'DIABETICS SEE NEW LIGHT IN TREATMENT RULES AND DRUGS' Novo Nordisk reports from the recently held Incretin Leadership Forum in Cape Town 1 InCTOZA Liraglutide 6 nsg/m1 s■Alloo R...0,1 111 opirnsin9vi, invn.t , "51 sr la * Diabetes and obesity are like conjoined twins: globally, the epidemics are exploding at similar rates; often, they occur in the same patient. What a conundrum, then, for doctors who must prescribe treatments for one condition - diabetes - which may trigger the other - excessive weight gain. But now it is anticipated that healthcare funders will use the revamped national guidelines for type 2 diabetes treatment when they decide whether or not to provide coverage for newer classes of anti- OSTEOARTHRITIS, AFFECTING MORE THAN 70% OF ADULTS CAN BE DELAYED NATURALLY Osteoarthritis (OA), also known as degenerative arthritis, is the most common form of arthritis, affecting over 135 million people worldwide. It is the fourth most frequent cause of health problems in women worldwide and the eighth in men. It is the breakdown and eventual disappearance of cartilage in the joints. 60-70% of people suffer from some degree of joint degeneration and pain, by their 7th decade, but by supplementing with glucosamine sulphate, it is thought that age-related thinning of the cartilage can be delayed, and the protective fluid increased, says PharmaChoice spokesperson and pharmacist Liezl van Tonder. "Slow joint degeneration causes aches and pains as you get older and mainly affects people over the age of 40, but can also arise as a result of wear and tear on the joints through sport. It most often affects the weight-bearing joints of the spine, hip and knee, as well as the hands and feet," she says. Van Tonder advises that treatment is primarily lifestyle modification, such as the loss of weight and the adoption of helpful exercise regimes, "I also advise taking a supplement, with an optimal dose of glucosamine sulphate - which provides natural disease modification potential." Glucosamine sulphate occurs naturally in the body, in the fluid around the joints, and is used by the body to produce a variety of other chemicals that are involved in building tendons, ligaments, cartilage and the thick fluid around the joints. By supplementing with glucosamine sulphate, it is thought that age-related thinning of the cartilage can be delayed, and the protective fluid increased. For more information visit: www.pharmachoice.co.za diabetic drugs that avoid the problems of weight gain and dangerous hypoglycaemia. However the industry still "needs to catch up" regarding this drug, according to Prof Jeffrey Wing from the Charlotte Maxeke Johannesburg Hospital, speaking at a conference on advanced diabetic treatments held in Cape Town this month. The star of the show was a new drug which uses the body's incretin hormone to stabilise blood sugar, by causing insulin to be released only when it is needed, as compared to older treatments which can cause a continual production of insulin or alternatively injecting insulin. The revised national diabetes treatment guidelines, published recently by the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) after consultation with government, health care funders and others allows doctors to integrate the new drugs into treatment regimes. .4.4...2040, ..0111■011■4■44. 41%., *■4b, ■ 4.0.".'VW-44.:11041■.***tetli■-■*-..„ ■6-' PA,,4_ '41e*-* ....w■ 4e4;; ' I HELPING BUILD CAREERS Suppoittate. 9:Zee/luau/I/ in/ c6h.e. 9/Vosteitn. 4Sk- cgastemv Tape; Contact: Ian Cameron on Tel: 021 939 7041 or E-mail: ian@cameronrecruitment.com Pharmasales 11

MOZAMBIQUE LAUNCHES BRAZILIAN FUNDED DRUGS PLANT TO BATTLE HIV Mozambique recently launched a Brazilian funded pharmaceutical plant that will make anti-retroviral drugs to battle the HIV/AIDS scourge in the country. The factory, built with $23 million in aid from Brazil and $4.5 million from that country's mining giant Vale, will initially package drugs from Brazil but start producing the pills by the end of the year. Mozambique has more than 2.5 million people living with HIV, nearly 12 percent of the population but fewer than 300,000 of them now take antiretroviral (ARV) drugs, according to the health ministry. ARVs suppress the HIV virus, reducing sickness and death rates as well as the transmission of the virus that causes AIDS. Brazil's Vice President Michel Temer attended the launch of what is thought to be Africa's first fully public ARV factory in Matola, along with Mozambique's Industry and Commerce Minister Armando Inroga. "As of now drugs which were manufactured in Brazil will be packaged here in Mozambique, certified and distributed to the Mozambican people," Temer said. "There is an excellent partnership between the Brazilian and the Mozambican people and there is an absolute integration between the two countries in both public and private sectors." In 2010 Brazil's then-president Luiz Inacio Lula da Silva visited the plant site and called it a "revolution" in Africa's fight against HIV/AIDS. Brazil offers free ARV treatment to HIV-positive citizens, a programme that sparked controversy when it was announced in 1996 because of concerns about drug resistance and violation of pharmaceutical copyright. But it has since been praised as a model for the developing world. The World Bank estimates the free medicine saved more than half a million lives. Mozambican technicians and other staff for the plant are now being trained, some of them in Brazil, through a partnership with the Brazilian public health institution A Fundacao Oswaldo Cruz. 12 Pharmasales ZIMBABWE LAUNCHES PROBE INTO CHILDREN'S IMMUNIZATION SIDE EFFECTS Zimbabwe has launched an investigation into the efficacy of drugs used during last month's nationwide vaccination campaign after hundreds of children reacted to some of the vaccines, Health Minister Henry Madzorera said recently. Madzorera said the probe is expected to guide the government's response to future vaccination campaigns. "My ministry will, as per protocol, convene meetings with the relevant specialists and in due course provide a comprehensive update of all the adverse events, type and nature and extend and establish casualty once information on the vaccines, batch numbers and other parameters has been received from the vaccinating centres," Madzorera told the official Herald daily. Scores of children fell ill after getting vaccinations during the immunization programme for children under five years which was held at the end of June. The children received vaccinations for measles and polio and in addition they received vitamin A supplements. Cases of children being hospitalized after taking vaccines against measles and polio have become an annual occurrence over the past few years, prompting some parents to withhold their children from the immunization campaign. ANGOLA'S MOH TO LAUNCH PNEUMOCOCCAL VACCINE CAMPAIGN Angola's Ministry of Health (MoH) has revealed that it is going to launch a pneumococcal vaccine campaign throughout the country in October. According to the Angola Press Agency, the vaccine will be comprised of 13 serotypes, which cover the major causes of pneumonia in children under the age of five. Further details are scarce, although the MoH noted that its pneumococcal vaccine is the most effective in the world at preventing pneumonia. The MoH also revealed that it is going to introduce a rotavirus vaccine in 2013, in order to reduce the high childhood mortality rate caused by severe diarrhoea. UGANDA GOV'T CAUTIONS ON REPORTED HIV VACCINE The Ugandan government has cautioned the public not to rush for drugs reported in the media as new HIV vaccine. Pontiano Kaleebu, Director Uganda Virus Research Institute was quoted by the Daily Monitor as saying that Truvada is not an HIV vaccine and there is no discovered vaccine as yet. "Truvada is not an HIV vaccine and no HIV vaccine has yet been discovered. There are, however, ongoing studies and efforts to discover an HIV vaccine," he said. Local media quoted reports that the Antiviral Drugs committee of the United States Food and Administration recommended that the Food and Drug Administration approves Truvada drugs for use to prevent HIV (pre-exposure prophylaxis). Chidi Victor Nweneka, the executive director of the African Aids Vaccine partnership, said there are many issues yet to be addressed before the drug can be recommended. "You should better listen to the country public health officials until the drug is recommended," he said. Nweneka said that as studies continue to find an HIV vaccine, people should stick to the old prevention methods of using condoms, abstinence and being faithful. In the past decades, HIV/AIDS has killed millions of Ugandans. At least 1.3 million Ugandans are reportedly infected with HIV, according to statistics by the Uganda Aids Commission. The infection rate is also said to be going up after years of stagnation at six percent. Apart from the other preventive measures, the country has also embarked on massive safe male circumcision after health workers' reports indicated removal of the fore skin could reduce the risk of contracting the disease by up to 60 percent.

INDIA MAY ADOPT PER CAPITA INCOME-LINKED REFERENCE PRICING MECHANISM FOR BRANDED DRUGS The Indian government is to introduce a new per capita income-linked reference pricing mechanism for branded prescription medicines following recommendations from a task group looking at ways to regulate drug prices. Pharmaceuticals secretary Dilsher Singh Kalha recently indicated that the committee had finalised its proposal, adding that "there could be a reference pricing system or maybe fixed pricing, but a final decision has not been taken." The Economic Times noted that under the proposed system, prices of patented drugs would be fixed by comparing the cost at which they are procured by governments in the UK, Canada, France, Australia and New Zealand. The committee suggested that the retail price should be fixed by adjusting it to the per capita income of the country. According to the task group, Roche's Tarceva (erlotinib) costs around 121,000 rupees ($2170) in Australia and France, while it costs 35,450 rupees ($636) in India. However, when adjusted for per capita income, the price falls to 10,309 rupees ($185) and 11,643 rupees ($209), respectively, for Australia and France. The committee has reportedly recommended that the Indian retail price should be at these levels, with the formula applicable to all patented drugs that don't have a therapeutic equivalent on the market. For products that have similar alternatives already on the market, the task group said the price of these drugs should be fixed at a level that does not lead to an overall increase in the treatment cost. According to the newspaper, under the proposals, if the global launch of a patented drug takes place in India, the retail price should be based on several factors, including the cost of developing the medicine. The Organisation of Pharmaceutical Producers of India (OPPI) said that the recommendations are fundamentally flawed and has sought further discussions with the government. "To apply the ratio of per capita income of India and a developed country to arrive at the in-market price of an imported patented product manufactured in a developed country with a totally different cost structure will be highly irrational and construed as comparison between apples and oranges," remarked OPPI director-general Tapan Ray. However, the Indian Pharmaceutical Alliance has supported the reference- based system, noting that the government should select developed countries because in these markets it is the governments that fund healthcare and are, therefore, able to negotiate lower prices. GLAXOSMITHKLINE TO DIVEST MAJORITY OF PRODUCTS IN AUSTRALIA TO ASPEN PHARMACARE FOR $172 MILLION GlaxoSmithKline announced that it agreed to divest the majority of its "Classic Brands" distributed in Australia to Aspen Pharmacare for approximately 172 million pounds ($270 million). GlaxoSmithKline remarked that the move is an example of the company's "commitment to realise value and enhance returns to shareholders through the sale of low-growth or non- core businesses, and to focus on priority brands, products and pipeline opportunities that have long term growth potential." The 25 non-promoted and genericised products to be divested include Valtrex, Lamictal, Timentin, Amoxil and Aropax. The products generated total sales of approximately 83 million pounds ($131 million) in 2011 and about 31 million pounds ($49 million) in the first half of this year. GlaxoSmithKline noted that revenues for these products have "gradually declined over recent years due to local market price reductions and generic competition." Aspen stated that the ziA r deal, which is expected to close in the fourth quarter, could be subject to a small price reduction if the divestiture is not completed by October 31. GlaxoSmithKline estimated that 2012 pre-tax net profit on the disposal of the products will be 131 million pounds ($205 million) and will be recorded as a non-core item. In April, GlaxoSmithKline divested some of its international over- the-counter brands to Aspen for 164 million pounds ($264 million). In addition, the UK drugmaker also reached deals to divest other non-core OTC brands in North America and Europe to Prestige Brands and Omega Pharma, respectively. BRISTOL-MYERS SQUIBB COMPLETES TENDER OFFER FOR AMYLIN Bristol-Myers Squibb announced the successful completion of its previously announced tender offer for all outstanding shares of common stock of Amylin Pharmaceuticals at a purchase price of $31.00 per share, or about $5 billion. As of the expiration of the offer on August 7, 140.55 million shares of Amylin common stock were validly tendered and not withdrawn and Bristol- Myers Squibb noted that all such shares have been accepted for payment in accordance with the terms of the tender offer. Bristol-Myers Squibb now owns approximately 85.6 percent of the outstanding shares of Amylin and indicated that it has exercised its right to purchase additional shares from Amylin in order to close the deal. Upon completion of the merger, Amylin will become a wholly-owned subsidiary of Bristol-Myers Squibb. As previously announced, Bristol-Myers Squibb will also enter a marketing partnership with AstraZeneca once the Amylin merger is completed. Under the agreement, which will see the companies developing and marketing Amylin's drugs, AstraZeneca will make a payment of approximately $3.4 billion to Bristol-Myers Squibb. Pharmasales 13

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TO GAIN THE EDGE: make sure you use a Contract Sales Organisation with the edge... apor4 Exceed your expectations. Not your budget. Brian Vermeulen - 15 solid years "Dedicated" Contracting! It's the way Safrimed does business. One of our key objectives is to achieve long term relationships with our clients. By working as close partners it enables us to optimize our performance as well as allowing you to take advantage of the added values our consultative approach offer 6 Safrimed Healthcare Employment Professionals BRIAN VERMEULEN'S CONTACT DETAILS: Cell: 083 455 8008 * E-mail: safrimed@absamail.co.za * Fax: 086 6347592 * PO Box 1858, Randpark Ridge, 2156

Pharmacists in South Africa have indicated that the appointment of Designated Service Providers (DSPs) by medical schemes has negatively impacted their business, according to the results of a new survey conducted by PPS. The survey of more than 252 South African pharmacists revealed a confidence level of just 39% that the appointment of DSPs - whereby a medical scheme specifies to its members exactly which healthcare provider must be used in order to receive full cover for Prescribed Minimum Benefits (PMBs) - would not adversely affect their business. This concern was also reflected in the fact that only 38% of respondents said that they would encourage their children to enter their profession. According to Gerhard Joubert, Head of Group Marketing and Stakeholder Relations at PPS, the financial services provider focused on graduate professionals, it is very concerning that pharmacists in South Africa feel that their business is under threat by DSPs. "This may be contributing to their low levels of confidence in recommending their career to their children, which is an issue that needs to be urgently addressed, especially given the fact that the country needs to retain and grow these critical healthcare skills." The respondents also revealed a slightly lower, but still positive, confidence level of 73% in the future of their profession over the next five years, compared to the average level of 80% recorded by all the other seven professions* that were surveyed. Pharmacists' overall confidence in the future of the healthcare industry in South Africa was low - but on par with the other 16 Pharmasales Appointment of Designated Service Providers professionals surveyed - with a level of 44%. "These results relate directly to the low confidence levels in the implementation of National Health Insurance (NHI) with the survey indicating that only 17% of pharmacists agree with the principle behind NHI and only 17% believe NHI will solve the country's ailing healthcare system," says Joubert. The survey also revealed a confidence level of only 52% that medical schemes provide adequately for the reimbursement of chronic medicines and only 51% for the reimbursement of acute medicines. Ivan Kotze, Executive Director of the Pharmaceutical Society of South Africa, says that reimbursement for medicine by some medical schemes is pegged at the old 26% markup capped at R26 per item, which was found by the Constitutional Court to be inadequate to cover the cost of providing a pharmaceutical service. "Despite this, members of medical schemes often find that their benefit for medicines is depleted fairly early in the year," says Kotze. While pharmacists have a confidence level of 79% about remaining in South Africa, they are still highly concerned about crime and unemployment with both these issues scoring the lowest confidence level of just 40% when asked whether these areas would show improvement over the next five years. Confidence in the standard of education in South Africa improving over the next five years was slightly higher at 48%. However, 94% of respondents said they were concerned about the lack of mathematics and science graduates in South Africa. "The survey has revealed that while pharmacists are happy to remain in South Africa they are worried about the future of healthcare industry. It is vital that these issues are addressed in order to improve the uptake of this necessary profession among the youth to ensure the country has enough pharmaceutical professionals in the future," concludes Joubert. * Advocates, Attorneys, Chartered Accountants, Dentists, Engineers, Medical and Pharmacy Other results from the survey: * Confidence that they would be able to comply with the conditions of the Consumer Protection Act was 67%. * Confidence in their ability to earn an income that keeps up with inflation was 66%. * Confidence in the economic outlook for South Africa over the next 12 months was 62%. * Confidence in the outlook for local equity/share markets was 64%. * Confidence that South Africa has seen the worst of the global economic turmoil was 54%. * Confidence that they have saved enough to retire was 56%. * 7% believe the tax incentives offered by government are enough to encourage South Africans to save. * 68% believe that compulsory preservation is necessary to enforce South Africans to save.

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* a a u, HEALTH MINIS R FOR OVERHAUL OF PUBLIC HEALTHCARE The public healthcare system in South Africa must be completely overhauled if NHI is to succeed This was the message from the Minister of Health, Dr Aaron Motsoaledi, on the first morning of the Board of Healthcare Funders' Southern Africa conference, held recently in the Champagne Sports Resort in the Drakensberg. The Minister bemoaned the fact that the country still has two healthcare systems: public and private. "It is not the aim of the NHI to abolish private health, but to make sure that two systems are able to work in synergy. The fragmentation has to be dealt with," he said. Dr Motsoaledi pointed out that, according to the World Health Organisation's 2008 report on world health, there are three trends that undermine the improvement of health outcomes globally. These are: * Hospital centrism, which has a strong curative focus; * Fragmentation in approach which may be related to programmes or service delivery; * Uncontrolled commercialism which undermines the principles of health as a public good. "In South Africa we are dealing with all three," he said. When he spoke of 18 Pharmasales uncontrolled commercialism, the Minister was careful to point out that he was not pointing fingers at the private healthcare system. "In the public sector we have replaced a healthcare system with a tendercare system. Tenders come first, health comes later. Everyone knows that in our healthcare system commercialism comes first." In his presentation, the Minister reminded delegates that the NHI is based on seven main principles. First is the constitution, which states that no one may be refused emergency medical treatment. The other six principles are social solidarity, equity, appropriateness, effectiveness, efficiency and affordability. "Our current system does none of these things," he said. Dr Motsoaledi announced a number of measures to improve the public health system. Flagship projects include a new medical school in Limpopo (the 9th in the country), a new George Mukhari Academic Hospital and a new structure for the Chris Hani Baragwanath Hospital. The government also plans to spend R1.2 billion to revitalise nursing colleges. "Our nursing colleges were not abolished but they were ignored. This was because in 1984 the government took the decision to train nurses in university. But now we say university can only come after basic training in college." Under NHI, health standards compliance will be mandatory. The Minister announced that he will be appointing an ombudsperson who will be a public protector in health and will "chase institutions if they give people a raw deal. We need to re-engineer our primary healthcare system. Before end-of-year we will launch a school healthcare system which will focus on eyes, hearing, oral hygiene, immunisation, drugs and alcohol, reproductive health rights and HIV counselling and testing." The school system will be housed in a mobile unit which will travel between districts, providing access to primary healthcare. "We have seen cases of school children in this country demanding abortions three times in six months. When we staged a fight against HIV, we threw family planning out of the window. It must come back." A National Health Commission will be established by March 2013 to deal with smoking, alcohol, diet, exercise, and motor vehicle accidents. The commission will be outside the Ministry of Health. It will fall under the Presidency and will be mandated to reduce the burden of disease and to make healthcare affordable.

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Medical schemes in South Africa are under threat and the enforcement of Prescribed Minimum Benefits (PMBs), which most affect their sustainability, is unconstitutional. 20 Pharmasales This is the opinion of Advocate Isabelle Ellis from the Pretoria Society of Advocates. She was speaking on the first day of the Board of Healthcare Funders' Southern African Conference, at Champagne Sports Resort in the Drakensberg. The conference, which has as its theme The Power of Now: Into the changing future brings together leaders in the private healthcare sector, service providers and public sector representatives. As the starting point of her address, Advocate Ellis referred to Section 27 (1) (a) of the Constitution which states that everyone has a right to healthcare services. This, she contends, places an obligation on the state to create effective policies to benefit the whole population. This obligation is underpinned by Section 7 (2) of the Constitution which provides that the state must take reasonable legislative and other measures within its available resources to achieve the progressive realisation of each social security right enshrined in the Bill of Rights. The term 'progressive realisation' is important, the Advocate said. It shows that the right may not be realised immediately but that the state must be seen to be taking steps to achieve this goal. This means, she says, that the state must recognise the responsibilities of other actors by enabling them to make the required provision. It is here that the medical schemes come in. When it comes to the realisation of the basic right to health, the Medical Schemes Act works in conjunction with the Constitution to fulfil the government's obligations. This form of assistance is known as complementarity. Section 7 (1) (b) explains that medical schemes have a role to play that is complementary to the national health policy. "Without medical schemes, health policy won't go anywhere," she