In the United States that have done some research about many of these drugs online have been fake or counterfeited drugs. So people have to be careful when they purchase these drugs because one of the things that could lead people to go ahead and buy these drugs is the price. But there is no question about the quality so this is something people have to keep in mind all the time. Who makes them . Many come from south america, india, peru, different regions of the world. They have no drugs in them at all or they are not as good as the brand name . What happens with these fake decrugs some of them have no active ingredient at all. And in some cases the ingredients are aadulterated. So if these drugs do not come with different certificates of manufacturing practices from the world organization, then they have no validity because no one know what is is inside them. That is one of the major issues that exists with them. You also said one of the biggest problems in africa is fake drugs. Absolutely. One have to understand many of the drugs being sold in africa are sold to countries where systems are not as stringent as the ones in the United States or europe. Therefore many people who are dwat suffering from stating diseases do not know what is going on. Price is an issue then what happens is many people believe price is good. Well, that is not the reality. When did you first get interested in pharmaceuticals . My background is a scientific background. When i was working at Boston University with jim and charles who was one of the pioneers of the human gene project. Saw there was a link between that and human problems. That is how i first went to the law oh of diplomacy with a project with Harvard University and the school of medicine. And then i did an internship here in washington, d. C. In International Science and Technology Working on healthcare. And then i saw the link between pharmaceuticals. My background in genetics and then healthcare. And thats how i decided to write a thesis through a project on the issue of pharmaceutical development. Where did you grow up . I grew up in panama. I was in panama until i was 18 years old. Then i receive a scholarship to the United States for International Development to study genetics. At that time i was a student at the medical school in panama. They gave me a scholarship to come to the United States. I came to Iowa State University and then harvard and then i graduated and went to continue my studies in europe and eventually came back to the u. S. What was life like in panama . It was very difficult at the because i grew up through two different dictatorships. One it was general, the one who signed up the panama canal treaty and the other was so i throughout my my layoff saw a lot of problems in my country due to the lack of opportunities as well as the lack of freedom. And so it was for me the scholarship that i received from the u. S. Came as a god send gift because otherwise without that opportunity, i would not have become the person that i am right now. And that everybody ises an example that many of these programs that the United States have with other countries do bear frulet and allow people to fruit and allow people to train in the best places with access to the best technology and be able to serve not only their countries and also the world. What do your parents do . My mother its a very interesting story because my mother grew up in a very rural area of panama. It was a difficult situation so she did not go to school at all. She is a genius, i reserve the word jean use for remarkable people and my mother is one of them. Because of her limitations and she was a single mother and had to raise us all alone, it was very difficult for her. She brought up seven children and all of us went through college and we all became professionals. And herself she was always learning and learning. So the love for learning and the love for certaining other people and to help them came from her. Did you ever know your father . Yes, i do know my father. Are they both in panama . Yes, they are in panama and they are alive. What about your siblings . They are in pan massachusetts y sister is a professor by training. Another librarian. Electrical engineer, the other construction engineer, the other is a construction engineer. The other is a scientist and business man and public policy. Where is your permanent residence today sm right now it is panama but i travel back and forth between panama, the United States and other latin american countries and europe on business and research purposes. What would be the difference if we were in panama and had a medical problem and went to an emergency room versus here in the United States . The differences are big. Irst of all, in panama we have a universal healthcare system. But there are many issues with that. Having access to an emergency room cost very little. But the problem comes when one has to be taken care of or more importantly with medication. So even though we have a universal healthcare system, having access to the physicians, having access to the helingts inshurebes is not a problem. When it comes to purchase of medicine, then it becomes a great difficulty. In the United States the decinchesoverbl here prior to the obama care, there were about 46 Million People without Health Insurance. So many people would not go to the doctor fearing the high cost. So there are huge difference between these two systems. But the common denominators are two. Someone the high level of inefficiency and the cost of having access to the medicines. What is the core Model Corporation . It is a consultant narme works in twho different areas. One of them is invasion. And that is taking ideas from university, innovative centers through the hard process of becoming drug products. And that is a collaborative project throughout the world. The other part is healthcare reform and the different policies that need to be implemented in order to make possible a better healthcare ssm. And the third part which is a closer related is International Economic development. Because the issue of healthcare is a very complex problem that goes beyond Health Insurance. One has to take into consideration the economy and sose owe economic problem on how development plays a role in it. Why did you start the company and when and where is it based . Its now based in panama and it is a startup. It has been an ongoing process in the last year. The reason i wanted to in panama i could work in the whole area of latin america. Eventually it would open a subsidiary in the United States. Im working that process now. The goal of these companies is o bring a new perspective on healthcare. Sometimeses the difficult for scientists and Business People and policy makers to establish the relationship between research and development and the delivery of good health care. You gave a speech at the new york library and i want to show a clip from that and ask you about what you say about the future that you are predicting. And i personally believe and this is not just keep. I think the world is going to succumb sooner than late tore a plague and like the middle ages in which large percentages of the population were killed. That is the situation because we dont have enough atbats right now. And the antibite i cans right noufment and this is the issue in which the developed world help other countries and to help themselves. What kind f a plague . I think it will be a bacterial infection that will spread all over the world. The reason for that is through different climate changes and the facility to mobilize from one place to another. Many of the diseases travel through people and to other cuntrifments and the problem is many of these countries. And the problem is many of these bacteria or diseases are becoming resistent to the most i cans now. Bite we have in panama for instance new strains of t. B. Absolutely mpletely resistent to the medicines. The other problem is there is not enough interest on the part of the pharmaceutical industry to develop antibiotics. We need to make a global effort to work on this and develop collaboration between the developed world and developing world. Think the case of hiv is an example in which people in many of the developed world, countries say why should we do research on that if that is not our problem. Hiv prove that is not the case. This disease is spread very quickly and affects people all over the world. I think that the world is not ready for that. We have the experience h1n1 that we could have all over the world. You spent six years on a study and credit a man named daniel in switzerland for backing you up on that. I will back up a little bit. Daniel is a swiss man and he finances the whole project of writing the book. In the year 2003 i was working on a theory that led to the core model or theory which i will explain later. And i found that there was a new way of thinking about dealing with the issue of productivity at the pharmaceutical industry level about hemmingt care. And i was very fearful about publishing that work. I initially sent tony science here in the United States and they rejected it. And sent it to science here in the United States and they rejected it. I sent it to nature in the u. K. They got interested in this article and published it in the u. K. So daniel who say friend i met the first day i came to the United States in 1992 in the same bus going from iowa to aims iowa. He sat next to me. So we started a friendship for many years. Daniel became a very well man of healthcare. He had an interest in this. He said this is something quite remarkable and i see what you are saying could have a great impact in how people develop drugs and also how the world could benefit from your research. So why dont you just write a book . I said that is a difficult task. And it would take considerable amount of money. But i think i could have the book in two years. Two years became six years. So it became a very expensive project. As i started researching about the pharmaceutical industry, about the academic industry about healthcare, i found out that it was a very extremely complex subject matter so i have to travel all over the world. I have to go to different places and interview. And the key people involved in making policies regarding Drug Development and healthcare. O daniel who is from constituents certificateland switzerland funded to the end of the project. It was a project of 500,000 spent in order to write that book. And he supported it all. And something they wanted to mention, what we wanted to do was to create a work that was objective, that was not conditioned either by the pharmaceutical industry, nor by the University System in the United States. But something that would be an independent and objective work that would contribute and say listen, these are the problems, these are the causes of the problems and these are the Different Solutions to deal with the Global Healthcare crisis. Whats the biggest most important Prescription Drug ever produced . It depends how you look at it. For instance lip or the has been one of the best sold drugs all over the world. It was about 9 billion before it became a generic. These have been very successful. There have been others too. These drugs are the one that sell 1 billion and above. We are talking about that range. You say when they spend 1 billion on research on the drug, they spend more money on marketing than they do the creation of the drug. Let us get into that. There is a study by the top center for Drug Development. And one of the find sgs on average it takes 1 billion and about 10 to 15 years to produce a new drug. But that is an average and that is for a handful of drugs. For instance for card vas cue lar card vascular diseases. If that were so no one would produce drugs. A few could go into that range or more but many others would never make that amount of money. If one looks into the buy Technology Based products, then would be impossible for any Capital Group to fund such drugs so that is not the case. Some drugs are cheaper than that some are more, but on average that is the price. Is a big k that there issue there because when the pharmaceutical industry says drugs are expensive, it cost too much to produce them, that is not trufmente they spend at least twice as much marketing and pro motion than they do on research and development. So that is a big problem. And eventually it is the consumer, the one who has to pay for all of this expenses regardless of the benefit cost benefit ratio. How long does a Pharmaceutical Company get to keep a drug solely in their company and sell it . In the United States the ystem is so that a drug is property for 20 years after filing. If one dounts years of development, a company would in ten, nine, eight years would try to make as much money as it goes on generics. However it various because on some they get some extra time. And then the pharmaceutical industry know its game. So what happens is they try as much as possible to extend the pat tent coverage by the formulation, by different type of use. By many tricks so that the products last as long as possible and continue making money for them. Do you have any opinion about the doctors relationship to the Pharmaceutical Company . Absolutely. It various from country to country but in the United States this has been a scandalous situation. In countries like switzerland there are stringent laws. In the United States and it is very well documented that the pharmaceutical industry is very emersed in the universities in terms of talking to doctors and finding all sorts of strategies, lavish pro motion, gifts. And although that has been regulated to some extent and it has improved, it is a big problem because it is an interference with the medical profession and also it is actually creating more harm than good. And that should be actually more stringent and stronger regulation for that. If you were in a Doctors Office and a doctor said you have this problem and he or she said let me get some medicine, ill give it to you and they come in the sample boxes and all of that. That is called marketing. There is nothing free. These samp are also marketing. So the pharmaceutical Companies Give those to doctors. But that is not free. That is part of use it, were giving a different product to other people. Try this chocolate or try this candy and if you like, you buy more. Its very simple. In recent years if you watch television in this country, you often see ads for named drugs and tell to you go to the doctor and ask for this drug and they tell you if you take this drug your right arm might fall off and go through a list of things. Yes. Prot now the fad has become active about regulating that issue and all of that rambling at the end you will probably have diarrhea and vomiting and all of that. There is a problem about this in the United States because the freedom of speech, the First Amendment is sthauch all of those tv advertisement which is it is crazy my opinion and that is costly to the industry and to the patient. To regulate that is very difficult because as speech it is protected from my understanding. So i think there should come a system in which the internet should be used more than this advertisement because the budget they consume are huge. And probably it is not as effective as detailing the visit to the doctor. There is a lot of room for improvement and also for regulation and also for an understanding on the part of the farnl suit cal industry that people are tired and sick of that and it is necessary to put these things into perspective. Put the American Medical System into perspective with other countries youve visited. The american system is the most privatized system in the entire world. Yes, it is the most inefficient in the industrialized world not only in terms of the amount that is invested. It spends 18 of the g. D. P. Which is the highest in the industrialized world. But also the outcomes in terms of mority rate, the amount of money that is spent per capita, the amount of the Life Expectancy of the United States compared to other industrialized nations. The age of 60 americans suffer significantly from chronic ailments. So they probably thrive average liveexpectancy would be the average Life Expectancy 74 years. But its with chronic ailments. I looked it up and we are listed as 34th in the world in infant mortality and listed at 35th in the world and in Life Expectancy. Singapore is number one in infant moretyty. Why is this . There are many different reasons. The United States, the system here is very stressful. Money is always a big concern. Work is a big concern. But also the habits of americans are very poor, the fast food and other issues that lead to a very unhealthy lifestyle compared to other countries where for instance people pay more atonings what they eat, to Healthy Habits like exercising etc. So i think in that area the United States falls quite short of other nat