insulin – The Russian Reader

insulinc Patriotic Russian diabetics treat their disease only with domestically produced insulin, such as Rosinsulin, pictured here. Photo courtesy of Medsintez Pharmaceutical Plant

For Insufficient Enthusiasm
Court Rules Saratov Regional Organization of Chronic Diabetes Sufferers “Foreign Agents.” Activists “Undermined the State’s Authority” by Questioning Insulin Produced in Russia
Nadezhda Andreyeva
Novaya Gazeta
March 28, 2018

Saratov’s Frunza District Court today concluded its hearing of administrative charges against the Saratov Regional Organization of Chronic Diabetes Sufferers. Judge Maria Agisheva ruled the diabetics had violated the law on “foreign agents.”

The defense had asked for a postponement of the hearing, since Moscow human rights lawyer Nikolai Dronov, who had been representing the diabetics in court the past five months, was unable to travel to Saratov today. In addition, the organization’s president, Larisa Saygina, had not been able to read the findings of a forensic examination of the case, submitted to the court on Friday, May 25. Judge Agisheva rejected the defense’s motion, but announced a half-hour recess so the diabetics could read the findings of court-appointed experts.

The forensis examination was carried out by faculty members at the Saratov State Legal Academy (SGYuA). The court had attempted to engage specialists from RANEPA and the Kazan Interregional Expertise Center, but they had turned down the court’s request on various pretexts. SGYuA had also rendered its expert opinion last year, when the administrative case was in the process of being filed. As we reported earlier, Professor Ivan Konovalov saw signs of the work of “foreign agents” in the activities of the diabetics organization. The forensic examination was performed by his SGYuA colleagues Associate Professor Elena Koloyartseva and Professor Viktor Kupin.

According to SGYuA’s experts, the Saratov Regional Organization of Chronic Diabetes Sufferers was awarded a grant of 712,000 rubles [approx. €9,800] from foreign pharmaceutical companies. The authors of the forensic examination thus concluded the organization had engaged in political activity, namely, it had submitted critical remarks about the work of officials to the authorities. According to the political scientists, the organization’s former head, Yekaterina Rogatkina, had publicly expressed doubts about the quality of insulin produced in Russia, thus undermining the Russian state’s authority. [The emphasis here and elsewhere is in the original article—TRR.]

The experts found it noteworthy the media reported on the filing of administrative charges against the diabetics organization. In particular, the commentary of the organization’s current president, Larisa Saygin, filmed for the Saratov TV program “Open Channel” on a city street, was regarded by the experts as a solo picket. According to SGYuA’s faculty members, the news report had been deliberately aired three months before the presidential election in order to discredit presidential candidate Vladimir Putin.

We should recall at this point it was Nikita Smirnov, the head of Putin’s student campaign headquarters in Saratov, who had filed the complaint against the diabetics with the the local prosecutor’s office.

As the experts emphasized in their findings, opposition leader Mikhail Khodorkovsky offered the Saratov diabetics legal assistance, which likewise testified to the organization’s guilt.

As indicated on SGYuA’s website, Professor Koloyartseva studied in the 1980s at the Saratov State Pedagogical Institute. In 2001, she was awarded a kandidat degree in political science. She serves on the public council of the Saratov Regional Duma. She is also a member of Civic Dignity, a grassroots organization that supports social and civic activism among young people and has been heavily involved in forums on moral and spiritual growth sponsored by the authorities.

According to the website Legal Russia, Viktor Kupin graduated from the Lenin Military Political Academy in 1978, while Saratov media outlets earlier reported he studied at the Engels Air Defense Academy.

Until 2007, Professor Kupin taught a course entitled “Philosophical and Political Problems of National Security” at military academies in Petersburg.

In 2004, Professor Kupin defended his doktor dissertation, entitled “The Geopolitical Imperatives of Global Security.”

In 2014, Kupin was an expert in the trial of Partnership for Development, an environmental organization that had operated in Saratov Region since 1995. The NGO received $42,000 from the US government to encourage civic involvement in the region’s villages and small towns. An anonymous complaint against Partnership for Development was filed with the prosecutor’s office on July 10, 2014. On July 22, an administrative case was opened against the organization under Article 19.34 of the Administrative Offenses Code (“Absence of registration in the relevant registry on the part of an organization performing the work of a foreign agent”).

Professor Kupin’s expert finding was ready the very same day. As he explained in court, he wrote the five pages of text in several hours, since he had been asked to do it “as soon as possible.” According to Professor Kupin, Partnership for Development showed clear signs of carrying out the “political orders of a foreign state, orders meant to undermine social stability, generate political tension in the region, expand the base of political influence on public opinion [sic], and implement US geopolitical interests.”

“The interest in Saratov Region was occasioned by its special place and exceptional geopolitical position in Russia as a lynch pin in the emergent Eurasian Union of Russia, Belarus, and Kazakhstan,” wrote Professor Kupin. “[Partnership for Development’s] activity runs counter to the security interests of Russia, which opposes the uni-polar dictatorship of the world, headed by the US.”

Less than a month after the prosecutor received the anonymous complaint, a court ruled Partnership for Development was a “foreign agent.” It was fined 300,000 rubles. Its chair, Olga Pitsunova, was also personally fined 100,000 rubles. Partnership for Development closed up shop.

At today’s hearing, Judge Agisheva denied the defense’s motion to summon its own expert witnesses to the trial. The diabetics were fined 300,000 rubles [approx. 4,100 euros]. The organization’s ex-president, Ms. Rogatkina, told us the diabetics would appeal the ruling.

“We are discouraged. This case was absurd from the outset. We consider it a miscarriage a justice.”

Putinist youth activist Nikita Smirnov. Photo courtesy of Novaya Gazeta

Last year, Mr. Smirnov, a student at the Saratov Medical University and head of Vladimir Putin’s student campaign headquarters, asked the Frunza District Prosecutor’s Office to verify whether the work of the diabetic organizations was covered by the law on “foreign agents.”

As the future physician told us, he had “read on the internet that the organization was financed by foreign companies, I don’t remember which.” He had felt it was his “civic duty” to “send a signal.”

Translated by the Russian Reader

Back to the World of Me-Too Drugs: How Anti-Sanctions Will Deal a Blow to the Mental Health of Russians
Takie Dela
May 2, 2018

The ban on the import of drugs from the United States and other “unfriendly” western countries, tabled by MPs in the Russian State Duma, will worsen the mental health of Russians. Two psychiatrists discussed the consequences facing people with mental illnesses if brand-name drugs are replaced by domestic lookalikes.

The Big Picture
In early April, State Duma Speaker Vyacheslav Volodin announced the imminent expansion of countersanctions by Russia towards the US and other western countries opposed to the Russian Federation’s foreign policies. In particular, there are plans to introduce a ban on the import of drugs from the countries on the sanctions lists, but only on those drugs for which there are domestic counterparts. However, many foreign-manufactured psychotropic drugs have domestic counterparts, and they will be banned, therefore.

Russia is not a happy country in terms of psychiatry. Every fourth Russian suffers from mental illness at some point in his or her life, and between three and six percent of the populace needs to take medications regularly.

Due to severe conditions such as epilepsy, schizophrenia, clinical depression, and bipolar disorder, hundreds of thousands of Russians lose the capacity to work and are unable to adapt to society. Many of them commit suicide. Modern drugs are effective enough to let most patients lead full lives. Their well-being depends on drugs, which they must take for many years and, sometimes, their whole lives.

The drugs in question are antidepressants, antipsychotics, tranquillizers (sedatives), and normotics (mood stabilizers). Nearly all the brand-name drugs in the field are produced in Western Europe and the US. If theban is adopted, they will vanish from Russian pharmacies, since nearly all these drugs have counterparts (i.e., generics), with the same active ingredients, that are produced in Russian and Eastern Europe.

When discussing the possbile stop list, experts named two popular antidepressants: Paxil (France) and Cymbalta (USA). Many other drugs popular in Russia, including the antipsychotics Zyprexa (Eli Lilly, UK) and Seroquel (AstraZeneca, UK/Sweden), and the antidepressant Zoloft (Pfizer, USA), could be included in the ban. What would be the consequences for millions of patients?

Increasingly Ineffective Treatment
Mental equilibrium is a delicate matter, and selecting drugs to treat psychiatric conditions can much more complicated than selecting drugs to treat somatic illnesses. The optimal outcome is for the individual not merely to stop experiencing severe symptoms like obsessive suicidal tendencies and hallucinations, but also to remain capable of working and leading a social life, rather than turning into a lifeless vegetable.

People with clinical depression, which can last for years, know well the laborious process of choosing the right drug and the right dosage that will finally let them live a normal life. The process can take weeks and months.

Matters are even more complicated with bipolar disorder. The disease’s two opposite phases require different medications, and an unsuitable drug can even worse the outcome of the illness. Schizophrenia presents such a variety of symptoms that a veritable cocktail of drugs is sometimes needed, and attending physicians have to make sure the side effects do not outweigh the benefits of treatment.

“Current guidelines for pharmacotherapy recommend prescribing the brand-name drug and not substituting a generic without good reason,” says Maria Gantman, a psychiatrist at the Mental Health Center.

Dr. Gantman prescribes her patient brand-name drugs, which have undergone high-quality trials on thousands of patients and have a proven effect. Generics also undergo trials when they are licensed, trials that prove their similarity to brand-name drugs, but the evidentiary base is filled with too many gaps, she notes.

“Generics are usually less expensive, and we start off with them if the patient cannot afford the brand-name drug. The abrupt replacement of one generic with another can produce a change in the effect. Due to the peculiarities of their ingredients, generics may be absorbed at a greater or lesser rate and generate a different concentration of the active ingredient in the blood. The people who suffer most are those forced to switch from a brand-name drug they have been taking for years and that was laboriously selected for them to a generic,” explains Dr. Gantman.

She fears the Russian authorities will approach the issue in a perfunctory manner.

“For example, there is a drug that is effective in treating schizophrenia, Rispolept. There are Russian lookalikes, sold under the generic name risperidone. But if the brand-name drug is banned, it hard to imagine what lies in store for people who survive by taking Rispolept Consta (Belgium), which does not exist in this form as a generic in Russia,” says Dr. Gantman.

“The problem is that theRussian pharmaceutical industry hopelessly lags behind the western pharmaceutical industry. There are certain types of drugs Russia just cannot produce, because it does not have the resources, the equipment or the research,” continues Anatoly Shepenyov, a psychiatrist and psychotherapist. “Say, the antidepressant Cipralex (Denmark) cannot be synthesized in Russia. Folic acid is an indispensable drug, too. In Russia, it cannot be produced in the form needed for the synthesis of serotonin, that is, in the form needed for maintaining normal brain function.”

Side Effects
The side effects of psychotropic drugs are numerous and varied. Mental impairment, convulsions, fainting, anemia, and fever are only some of them. Predicting them ahead of them is impossible: they are the individual body’s reactions. A drug that simultaneously provides relief while not producing agonizing side effects is a valuable find for many patients.

Dr. Shepenyov illustrates the circumstances by mentioning the antidepressant Paxil (France). It has generics, for example, Rexetin (Hungary). Rexetin works, but its therapeutic effectiveness is lower. To get the same effect she would get from 20 mg of Paxil, thae patient would need to take at least 30 mg of Rexetin. As dosages increase, so do the side effects.

“The main difficult is not synthesizing the right substance, but isolating it in pure form. I’ll give you an example. The antidepressant must fit the receptor in the brain the way a key fits a lock. When generics are synthesized, a whole slew of impurities emerge, extra ‘keys,’ if you like. If you use this ‘dirty’ molecule, you won’t open the lock, but there will be something jammed in it,” notes Dr. Shepenyov.

The use of generics thus introduces the risk there will be a lack of therapeutic effect coupled with a slew of side effects that would never be produced by brand-name drugs. The liver also suffers more from the constant intake of “dirty” drugs.

“Take the most popular Russian-made antidepressant, Fluoxetine (a generic version of the US-produced Prozac). It is terrible in terms of side effects. Although its benefits are weak, patients suffer from phenomenal absentmindedness,” explains Dr. Shepenyov.

Withdrawal Syndrome
If western-produced drugs one day vanish from Russian pharmacies, thousands of patients will undergo withdrawal syndrome, the body’s physiological reaction to the absence of a substance to which it is accustomed.

“I felt terribly sick within a few days. I had a terrible chill, severe dizziness, nausea, weakness, and insomnia,” a female patient described her withdrawal from Paxil.

It is necessary to gradually reduce the dosage to avoid this effect, which means having a good supply of the drug and then just as gradually increasing the dosage of the new drug. This means weeks of enduring shaky health.

The Anti-Placebo Effect
“The anti-placebo effect is no less frequent and severe than the placebo effect. The patient knows she has taken another drug. This exacerbates her anxiety and could ultimately destabilize her condition. So, if an individual has taken the same drug for years and feels fine, there is no need to give her another drug. It’s risky,” says Dr. Gantman.

Both doctors are agreed that patient health should not be a geopolitical bargaining chip. According to Dr. Gantman, medical issues should be left out of the political games countries play, and she calls the State Duma’s plans to ban the imports of foreign-made drugs “profoundly unethical.”

“If Russian MPs adopt such a law, we should oblige them to be treated solely with Russian-made drugs, drive Russian-made cars, and use Russian-made telephones and computers. Those would be excellent sanctions that would finally force them to use their brains before making radical decisions without having the foggiest notion about either medicine or how the body functions,” concludes Dr. Shepenyov.

Translated by the Russian Reader

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Anastasia Plyuto
VK
May 12, 2018

A group picket was held on Saturday, May 12, 2018, in Petersburg’s Ovsyannikov Garden, to protest the Russian State Duma’s tabling of a bill that would ban the purchase of drugs abroad. Yes, we have heard that legislators have suggested removing the word “drugs” from the wording, but we know much freighted the phrase “and other goods” can be.

To increase the chances city authorities would authorize the picket, activists applied for several venues at once. The authorities waited until the last possible moment to render a decision, and so there was no time to inform the public about the planned protest. Around a dozen people were in attendance, including a diabetic who depends on imported insulin, and several people outraged by the politics and statements of our MPs.

One of the placards featured a toy pyramid for little children, which MP Iosif Kobzon gave to a teenaged cancer patient while visiting a hospital in Simferopol in 2015. In our view, the incident reflects the lack of understanding displayed by our bigwigs when it comes to the needs of patients.

There were few visitors in the garden, and nearly none of them had heard of the law bill, but no one, from schoolgirls to a seventy-year-old female pensioner, was left unmoved by the subject. They reacted with surprise, indignation, and complete support for the picketers.

“You want to ban imported drugs? Start with yourselves. Treat your ailments with oak bark!”

“Insulin addict. Bring it on! Deprive us of our doses, assholes. ‘Life in Russia is no picnic: you can survive without insulin.’ Insulin or formaldehyde? Neuroleptics or belladonna? You choose, Russia!”