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Kai Ryssdal: Over the past month or so we've been bringing you a series of stories from Russia by our health care reporter Gregory Warner. Today, we're going to turn to clinical trials. Pharmaceutical and biotechnology companies spend $35 billion a year testing their products in those trials. And it's not a quick process. By the time they line up participants, meet regulatory requirements, and then actually test the drugs, we're talking years.
In other parts of the world, like Russia, things move more quickly. Quickly enough, that the business of clinical trials there is growing 15 percent a year. Here's Gregory.
Gregory Warner: Getting drugs to market is basically a race against the patent clock. You want to get your drug tested, approved and stocked on pharmacy shelves as fast as possible.
David Passov: The number one reason why companies come to Russia is that they can enroll patients in Russia three to 20 times faster than in America or Western Europe.
David Passov runs Clinstar, it's a company that organizes clinical trials in Russia for big drugmakers. And yes, he really did say:
Passov: Three to 20 times faster.
Meaning a trial that starts for example in October and has its Russian patients ready to roll by November, might only just be giving its American patients placebo pills by the following June.
Passov: In the West, people participate in clinical trials if they want to do something good for mankind, or that's their last resource.
Patients aren't paid for taking part. But in Russia, participating in a clinical trial could mean seeing that specialist you couldn't afford, or getting a diagnostic test you wouldn't have gotten.
Passov: They would actually get free treatment.
Galina is a 59-year-old diabetic in the northern Russian city of Yaroslavl. She already gets her insulin paid for by the state. But then her doctor offered her the chance to participate in a clinical trial.
Galina: I wanted to take part in it. There was a good chance that the insulin they were going to give me was of a higher quality than the insulin I was currently taking and I thought, well, maybe there's hope that I could get completely better!
She knew, at least the rational part of her, knew that you can't get completely better from diabetes. But she could still hope.
Galina: Well I think science generally moves forward.
Much of clinical trial work is not about breaking new scientific ground. It's usually seeking new uses for old brands or new brands to compete with drugs that already do a pretty good job. And in America, this kind of research is increasingly done not by top specialists but by doctors looking for extra cash. Not so in Russia.
Passov: Our investigators in clinical trials tend to be more prominent physicians because they get to be on the cutting edge of medicine.
Doctors like Andrei Koronov. He's the one that brought Galina into that clinical trial. But he's also tested drugs in cardiology, pulmonology, dermatology, gastroenterology, post-surgery drugs, anemia and endocrinology. Koronov tells me he does this research both for the cash and for professional pride. Out here in Yaroslavl's municipal center, far from the research centers of Moscow.
Andrei Koronov: Doctors here don't often get to work with novel drugs. Now we get to learn about these drugs before they get on the market. And we can let the doctors around us know about which way the science is heading.
And when Koronov talks about a drug to other doctors, its not just one or two colleagues in the break room. As a clinical pharmacologist in one of the city's largest hospitals, he gives the lectures to other doctors about which drugs they should use and when.
Koronov: Companies are naturally interested that we know about their drugs. So that we can give presentations to other doctors about those drugs.
This is where the clinical trial industry becomes as much about marketing drugs as about testing them. Drug companies even have a code name for these influential doctors in foreign countries.
Tatyana Boloshova: If we are speaking about opinion leaders?
We are speaking about opinion leaders. This, by the way, is Tatyana.
Boloshova: Tatyana Boloshova.
A Russian biochemist, who in the late 1990s was plucked from her job as a poorly paid university professor and hired as a sales rep for the drugmaker Sanofi Aventis, then called Sanofi.
Boloshova: I like Sanofi very much.
Bolshova tells me she owes her professional esteem to that company because it gave her what the Russian economy could not: a good salary, interesting work, and the respect of her scientific education. For years, her job as a drug rep was to find ways to make influential doctors feel about that company like she did.
Boloshova: We had a different budget for opinion leaders. His birthday for example; when a very important specialist had his birthday.
Drug companies would show up to pay their respects. They'd form a line in the morning, she says, so that by suppertime, they could come up and say happy birthday, and hand them a present. Sometimes the receiving line was longer.
Boloshova: It depends on the level of the doctor!
Those birthday parties are more muted now. Russia has passed laws similar to those in the states limiting the gifts that drug reps can offer. And the U.S. Department of Justice is investigating several major drug firms for their financial ties to Russian physicians.
But Tatyana Boloshova is still in the business of courting doctors -- not with swag, but with science. She's no longer works as a drug rep. She now works for Clinstar, organizing clinical trials across the country. And she knows that every time they line up another doctor to test out a new drug, they snag a potential spokesman.
Boloshova: It's obviously because they were involved in clinical trials, and now this when this drug is registered in Russia, they like to use it.
And hopefully, recommend it, to hundreds of their doctor friends.
In Russia, I'm Gregory Warner for Marketplace.
Ryssdal: You can check out a map of the spread of the Russian clinical trial business and hear the rest of our series.