If North Korea can make fake Viagra for export, why can’t it make TB drugs for sick North Koreans?

Since the collapse of North Korea’s nominally free public health system, contagious diseases have spread widely, but only a lucky few North Koreans have been able to find medicine and medical care. Most of its people get by on whatever health care they can afford and whatever drugs they can find. A lucky few use retired doctors or doctors who moonlight after regular working hours. Some pay steep bribes to get access to care and medicine in state hospitals and clinics. Some buy medicine from market vendors, which may or may not be fake. The least fortunate rely on unlicensed healers, soothe their pain with methamphetamine or opium, or simply go without.

As the Washington Post recently discovered, however, if you’re a foreigner with hard currency, it’s not at all hard to buy medicine in Pyongyang. In May, a Post reporter visited the North Korean capital, possibly for the recent Workers’ Party congress, and “bought a box of the North ­Korean-produced medicine to treat erectile dysfunction.” He then “sent it to a Pfizer lab in Massachusetts to be tested.”

Surprisingly, each dose of Neo-Viagra – brown granules in a vial that looks like traditional Korean medicine – turned out to contain 50 milligrams of sildenafil, the active ingredient in Viagra. The little blue genuine Viagra pills come in 50- and 100-milligram doses.

“Lab analysis of the product known as ‘Neo-Viagra’ . . . did detect the presence of sildenafil,” said Yasar Yaman, Asia-Pacific director for Pfizer’s global security team. “Sildenafil is the active ingredient in Viagra, however this is a different formulation to the sildenafil found in authentic Pfizer tablets.” []

This finding should not have been too “surprising,” given longstanding that North Korea sells many counterfeit products, including Viagra, as Fifield notes later. This was my favorite line in the story, by the way:

Pfizer couldn’t say whether the medicine would actually work or was safe because it had not conducted any clinical trials, and the reporter was not successful in convincing any male acquaintances to try it.

Pfizer told the Post that it was “‘currently reviewing’ whether to take any action against the North Korean manufacturers for patent or copyright infringement.” Pfizer’s lawyers will find that it is possible to sue a foreign government that engages in “commercial activity;” but historically, the plaintiffs who’ve obtained large civil judgments against the North Korean government for its terrorist acts have found it difficult to find North Korean assets to attach. A more promising strategy may be to identify and sue the Chinese and Russian companies that are selling the North Korean viagra and try to attach their assets.

Websites based in China and Russia have been selling Kumdang; Neo-Viagra; Tetrodocain, which purports to treat an array of diseases including tuberculosis and HIV; and Chonghwal, which is said to do the same job as Viagra. []

There is, needless to say, no independent scientific evidence for the effectiveness of North Korea’s cure for HIV. There is evidence that other North Korean “medicine” is toxic or harmful. An investigation by Radio Free Asia found that North Korean doctors in Tanzania have prescribed “medications containing high percentages of lethal heavy metals to patients.” According to an anonymously sourced story published by Radio Free Asia, North Korea has at least two factories that make supplements to enhance the performance of athletes, and it reports that those drugs are in high demand among the elites in Pyongyang for “recreational” use. RFA did not test a sample, but South Korea’s Ministry for Food and Drug Safety did analyze samples of North Korean-made supplements for sale in Asian countries and found that some “exceeded the permitted levels of hazardous heavy metal substances,” including mercury, arsenic, and lead. Another, called Keum Dang No. 2, contained “[n]arcotic components.” Vietnamese authorities suspended sale of the supplements following the reports.

Much later in her story, Fifield alludes in passing to the greater harm done to the North Korean people.

Indeed, North Korea’s pharmaceutical factories have largely ground to a halt along with the rest of the industrial sector, and many pharmaceutical products are imported from China to be sold in the markets. Medicines for chronic outbreaks are donated by humanitarian organizations, such as the drugs to treat multi-drug resistant tuberculosis that are imported from South Korea.

I don’t want to move off this point just yet. Instead, I want to turn to another story by the same reporter from last March. Its tone is much darker than the quirky tale of the fake-but-effective Viagra and the plucky little regime that defies the world to sell boner pills to middle-aged guys with more money and libido than sense.

The lives of more than 1,500 North Korean tuberculosis patients are at risk, an American-run humanitarian foundation said Wednesday, because tough new sanctions are stopping medicine from getting to sick people.

After the United Nations imposed multilateral sanctions this month as punishment for North Korea’s recent nuclear test and missile launch, South Korea this week imposed direct sanctions of its own. But unlike the unilateral U.S. sanctions recently passed by Congress, the South Korean measures do not make a general exception for humanitarian aid.

That has hamstrung the ­Eugene Bell Foundation, which treats people with multi-drug-resistant tuberculosis inside North Korea but cannot get the export licenses it needs to ship medicine from the South to its treatment facilities in the North.

“Unless something is done quickly, our patients will fail treatment and die,” said Stephen W. Linton, chairman of the foundation. “Short of all-out war, I cannot imagine a greater tragedy for the Korean people.” [Washington Post, Anna Fifield, March 9, 2016]

Let’s stipulate that when South Korea temporarily blocked that shipment of tuberculosis drugs, it made a misstep. U.N. sanctions emphasize that sanctions should be administered to avoid adverse impact on humanitarian aid programs. Blocking humanitarian aid shipments does nothing to help enforce sanctions, and only plays into the hands of dishonest or ill-informed criticisms that sanctions only hurt the North Korean people. The Post’s headline for that story played into that narrative perfectly. It read, “North Korean tuberculosis patients at risk as sanctions hamper medicine shipments.” (Emphasis mine.)

The best I can say for this headline – reporters don’t necessarily write their own headlines – is that it isn’t entirely false. As narrowly applied to South Korea’s unilateral sanctions, it was true at that time. It’s also true that U.N. and U.S. sanctions have had indirect effects on humanitarian aid, but only for reasons that the North Korean government itself could easily avoid. Because North Korea co-mingles its proliferation-related transactions with the transactions it uses for other, non-sanctioned purposes, aid groups report that banks have also hesitated to process transactions related to aid shipments, too. That’s unfortunate.

It’s also unfortunate that the aid groups that operate in North Korea under the watchful eyes of state minders – and who must keep the recent examples of Regina Feindt and Sandra Suh in mind – use those delays as excuses to blame sanctions for the hardships of the North Korean people. What makes that criticism dishonest – even unethical – is those same groups’ consistent refusal to hold the North Korean government responsible for the deliberate policies and priorities that impoverish the North Korean people to begin with. You will often hear NGOs criticize U.S. or U.N. sanctions for hampering shipments of TB drugs, but you will never hear these same NGOs call on Kim Jong-un to produce TB drugs instead of Viagra, supplements, methamphetamine (see also), or narcotics to sell for a profit.

The press also bears its share of blame for failing to raise legitimate questions about that narrative. One of those questions is why a regime that can afford yachts, jewelry, and luxury sedans can’t afford to import medicine. Another is why a regime that can make Viagra to raise cash can’t make TB drugs for its sick citizens. In that light, headlines that blame sanctions for denying the North Korean people medicine — medicine their own government has the means to make and provide, but has chosen not to — are misleading at best.

I’m not a pharmaceutical expert, so the assumption I’m making is that it’s no more difficult to make anti-TB drugs than it is to make Viagra. I invite readers to question that assumption. What’s clear is that Pyongyang has the means to produce advanced pharmaceuticals when it smells a cash profit. Unfortunately, the welfare of the North Korean people is a lower priority than whatever priorities Kim Jong-un has in mind for the revenue he earns by exporting his country’s health care workers and drugs for sale to foreign buyers.