Diabetic prepared to die for Brexit

doug56hl

But you should be able to produce some document to show that all steps have been taken to avert the risk of something happening. If not, frankly your statement is B/S.
What about the results of dry runs? or failure stress testing? Can't find any of them?

It can not be proved that something untoward will not happen in a no deal brexit. I am not aware of a trial of say supplying all radioisotopes by air which normally come by land for a two week period to see what practical difficulties may present themselves. There is talk of switching supply chains to the by air route just before a no deal brexit but that may be leaving it too late to iron out any problems. Some companies have said there may be delays in their delivery times.

Do a dry run, prove the systems work and then it can be said something will not happen. Until then it is just trust us, it will all be fine on the day. I have zero trust in a government which contracted a ferry company without any ferries as a contigency for supply difficulties. And wasted millions of pounds in the process.

When I was involved in disaster recovery planning for datacentres we would never say nothing unplanned/unexpected will not happen until the processes and procedures had been tested fully in the real world i.e. invoke the disaster protocols.

There are too many historical examples of government cockups to believe they will get it right first time. And unlike systems testing there will not be a roll back option available with no deal Brexit.
So your advice to the radiologists and oncologists who are concerned about the possibility of having to cancel their patients treatment due to non arrival of JIT isotopes is "deal with it and move on".

Current official advice is to reduce the number of appointments for the first week following a no-deal Brexit, in order to see what the impact is likely to be. This will lengthen waiting times for patients who really do not have time to wait for their treatments.  Is your advice to affected patients also to "deal with it and move on"

So there will be nothing wrong with some changes. What about changes for the worse?
Only a problem when people want to make it a problem? You come over the same way (whether intentionally or not) as the consultants I've seen who didn't know their arse from their elbow, made a deal of money and then moved on leaving the mess behind them that others then had to clean up.

ashenfie

There are three main insulin manufacturers: Eli Lilly, Novo Nordisk and Sanofi. The latter two of them are EU companies. A good US trade deal will thus not reduce costs of the insulin from the two EU companies.

Novo Nordisk is the world’s largest producer of insulin. They have production sites in the US, Brazil, Denmark, France, China, Russia, Algeria and in Japan.

Lilly produces insulin in the US, Puerto Rico, France and Italy. They have packaging facilities for these products in France and China.

Sanofi has manufacturing sites in Germany, Russia, India, China and Saudi Arabia. They do manufacture some drugs in the UK, but insulin is not produced in the UK by them.
Diabetes UK responds to reports that a no-deal Brexit could disrupt UK insulin supply

Bl4ckGryph0n

But as you see the main locations Novo Nordisk produce as I said in US & Brazil which outside the EU and therefore outside EU tariffs

tapzilla2k

LOL Well you clearly made your bed and are laying in it...Must be uncomfortable with that chip on your shoulder. All those consultants making all that money and poor old you having to clean up after them. Just have a think for a moment what you are actually saying there.

But yes, you are right from one perspective, just drawing the wrong conclusion. I have indeed seen that sadly too many times.

doug56hl

Usually medical isotopes are transported overnight through the channel tunnel, if we don't have an agreement in place for those isotopes they will get held up in customs which might well push past the usefulness of some isotopes used in medicine. Some medical Isotopes come ready made and others have to be extracted from a parent nuclide in hospitals or specialist facilities.



Because they extract Tc-99m from it's parent nuclide in hospitals,  the parent nuclide has a longer half life of around 66 hours, more than enough time to transport it from Europe to the US then extract Tc-99m for medical use.  

Because they would have to build nuclear reactors with the express aim to produce medical isotopes, which would cost billions of dollars. There are only about 5 nuclear reactors worldwide that can produce the parent nuclide of Tc-99m from what I remember. Some of which are located in Europe.
It's much cheaper to buy from countries with those nuclear reactors than to build a nuclear reactor with the express aim of making medical isotopes, again it would cost billions of dollars.

Note - Tc-99m has a half life of six hours, once it goes past that it becomes pretty much useless for medical use. It's still radioactive just of no use for nuclear medicine.

The transport of nuclear materials is subject to heavy regulation, as you should well know. Other medicines will be easier to transport but those that have specific time limitations cannot be delayed for very long. You'd also find Big Pharma will jack the prices up on medications to make a quick profit, which might restrict access or restrain supply.

There is a difference between transporting people and transporting nuclear materials. Transporting nuclear materials is heavily regulated - Regulations for the Safe Transport of Radioactive Material | IAEA

So yes the Government could charter planes (or use the RAF) to transport nuclear materials, but they would still be subject to IAEA regulations and also require the necessary licenses from the EU to transport them into the UK. That's where the delay will stem from, unless a deal is struck to cover all of the issues around nuclear materials being imported/exported to and from the EU into the UK and vice versa. Some medical isotopes have such short half life's there will be no choice but to import them from the EU.

tapzilla2k

And?

This applies to the 60% of the world that Europe supplies, that is a much longer distance away than the UK is.

And plenty of time to make the much shorter journey to the UK and then do the same extraction.

And yet, it's still economic for the US health system to import these things from Europe, and they still have a long enough life to be useful.

So why wouldn't we be able to do the same in the UK?

Note : the flight time to most of the USA from France is longer than that.

How would they jack up prices? The supply and demand is unchanged. We are only talking about using air freight rather than road / rail to transport this.

We already comply with the IAEA (which is not an EU agency) and will continue to do so.

doug56hl

Checking my Novo Nordisk insulin just now I can assure you it is made in the EU. France to be precise.
Country of manufacture can be determined by the batch number on the packaging.

Care to show any info that their main manufacturing locations are the US and Brazil? The latter is shown to be their largest manufacturing location outside of the EU. Personally I'd rather my insulin came from Denmark or France than Brazil.

There aren't any EU Tarrifs.
Tariffs are imposed by the importing country not the exporting one. Many countries (US, members of the EU, Canada, Switzerland, Japan, Norway, Czech Republic, Slovakia, Macau in China) have zero percent tariffs as part of the Pharmaceutical Agreement of the WTO Uruguay Round of TRIPS

A number of WTO members, mainly upper income countries, concluded the Pharmaceutical Tariff Elimination Agreement in 1994.  Under this agreement, the parties to the agreement eliminated tariffs on all finished pharmaceutical products as well as on designated active ingredients and manufacturing inputs.
http://haiweb.org/wp-content/uploads/2016/04/ACCISS-Tariff-April2016_FINAL.pdf

Whether or not the UK becomes a signatory to the Pharmaceutical Tariff Elimination Agreement after it leaves the EU, it will still be able to trade with the EU on the basis of a zero tariff for pharmaceutical products. In written evidence to the House of Lords EU External Affairs Subcommittee in February 2017, the Government confirmed that:
            
The Pharmaceutical Agreement is extended on a Most-Favoured Nation (MFN) basis. This means that signatories extend the tariff eliminations to all WTO members. So, all WTO members enjoy the benefits of tariff free trade to signatory countries irrespective of whether or not they themselves are members. The UK will therefore continue to benefit from the tariff eliminations of negotiating parties and in line with our technical rectification approach, the UK will continue to place zero tariffs on pharmaceutical goods covered by the Agreement.
The impact of Brexit on the pharmaceutical sector - Business, Energy & Industrial Strategy - House of Commons

IronGiant

This might shed some light on the medical isotope problem -

doug56hl

Although new technolgies are being developed to manufacture with no residual nuclear waste. One I mentioned previously is expected to be producing after 2021 and could make the majority of the USA requirements from one manufacturing plant. Three US firms awarded Mo-99 production funds - World Nuclear News

Another is using an approach of enhancing the cyclotrons some hospitals have to be able to produce Tc-99m. These would supply the hospital and possibly others within a close location.  Not clear if this would just be a backup facility or a main production facility.
Schematics of current production vs the concept of localised production



There is a 2017 article which mentions a UK company licensing the ARTMS Products Inc technology
ARTMS Products  and beginning Uk production in 2019 but there is nothing dated later to show this has occurred yet.
Solving the technetium medical isotope shortage
plus this press release also dated 2017
ARTMS Products Inc. partners with Alliance Medical to modernize, stabilize UK medical isotope supply chain | Alliance Medical UK

So this would appear not to be able to affect the Tc-99m supply issues around a no deal brexit on October 31st.

IronGiant

All well and good, but if we are talking about the technetium generators where the pre-cursor has a half life of 66 days, even if it sat on the docks for 2 weeks you'd still have 86% of the activity you started with. Not ideal, but surely we could cope until such time as the (import) process becomes more stream lined.