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#2. E$ C%&E'C(% &%)D#* 24 +,)E 2013
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Over 23,000 Peruvians are enlisted for
experiments by foreign drug ompanies
$aboratories ma2 pa2 a doctor bet3ee4 5500 a4d 5136000 7or each perso4
recr8ited 7or their st8dies. (4 20076 the the4 /eath &i4ister Caros 9ae:os6
7reed 8p re"8atio4s 7or a8thori;i4" this acti<it2 i4 the co84tr2 a4d toda2 is
amo4" the researchers 3ho hod the most co4tracts 3ith pri<ate e4tities to
84derta=e their ci4ica trias.
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.abioa !orres $?pe;
EAperime4ts o4 h8ma4s are a "ro3i4" medica practice i4 -er8. !he2 are
784ded b2 4i4e 7orei"4 pharmace8tica compa4ies recr8iti4" <o84teers to
test the sa7et2 a4d eBecti<e4ess o7 their 4e3 prod8cts be7ore the2 pate4t
them a4d bri4" them to mar=et. /o3e<er6 the re"8atio4s 7or this acti<it2
ao3 it to operate as a m8timiio4 doar b8si4ess that ac=s tra4spare4c2
a4d is be2o4d the capacit2 o7 state to s8per<ise.
!here are c8rre4t2 236207 peope e4roed i4 300 eAperime4ts b2
i4ter4atio4a aboratories i4 137 hospitas6 ci4ics6 a4d e<e4 4o4-
"o<er4me4ta or"a4i;atio4s i4 the co84tr26 accordi4" to the a8thori;atio4
re"istr2 o7 the )atio4a (4stit8te o7 /eath C)(/). !his bod2 re"8ates this
research6 b8t has o42 o4e s8per<isor i4 the Ded to e4s8re the protectio4 o7
tho8sa4ds o7 <o84tar2 participa4ts.
!he probem be"a4 i4 2007 3he4 the the4 /eath &i4ister Caros 9ae:os6
7reed 8p the proced8res a4d co4ditio4s 7or medica eAperime4tatio4 o4
peope6 thro8"h 35 modiDcatio4s to the )atio4a Ci4ica !ria 'e"8atio4
Csee the most importa4t o7 these i4 the attached tabe).
!he ori"i4a re"8atio4 had bee4 appro<ed i4 +82 20066 at the e4d o7 the
#e:a4dro !oedo admi4istratio4 a4d 3as co4sidered a step 7or3ard 7or the
protectio4 o7 participa4ts i4 eAperime4ts 3ith eAcessi<e or 844ecessar2 ris=
to i7e.
#s mi4ister6 9ae:os 3as the dri<i4" 7orce behi4d a cha4"e that res8ted i4 a
boom o7 appro<as a4d toda2 D"8res amo4" 15 doctors 3ho hod 10 or more
co4tracts 3ith aboratories a4d pri<ate e4tities to per7orm medica
eAperime4ts o4 peope thro8"ho8t the co84tr26 accordi4" to the ()1 reports
3hich E Comercio accessed thro8"h a 7reedom o7 i47ormatio4 reE8est.
%4coo"ists /e4r2 >?me; &ore4o6 +or"e 1aas 1F4che;6 1i<ia )ecios8p
De"ado a4d +ose /8rtado de &e4do;a aso 7eat8re o4 this ist. !o"ether
3ith 9ae:os the2 7o84ded >ecoper8 i4 20056 a pri<ate ci4ica research
or"a4i;atio4 co4tracted to per7orm tests o4 ca4cer patie4ts.
!on"dential payments
Ghe4 a medica eAperime4t 3ith h8ma4s is a8thori;ed6 the spo4sors hire
doctors a4d i4termediar2 compa4ies Cci4ica research or"a4i;atio4s 84der
co4tract) to recr8it <o84teers a4d r84 tests o7 their prod8ct. !he D4a4cia
i47ormatio4 a4d the pa2me4ts 7or the acti<it2 are co4sidered co4Dde4tia. (t
is =4o34 ho3e<er6 that a doctor ca4 recei<e bet3ee4 5500 to 5136000 7or
each perso4 e4isted a4d the amo84ts i4crease depe4di4" o4 the ris=s o7
the prod8ct 84der i4<esti"atio4 a4d the compeAit2 o7 the proced8res. !his
i47ormatio4 3as re<eaed to this 4e3spaper b2 pro7essio4as 3ho 3or= i4
the Ded a4d 3ho pre7er to =eep their 4ames co4Dde4tia.
-eope 3ho 84der"o the testi4" si"4 a4 i47ormed co4se4t 7orm. !he2
recei<e 4o pa2me4t. !he be4eDt is the hope that the prod8ct 84der
i4<esti"atio4 3i be eBecti<e a"ai4st their i4ess. %4ce the eAperime4t has
co4c8ded the2 4o o4"er ha<e access to it a4d ha<e to 3ait 7or it to reach
the mar=et6 a7ter 3hich the2 m8st pa2 7or it.
(4 additio46 the doc8me4t that the <o84teers si"4 does 4ot eApicit2 i47orm
them that the2 mi"ht recei<e the dr8" i4 the 7orm o7 a pacebo Ca harmess
s8bsta4ce that has 4o therape8tic <a8e) 7or eAperime4ts i4 3hich the
eBects are compared bet3ee4 those 3ho 8se the prod8ct a4d those 3ho do
!he )atio4a Ci4ica !ria 'e"8atio4s addresses 4either the sit8atio4s
described 4or a scae o7 pe4aties 7or D4a4ciers a4d the doctors 3ho breach
sta4dards o7 "ood ci4ica practice d8ri4" research a4d 3ho ca8se serio8s
i4:8r2 or death to peope.
.or siA mo4ths6 the head o7 the )atio4a (4stit8te o7 /eath6 CHsar Cabe;as6
has had i4 his oIce a dra7t eAec8ti<e decree co<eri4" these "aps6 b8t6 i=e
the e"isati<e proposa addresses the ame4dme4ts made b2 9ae:os6 it is
sti 84der e<a8atio4.
1i4ce there has bee4 a re"8atio4 7or eAperime4tatio4 3ith h8ma4s i4 the
co84tr26 the ()1 has i4<esti"ated 19 cases o7 breaches o7 "ood ci4ica
practice that ca8sed serio8s harm a4d deaths o7 participa4ts. .i<e
co4c8ded simp2 3ith reprima4ds 7or the medica researchers6 o4e is sti i4
pro"ress a4d the rest are cosed. # are =ept secret. !hese are re<eaed i4
the seco4d part o7 this report.
Co4ce4tratio4 o7 co4tracts
Jet3ee4 2009 a4d 20106 the )atio4a (4stit8te o7 /eath C()1) so8"ht to
re"8ate the 48mber o7 eAperime4ts o4 peope accepted b2 each medica
researcher6 to e4s8re the time 7or a4d staB 7oo3-8p o7 his deicate tas=.
/o3e<er6 the -er8<ia4 #ssociatio4 o7 Ci4ica 'esearch %r"a4i;atio4s
Co4tract C#poicc) 4oted that the meas8re <ioated its member ri"hts.
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EA &i4ister 9ae:os remai4s sie4t
&edica eAperime4ts i4<o<i4" h8ma4 bei4" ha<e bee4 per7ormed i4 -er8
si4ce 19K06 b8t the &i4istr2 o7 /eath o42 appro<ed speciDc re"8atio4s to
"o<er4 this acti<it2 i4 2006 3ith the aim o7 protecti4" the ri"hts o7 e4isted
participa4ts. +8st o4e 2ear ater6 the the4 /eath &i4ister6 Caros 9ae:os6
3ho re78sed to co4trib8te to this report6 7reed 8p the pro<isio4s 7or medica
eAperime4tatio4 o4 peope.
!/E C/#)>E1 G/(C/ .'EED-,- !/(1 #C!(9(!*
!hese are the most se4siti<e cha4"es appro<ed b2 Caros 9ae:os i4 2007 to
the )atio4a Ci4ica !ria 'e"8atio4s.
!/E 2006 'E>,$#!(%)1
1 C%)!'#C!1
!he D4a4ciers o7 a4 eAperime4t 3ere to prese4t to the )atio4a (4stit8te o7
/eath C()1) a cop2 o7 their co4tracts 3ith the doctors6 the impeme4ti4"
compa4ies a4d those i4 char"e at the i4stit8tio4 hosti4" the eAperime4t.
2 -%$(C(E1
(t 3as ma4dator2 7or spo4sors Cpri<ate a4d state) to p8rchase i4s8ra4ce
poicies 7or each o7 the participa4ts recr8ited 7or a medica eAperime4t6 3ith
the aim o7 co<eri4" a42 harm to their heath.
3 C%&&(!!EE1 ()C$,D()> # $#G*E'
!he research ethics committees Cco4sidered the Drst Dter to e<a8ate
3hether a4 eAperime4t is 7easibe or <er2 ris=2 7or the participa4ts) 3ere to
i4c8de a a32er a4d t3o bioethicists amo4" their se<e4 members.
4 -'(9#!E 1,'>E'(E1
&ore compeA h8ma4 eAperime4ts 3ere prohibited i4 pri<ate practice.
5 !/E -'%CE11E1
!he proced8res 7or appro<a or re:ectio4 o7 a pro:ect 3ere to ta=e 60 da2s. (4
more co4tro<ersia sit8atio4s6 the2 3ere to ta=e 90 da2s.
6 $(#J($(!*
!he i4stit8tio4 hosti4" the st8d2 3as to be :oi4t2 iabe i4 cases o7 harm to
!/E 2007 #&E)D&E)!1
1 .%'&1
1po4sors 3o8d o42 ha<e to D o8t a 7orm i4dicati4" the b8d"et aocated
to the eAperime4t. !he respo4sibiities a4d obi"atio4s o7 eAec8tors a4d
i4stit8tio4s 3ere 4ot to be deD4ed.
2 1G%') 1!#!E&E)!1
!he 1tate 3as eAo4erated 7rom p8rchasi4" poicies 7or participa4ts i4
st8dies co4d8cted b2 the /eath sector. -ri<ate spo4sors 3ere permitted to
prese4t s3or4 stateme4ts abo8t compe4satio4.
3 $E11 DE&#)D()>
!he compositio4 o7 research ethics committees 3as red8ced to D<e
members a4d the reE8ireme4t 7or prese4ce o7 a a32er 3as remo<ed. (4
additio4 it is 4o3 s8Icie4t that members demo4strate basic certiDcatio4 i4
4 &%'E C%)CE11(%)1
-ri<ate ci4ics ca4 be ce4ters 7or compeA st8dies e<e4 i7 the2 ac= adeE8ate
5 1/%'!E' !(&E.'#&E1
-rocessi4" times 3ere red8ced to 30 da2s. (4 more co4tro<ersia cases6 the
time7rame is 45 da2s.
6 )% 'E1-%)1E
!he :oi4t respo4sibiit2 o7 the host i4stit8tio4 3as remo<ed
#4 E$ C%&E'C(% &%)D#* 24 +,)E 201
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!ommission to determine santion for dotor #ho
abandoned his patient during an experiment
(4 comi4" 3ee=s6 the )atio4a (4stit8te o7 /eath C()1) 3i determi4e
3hether to rati72 or i7t the sa4ctio4 a"ai4st cardioo"ist #eA >ae"os
Ca;ora 7or recr8iti4" a patie4t 7or a pharmace8tica eAperime4t i4 CaaoLs
Da4ie #cides Carri?4 /ospita6 a4d the4 aba4do4i4" him 3he4 his heath
s8Bered irre<ersibe dama"e that ed to his death i4 2011.
!he patie4t6 #st8dio 'amo4 'ios6 566 3as co4<i4ced b2 his doctor to
participate i4 a st8d2 7rom 9 1eptember 2009 to test the eBecti<e4ess o7
the a4ticoa"8a4t #piAiba b2 the &2ers 1E8ibb Jr2sto -er8 1#C $aborator26
aimed at peope 3ith a dia"4osis o7 ac8te coro4ar2 s24drome Carteries
obstr8cted b2 bood cotti4").
(;ar4?te"8iLs 3ido3 9ictoria 'ios6 3ho 7or t3o 2ears has bee4 see=i4"
:8stice6 tod E Comercio6 MDoctor >ae"os doctor tod m2 h8sba4d that it
3o8d be a "ood ater4ati<e 7or his i4ess6 b8t 'amo4 s8Bered too ma42
compicatio4s. !he2 had to amp8tate his e7t e" i4 2010 a4d the doctor
3ashed his ha4ds o7 the 3hoe matter.M
!he re<ie3 o7 the case is i4 the ha4ds o7 a4 ad hoc tech4ica committee
appoi4ted b2 the ()1 o4 1 &arch a7ter the doctor chae4"ed the Drst D4di4"
o7 this bod26 3hich s8spe4ded him 7rom the practice o7 ci4ica research 7or
o4e 2ear.
(4 its 'eport )o. 9616 the ()1 bac=ed the sa4ctio4 a"ai4st #eA >ae"os M7or
4ot ha<i4" a4 appropriate therape8tic approach to the serio8s ad<erse
eBects a4d irre<ersibe dama"e s8Bered b2 'amo4 'ios d8ri4" the #piAiba4
&oreo<er6 prior to e4isti4" him 7or st8d26 MDoctor >ae"os =4e3 that this
3as a patie4t 3ith a set o7 chro4ic diseases that p8t him at ris= o7 s8Beri4"
ma:or compicatio4s a4d the ris= o7 arteria thrombosis Na bood cot that
obstr8cts the <ei4s a4d arteriesO.M !his precise set o7 s2mptoms 3as the
ca8se o7 the death o7 'amo4 'ios o4 15 %ctober 2011.
#4other 7act that the ()1 too= i4to acco84t 3as that the harm to the patie4t
3as hidde4 bet3ee4 24 &arch a4d 1 +84e 20106 d8ri4" 3hich time
medicatio4 3as s8spe4ded a4d the e7t e" amp8tated d8e to the s2mptoms
o7 arteria thrombosis. >ae"os did 4ot re"ister these 7acts i4 the patie4t
record 7or 'ios6 4or did he i47orm the ethics committee that e<a8ated the
eAperime4t. /o3e<er6 the mai4 ar"8me4t to appea his p84ishme4t is e"a
error. !he doctor poi4ted o8t that >abriea &i4a2a6 c8rre4t Director >e4era
o7 the ()1 %Ice o7 'esearch a4d !ech4oo"2 !ra4s7er6 had iss8ed the
sa4ctio4 i4 spite o7 the 7act that she sho8d ha<e eAc8sed herse7 7rom the
case beca8se t3o 2ears a"o she 3as part the team o7 s8per<isors that
i4<esti"ated him. !he eAperime4t 3ith #piAiba46 i4 3hich 150 patie4ts
participated6 3as s8spe4ded i4 the co84tr2 i4 2010.
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Gido3 dema4ds compe4satio4
!he <erdict iss8ed b2 the ad hoc committee o7 the )atio4a (4stit8te o7
/eath &edica i4 respect o7 #eA >ae"os co8d cha4"e the co8rse o7 the
i4<esti"atio4 o7 him 7or medica 4e"i"e4ce a4d the death o7 his patie4t
'amo4 'ios6 recr8ited 7or a pharmace8tica eAperime4t i4 the Da4ie #cides
Carri?4 /ospita.
%4 4 +a48ar2 20126 the )i4th -ro<i4cia Crimi4a -rosec8tor o7 Caao
recei<ed a compai4t 7rom 9ictoria (;ar4?te"8i6 the 3ido3 o7 'amo4 'ios6
a"ai4st #eA >ae"os6 the &2ers 1E8ibb Jr2sto -er8 1#C $aborator26 --D
-er8 1#C Cthe compa42 to 3hich eAec8tio4 o7 the eAperime4t 3as
o8tso8rced) a4d the Da4ie #cides Carri?4 /ospita. (4 #pri6 ho3e<er6
-rosec8tor +or"e $8is C8sma recomme4ded that the case be cosed 7or ac=
o7 e<ide4ce. 9ictoria (;ar4?te"8i decided to appea this decisio4 a4d is aso
co4sideri4" a a3s8it a"ai4st Jr2sto &2ers 1E8ibb -er8 1#C 7or
compe4satio4 d8e to her h8sba4d 7or the harm he s8Bered.
P(!L1 C%).(DE)!(#$Q
E Comercio reE8ested a4 i4ter<ie3 3ith the cardioo"ist #eA >ae"os to
obtai4 his <ersio4 o7 e<e4ts6 ho3e<er the doctor said that he 3o8d co4s8t
3ith his 2o8r a32er beca8se Mit is a co4Dde4tia matter.M #t the time o7
"oi4" to press6 >ae"os had pro<ided 4o 78rther respo4se. &ea43hie6 the
Jr2sto &2ers 1E8ibb -er8 1#C $aborator2 simp2 4oted b2 emai that the
compai4t a"ai4st the compa42 had bee4 cosed.
Only #arnings issued for seven serious breahes
E Comerico "ai4ed access to se<e4 cosed Des abo8t serio8s breaches o7
"ood ci4ica practice d8ri4" eAperime4ts o4 peope i4 -er8 o<er the ast D<e
2ears. (4 the abse4ce o7 a scae o7 pe4aties i4 the r8es6 the )atio4a
(4stit8te o7 /eath o42 iss8ed reprima4ds to those respo4sibe.
C#1E: Co4ceai4" i47ormatio4 a4d patie4t death
'E-'(&#)DED: >8sta<o $e?4 -ortocarrero
%4 12 &a2 20126 rhe8matoo"ist >8sta<o $eo4 -ortocarrero 3as
reprima4ded 7or co4ceai4" a serio8s ad<erse eBect 3hich the4 ca8sed the
death o7 a 7K 2ear od 3oma46 e4isted 7or a st8d2 o7 a 'i"e -harmace8tica
prod8ct to treat rhe8matoid arthritis at the )atio4a (4stit8te 7or >24ecoo"2
a4d 'eprod8ctio4 i4 2010. $e?4 4e<er reported to a8thorities the ast three
co4sec8ti<e i47ectio4s s8Bered b2 the patie4t.
C#1E: E4isti4" peope at 84a8thori;ed ocatio4s
'E-'(&#)DED: $8is 9ida )eira
%4 11 &a2 11 20126 rhe8matoo"ist $8is 9ida )eira 3as reprima4ded 7or
e4isti4" 7o8r peope at 84a8thori;ed ocatio4s 7or a st8d2 testi4" the sa7et2
a4d eBecti<e4ess o7 the &erc= 1harp R Dohme -er8 1'$ a4ti-osteoporosis
prod8ct %da4acatib. !he record sheets a4d pro"ress o7 patie4ts recr8ited
7or the st8d2 i4 2010 co4tai4ed <ario8s errors that p8t their i<es i4
C#1E: Jreach o7 protocos
'E-'(&#)DED: Gater &o"ro<e:o 'amos
%4 24 %ctober 20116 Doctor Gater &o"ro<e:o 'amos 3as reprima4ded 7or
p8tti4" the i<es o7 patie4ts 3ith heart disease i4 ris= beca8se he breached
the protocos o7 a medica eAperime4t 784ded b2 the Ei $i2 $aborator2.
&o"ro<e:o 3as compari4" the eBects o7 the prod8cts -ra8"re a4d
Codid8"re at the 'esearch Ce4tre o7 the )e8rocardio<asc8ar (4stit8te.
C#1E: -atie4t e4roed 3itho8t permissio4 a4d breach o7 re"8atio4s
'E-'(&#)DED: .HiA &edi4a -aomi4o
%4 17 1eptember 20106 ph2sicia4 .eiA &edi4a -aomi4o e4isted a patie4t
3itho8t their co4se4t a4d <ioated the protocos o7 research i4 the Ca2eta4o
/eredia Ci4ic to test the eIcac2 o7 the Ja2er 1# prod8ct 'i<aroAaba4 to
pre<e4t stro=e i4 peope 3ith cardiac arrh2thmias. !he sec8rit2 a4d sa7et2 o7
the participa4ts 3ere p8t at ris=. !he aborator2 stopped its research at this
C#1E: E4isti4" babies 3itho8t their pare4tsL co4se4t
'E-'(&#)DED: Ca8dio $a4ata de as Casas
%4 25 .ebr8ar2 20096 Doctor Ca8dio $a4ata de as Casas 3as reprima4ded
7or e4isti4" chidre4 a"ed 2 to 11 2ears6 3itho8t the i47ormed co4se4t o7
their pare4ts6 i4 a st8d2 testi4" the sa7et2 a4d imm84e respo4ses o7 1a4oD
-asteo8rLs a4ti-de4"8e <acci4e chimeri<aAstam i4 Ch88ca4as C-i8ra). !he
-8bic De7e4der had to i4ter<e4e 7or the )atio4a (4stit8te o7 /eath to ope4
a4 i4<esti"atio4 ope4i4".
C#1E: E4isti4" patie4ts 3itho8t permissio4
'E-'(&#)DED: #4a &arSa Jo;a
%4 11 +84e 20076 ps2chiatrist #4a &arSa Jo;a 3as reprima4ded 7or e4roi4"
patie4ts 3ith bipoar disorder i4 $arco /errera /ospita 7or a comparati<e
st8d2 o7 t3o dr8"s CE8etiapi4e a4d ithi8m) e<e4 tho8"h she did 4ot ha<e
the a8thori;atio4 o7 the )atio4a (4stit8te /eath to do so. !he eAperime4t
had o42 bee4 a8thori;ed 7or the &arSa #8Aiiadora Ci4ic.
1e capt? a 57 si4 co4se4timie4to
57 e4isted 3itho8t co4se4t
(4 20076 i4spectors 7rom the )atio4a (4stit8te o7 /eath detected that
o4coo"ist /e4r2 >?me; &ore4o had recr8ited 57 ca4cer patie4ts 3itho8t
ha<i4" them si"4 i47ormed-co4se4t doc8me4ts - 7or t3o medica
eAperime4ts per7ormed at the )atio4a (4stit8te o7 )eopastic Diseases
C()E)). !he report recomme4di4" his sa4ctio4 3as ee<ated to the
eadership o7 the a"e4c26 b8t 3as the4 she<ed.
$ost studies do not fous on endemi diseases
-er8 is 84derstood to host the D7th hi"hest 48mber o7 i4ter4atio4a medica
eAperime4ts i4 $ati4 #merica. !his is accordi4" to the 3ebsite
333.ci4icatrias."o<6 the ar"est database o7 ci4ica trias i4 the 3ord r84
b2 the )atio4a $ibrar2 o7 &edici4e o7 the ,4ited 1tates )atio4a (4stit8te o7
/o3e<er6 3hat ca4 be i4terpreted as a bi" step 7or3ard i4 heath research
carried o8t b2 oca aboratories a4d pro7essio4as has ope4ed 8p a debate
i4 the medica comm84it2 abo8t 3hether the proi7eratio4 o7 784ded
research is or is 4ot "e4erati4" 4e3 =4o3ed"e to so<e the co84tr2Ls
pri4cipa heath probems.
M&ost st8dies respo4d to the commercia i4terests o7 the aboratories that
784d them. !he 1tate has to promote research 3ith reso8rces a4d
i4ce4ti<es that 7oc8s o4 4e3 3a2s to treat e4demic i4esses Cmaaria6
de4"8e6 t8berc8osis6 etc.)6M said >ermF4 &Fa"a6 a medica researcher at
the Ca2eta4o /eredia ,4i<ersit2.
.or Doctor #rma4do Ca<o6 -reside4t o7 the -er8<ia4 #ssociatio4 o7 Ci4ica
'esearch %r"a4i;atio4s C#poicc)6 the choice o7 -er8<ia4 pro7essio4as to
84derta=e st8dies 7or i4ter4atio4a compa4ies has heped to 7orm research
teams i4 the co84tr2 that ha<e "ai4ed eAperie4ce a4d presti"e.
Ca<o ar"8es that doctors are more tha4 patie4t recr8iters6 beca8se i4
rece4t 2ears the2 ha<e become more i4<o<ed i4 the desi"4 a4d
de<eopme4t o7 the research o7 aboratories a4d pri<ate e4tities. !he
therape8tic areas 3ith the most pharmace8tica prod8cts st8died are
o4coo"26 i47ectio8s diseases6 rhe8matoo"2 a4d diabetes. !hree 3ee=s
a"o6 E Comercio aso as=ed the )atio4a #ssociatio4 o7 -harmace8tica
$aboratories C#$#.#'-E)6 3hich bri4"s to"ether 19 compa4ies 3ith 7orei"4
capita6 7or a4 i4ter<ie3 7or this stor2. (ts spo=esme4 se4t statistica data6
b8t did 4ot respo4d abo8t 3hether a42 o7 its eAec8ti<es 3o8d be
!/E ),&JE'1
-E) 60m i4<ested b2 the pharmace8tica i4d8str2 to test their prod8cts o4
peope d8ri4" 2012.
-E) 2466000 is the cost o7 a test st8d2 o7 peope i4 the co84tr26 accordi4" to
estimates b2 #a7arpe.

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