotapharm is suing only those who “were putting lie and wrong details in news/newspapers about us.” [sic]

Rotapharm is suing Burul Makenbaeva, a member of the Ministry of Health’s Public Oversight Committee, who works with the Medical Transparency Alliance (MTA), an international partnership in collaboration with the World Health Organization that is designed to help governments and pharmaceutical firms cooperate. Makenbaeva, plus a doctor and a lawyer who have also publically questioned Rotapharm, face $20,000 in damages, if the company’s case for “damage to commercial reputation” wins in a local court.

Makenbaeva fears the suit will have a chilling effect on civil society groups’ attempts to monitor the pharmaceutical sector. She argues that Rotapharm’s success in the country is the result of “widespread and aggressive bribery of doctors” – a claim that has been championed by some local media outlets. On the other hand, media outlets have also reported that the wife of the MTA chair in Kyrgyzstan works for Hoffmann-La Roche, a fact Rotapharm is likely to argue constitutes a conflict of interest.

State tenders to supply hospitals are “frequently bought,” Makenbaeva claims. The fact that Kyrgyzstan ranks 154th of the 176 countries surveyed in the watchdog group Transparency International’s latest Corruption Perceptions Index suggests Makenbaeva’s claim may be plausible. Whatever the case, there is a widespread lack of public trust in officials to work for society’s best interests.

Makenbaeva, who is also director of Mental Health and Society, a non-governmental organization, says authorities must pay more attention to the process of drug registration, since once a drug can be legally distributed, it is difficult for doctors and specialists to contest its continued use on medical grounds. Drug registration documents, including evidence of clinical trials, go through the Health Ministry’s Department of Drug Provision. But, Makenbaeva notes, the department “is not funded by the state budget and lives off registration fees alone.” Under such conditions “it is profitable [for the department] to register every drug under the sun. We have become a dumping ground for low quality drugs.” [Editor’s note: Mental Health and Society has received grants money from the Soros Foundations Network. EurasiaNet operates under OSF’s auspices].

MP Aitmatova’s calls to set up a special parliamentary commission to investigate Rotapharm have so far met resistance among her colleagues, such as Damira Niyazaliyeva, a former director of a local pharmaceutical supplies company, Amanat-Pharm. Niyazaliyeva now leads the legislature’s influential Committee on Social Policy. In 2009 Amanat-Pharm was blacklisted from applying for government tenders for three years after an investigation found the company was supplying hospitals with faulty insulin syringes.

The controversy has left patients like Monolov certain of one thing: they are hesitant to trust anyone’s advice. “If a man in a white coat offers you some kind of medicine, you expect it to work. But this is Kyrgyzstan. Whoever pays the money, calls the tune,” Monolov says.