Durante mucho tiempo no había principios uniformes para la Atribución de nombres a los antibióticos https://antibioticos-wiki.es . Más a menudo se les llama por el nombre genérico o especie del producto, con menos frecuencia-de acuerdo con la estructura química. Algunos antibióticos se nombran de acuerdo con el lugar donde se asignó el producto.
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THIS WON’T HURT A BIT: Why the vaccine crisis shows we shouldn’t believe what health “planners” tell us about how to reform drug policy JULIA WITT BRIAN FERGUSON AIMS COMMENTARY Atlantic Institute for Market Studies
The Atlantic Institute for Market Studies (AIMS) is an independent, non-partisan, social and economic policythink tank based in Halifax. The Institute was founded by a group of Atlantic Canadians to broaden thedebate about the realistic options available to build our economy.
AIMS was incorporated as a non-profit corporation under Part II of the Canada Corporations Act and
was granted charitable registration by Revenue Canada as of October 3, 1994; it recently received US char-itable recognition under 501(c)(3) effective the same date.
The Institute’s chief objectives include:a) initiating and conducting research identifying current and emerging economic and public policy
issues facing Atlantic Canadians and Canadians more generally, including research into the economic andsocial characteristics and potentials of Atlantic Canada and its four constituent provinces;
b) investigating and analyzing the full range of options for public and private sector responses to the
issues identified and acting as a catalyst for informed debate on those options, with a particular focus onstrategies for overcoming Atlantic Canada’s economic challenges in terms of regional disparities;
c) communicating the conclusions of its research to a regional and national audience in a clear, non-
d) sponsoring or organizing conferences, meetings, seminars, lectures, training programs, and publi-
cations, using all media of communication (including, without restriction, the electronic media) for the pur-pose of achieving these objectives. Board of DirectorsChair: David McD. Mann; Vice-Chairs: John F. Irving, Peter C. Godsoe, John C. WalkerChairman Emeritus: Purdy CrawfordDirectors: George Bishop, George T.H. Cooper, Hon. John C. Crosbie, Brian Lee Crowley, Jim Dinning, Colin Dodds, Frederick E. Hyndman, Bernard Imbeault, Dianne Kelderman, Phil Knoll, Colin Latham, Martin MacKinnon, G. Peter Marshall, John T. McLennan, Norman Miller, J.W.E. Mingo, Arnold G. Park, Elizabeth Parr-Johnston, Derrick Rowe, Jacquelyn Thayer Scott, Paul D. SobeyPresident: Brian Lee Crowley
Advisory CouncilJohn Bragg, Angus A. Bruneau, Don Cayo, Purdy Crawford, Ivan E.H. Duvar, JamesGogan, Denis Losier,Hon. Peter Lougheed, James W. Moir Jr., Peter J.M. Nicholson, James S. Palmer, Gerald Pond, John Risley, Cedric E. Ritchie, Joseph Shannon, Allan C. Shaw
Board of Research AdvisorsChair: Professor Robin F. Neill, University of Prince Edward IslandProfessor Charles S. Colgan, Edmund S. Muskie School of Public Service, University of Southern Maine;Professor Jim Feehan, Memorial University of Newfoundland; Professor Doug May, Memorial Universityof Newfoundland; Professor James D. McNiven, Dalhousie University; Professor Robert A. Mundell,Nobel Laureate in Economics, 1999; Professor David Murrell, University of New Brunswick
Atlantic Institute for Market Studies2000 Barrington Street, Suite 1006, Halifax, Nova Scotia B3J 3K1Telephone: (902) 429-1143; fax: (902) 425-1393E-mail: aims@aims.ca; Web site: www.aims.ca
AIMS Commentary THIS WON’T HURT A BIT: Why the vaccine crisis shows we shouldn’t believe what health “planners” tell us about how to reform drug policy AIMS Commentary
2004 Atlantic Institute for Market StudiesPublished by Atlantic Institute for Market Studies2000 Barrington Street, Suite 1006Halifax, Nova Scotia B3J 3K1
Telephone: (902) 429-1143Fax: (902) 425-1393E-mail: aims@aims.caWeb site: www.aims.ca
Edited and prepared for publication by Barry A. Norris.
The authors of this report have worked independently and are solelyresponsible for the views presented here. The opinions are not necessarilythose of the Atlantic Institute for Market Studies, its Directors, orSupporters. AIMS Commentary Table of Contents
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Getting the Right Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The UK Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Don’t Blame the Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Great Flu Vaccine Panic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Attack of the “Lawyeraptors” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Problem with Government Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The FDA in the Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
AIMS Commentary About the Authors Julia Witt is currently a PhD student at the
Dr. Brian Ferguson is currently an Associate
at the University of Guelph. He earned a BA
at Mount Allison University, an MA at the
of Guelph. Her fields of specialization dur-
ing the PhD program include social welfare
been visiting faculty at the Australian NationalUniversity, was Consultant Economist to theStatistical Research section of the AddictionResearch Foundation of Ontario, and visit-ing researcher at the Kansas Health Institute(and visitor at the Department ofEconomics, University of Kansas). He isalso the author (with G.C. Lim) ofIntroduction to Dynamic Economic Models(Manchester University Press, 1998). AIMS Commentary Introduction
Americans, Canadians rely on just two pro-ducers to supply our stock of flu vaccine,
On October 24, 2004, the op-ed page of the
one of which — fortunately not Chiron —
New York Sunday Times carried an opinion
also supplies half the US stock. Second, if
piece (Bartlett and Steele 2004, 11) that
Canada’s federal and provincial ministers of
pretty accurately sums up the views of per-
health proceed with some of the policies they
discussed at their recent meeting, Canada’s
Canadians about the October flu debacle in
the United States — it’s all the market’s fault.
very much like its troubled US counterpart.
The article, by two Time writers, points outcorrectly that drug manufacturers make
Getting the Right Dose
much more profit from products like Viagrathan they do from vaccines and that, with
In the United States, approximately 95 per-
regard to the flu vaccine shortage, “[t]he
cent of the annual flu vaccine supply comes
reason for the shortage is this: Preventing a
flu epidemic that could kill thousands is not
French-based Aventis Pasteur’s US facili-
ties, each supplying nearly half the required
something like erectile dysfunction”. This is
partly true: the immediate reason for the
shortage was contamination of the output of
because it is a live virus, is not approved for
vaccine maker Chiron’s UK plant and the
most at-risk people. Canada also obtains flu
UK government’s subsequent refusal to per-
vaccine from Aventis Pasteur, but from the
mit the export of any of the plant’s output to
company’s French plant, whose output is
the United States. The Time writers then go
not licensed for use in the United States.
on to say that the United States does not
Canada’s second supplier, ID Biomedical, is
exercise any influence over pharmaceutical
located in Quebec and is responsible for the
prices, which, at least as far as vaccines are
in this area. A New York Times article pub-
monitors flu outbreaks worldwide and rec-
lished a few days earlier (Grady 2004) cited
experts as saying that the heart of the prob-
to be used for the next flu season. In the
lem was that government was not sufficient-
United States, the decision about which flu
ly involved in the vaccine market. As the
virus strains to include in the vaccine is
article put it, “The production, sale and dis-
tribution of vaccines, particularly those for
Related Biologicals Advisory Committee of
flu, are handled almost entirely by pharma-
but production and distribution of the vac-
cine are largely left to the private sector. A
back and watch the United States’ problems
relatively small amount is purchased by the
Centers for Disease Control (CDC) and state
shouldn’t, for a couple of reasons. First, like
AIMS Commentary
“cannot guarantee the safety of these vac-
States requires each year is largely deter-
cines”, states are not allowed to import them
until the agency has conducted what it consid-
previous year. For example, about 95 mil-
ers to be adequate testing of vaccine batches.
lion doses of vaccine were produced for the2002–03 flu season, of which 83 million
The UK Experience
doses were used. The requirement for the2003–04 flu season was set at about 87 mil-
Northern Ireland was also adversely affected
supplied 80 percent of its flu vaccine.
time to manufacture — production for the
However, two factors averted a crisis there.
October-November inoculation period starts
Services and Public Safety moved quickly to
secure doses from other suppliers without
viruses travel around the world, so unused
imposing debilitating requirements on the
approval process for the new supplies.
thrown away. It also raises the stakes for pro-
ducers because there are no guarantees that
their supply will be sold. Some companies
enough to be filled by the UK’s five other
suppliers of the vaccine. Chiron also sup-
altogether — ten years ago, there were four
plied nearly 20 percent of the required doses
in the rest of the UK, but the Department of
Health quickly secures additional supplies
from three of the remaining five companies,
regulations. Parkedale Pharmaceuticals in
thus averting a severe shortage of flu vac-
Rochester, Michigan, shut down its flu vac-
cine production facility after a long debate
flu vaccine suppliers is partly because of
company to halt its vaccine sales during the
that country’s pricing mechanism for phar-
only time doses would have been in demand,
maceuticals. The industry’s target profit level
wasting nearly 14 million doses. The prospect
of a recurrence left the flu vaccine market
(represented by the Department of Health)
and the pharmaceutical sector (represented
by the Association of the British Pharma-
ceutical Industry). The target is expressed as
a level of return on capital employed, and is
investing in costly FDA-required upgrades
derived from the average level of profitabil-
to the chicken-egg process makes less sense
ity of industry in the UK in general. The
than exiting the market completely. The FDA’s
strict guidelines are also the reason US states
prices” that “promote a strong and profitable
are unable to secure flu vaccines from other
pharmaceutical industry” that will “encourage
countries that have a surplus. Since the FDA
the efficient and competitive development
AIMS Commentary
Department of Health 1999). Contrarily, in
why aren’t those signals pointing in the
the United States, the CDC typically negoti-
other direction, toward certain vaccines?
ates prices for itself and other government
The answer, at least in the US flu vaccine
purchasers that are roughly half the private
case, is that government, not the market,
sector cost.1 Unreasonable prices do not pro-
sets the signals. The problem with the US
mote a strong and profitable pharmaceutical
vaccine sector isn’t too little government
Don’t Blame the Market The Great Flu Vaccine Panic
This year’s flu vaccine panic in the United
Critics of market involvement in health care
States is just the latest, and most dramatic,
argue that, while the market is fine for pro-
of the unintended consequences of deliber-
viding cereals and cosmetics, it simply cannot
be relied on where health care is concerned.
The story is set out in a pair of reports,
Barlett and Steele (2004) take the view thatthe flu vaccine case shows “[t]he money is
in the treatment — not prevention — so the
2003), the other from the General Accounting
market and good health care are at odds”.
Office (GAO) (United States 2002). In 1967,
Most health policy reformers believe that
26 manufacturers were licensed by the FDA
health care is simply too important to be left
to produce vaccines for the US market. By
to the market, implying that some sort of
1980, that number had declined to 17, and by
failure on the part of the market requires
that the number of firms and laboratories
pharmaceutical companies’ allocation of
A recent New York Times article (Pollack 2004)gives the impression that the vaccine market is
effort between vaccines and other products.
no longer unprofitable, and cites examples of
It is not true, though, that the market has
new vaccines various companies have under
failed. The market has done exactly what it
development. It characterizes older vaccines as
is supposed to: allocate resources toward
unprofitable by comparison with newer ones, butalso mentions that the prices of vaccines covered
their highest-value use or, more precisely,
by the Vaccines for Children program are capped
their highest-profit use. Firms make produc-
without seeming to appreciate the connection
tion decisions on the basis of market signals
between the two. The article also fails to addressthe shortage of suppliers in the huge US market.
that have led them to shift production away
And while it mentions that liability concerns
about a rare possible side effect have prompted
which reformers usually deride as “me-too”
Merck to run a massive clinical trial on a new
vaccine, the article ignores the implications ofsuch a trial for the cost of drug development. Infact, the article merely confirms that the market
For a comparison of the costs of children’s vac-
will allocate research funds toward highest-profit
cines to the CDC and the private sector, see web-
uses, which, thanks to government intervention
site: <http://www.cdc.gov/nip/vfc/cdc_vac_price
and concerns about litigation, do not include the
AIMS Commentary
cines for the US market had declined from
ceasing production of the vaccine because
demand had dropped off significantly, which
GAO report warned that, of the eight recom-
was true — demand had fallen precipitously
mended routine childhood vaccines, five were
as the rumours spread. Despite the FDA’s
made by a single firm. Two other vaccines
clean bill of health, a class action lawsuit
was brought against the manufacturer.
made by as many as three firms. It was also
reported that the number of manufacturers
over a million dollars, small change as lawsuits
go, but every penny went to the 34 lawyers
and paralegals involved in the case and not
one went to the vaccine’s purported victims.
based in the United States (Aventis Pasteur’s
The lawyers hailed the settlement as a victory
US vaccine industry were trial lawyers and
The Problem with Government Intervention Attack of the “Lawyeraptors”
The US government experienced the“lawyeraptor” effect first hand in 1976, as a
The trial lawyers had a field day in the 1970s
result of an outbreak of swine flu at Fort
and 1980s, driving up drug prices, forcing
manufacturers to build liability reserves, and
putting some out of business. The California
manufacturers were unwilling to participate
Supreme Court boasted that litigation had
because they were unable to get liability
driven all but two manufacturers of diphtheria-
insurance. In response, after hearing Congress-
tetanus-pertussis vaccine from the market
and the cost of a dose of the vaccine up from
lion, Congress decided, after suitably demoniz-
2002). A 1974 report linking pertussis vac-
ing the insurance industry for its lack of
cine to epilepsy, though rejected by later
social conscience, to provide the insurance
studies, led to the filing of 800 lawsuits over
itself. Total damage awards ultimately came
the next decade and resulted in all but one
to more than US$100 million (Tucker 2004). National Childhood Vaccine Injury Act,
removed the vaccine from the market three
years later after rumours began to circulate
that it was causing serious arthritis, although
cases determined by scientific panels.
Plaintiffs were still able to opt out and go
AIMS Commentary
directly to trial, however, and trial lawyers
the consumer price index inflation rate by
(2003) report refers to as “novel legal theo-
The FDA in the Way
two elements: keeping prices down anddriving manufacturing costs up.
prices down, it drives manufacturers’ costs
Barlett and Steele (2004) that the govern-
ment does not exert any influence over drug
which is responsible for ensuring the quality
cine so low that manufacturers refused to
sell to the CDC at that price, leaving the
quently does require upgrading of produc-
become available, even if there is no evi-
its purchasing clout to negotiate discounts
dence of problems with the old methods. As
Foulkes (2004) notes, the FDA has not hes-
2003). Since the government is by far the
itated to shut down production even when it
largest purchaser of vaccines, these dis-
acknowledges the absence of problems.
product profitability. Yet the government’s
entry and research in the vaccine field.
efforts to restrict prices go beyond merely
Before it will license a new vaccine, the
negotiating its own discounts. According to
FDA insists that the manufacturer construct
the IOM report, the Department of Veterans
and pass inspection of a commercial-scale
Affairs penalizes firms for increasing prices
production facility, and that the batches ofvaccine the FDA is inspecting as part of theapproval process be produced in that facili-
It is ironic that flu vaccine has been the largest
crisis in recent years, as flu was not on the 1993list. The CDC does, however, set the reimburse-
approval, the manufacturer could find itself
ment rate for flu shots under federal programs,
stuck with an unused and unusable produc-
and is quick to cry of “gouging” when prices
tion plant. Regulatory delays also sometimes
AIMS Commentary
mean that facilities are no longer state of the
to take their reformulated vaccines through
art by the time the vaccine comes into pro-
the whole regulatory approval process.
health scare with no scientific basis at the
efforts toward safe bets — vaccines that are
rejected it since, but it had the effect of
virtually guaranteed to obtain approval.
Innovative research — say, into vaccines
vaccine for the US market from four to two.
for hitherto neglected conditions — is effec-
tively discouraged by the risk that the vac-
uation surrounding the production of small-
cine might not pass large-scale trials and
that the company might be stuck with a use-
regulations, created as a result of changes to
the vaccine production, now treat smallpox
requirements suddenly. A recent case involves
increased standards associated with such a
its decision that the preservative thimerosal
decision.4 One can see how the FDA’s deci-
been used in vaccine manufacture for more
twice before deciding whether or not to pro-
than 60 years and has never been associated
in clinical trials with side effects other than
expect vaccines to meet certain standards of
swelling at the injection site (Foulkes 2004,
39). Its presence in vaccines reduces the
approach imposes large costs on producers
risk of bacterial contamination when indi-
vidual doses are drawn from multidose vials
short run. Some recent shortages of child-
hood vaccines have occurred because man-ufacturers could not make FDA-mandated
their production facilities off stream for
associated with autism. Despite the fact that
expected. Thus, the FDA’s ill-judged regu-
hypothetical problems instead created seri-
ous, real problems of vaccine shortages.
in the United States. This proved extremely
difficult in some cases. One manufacturer of
also do not allow manufacturers to pass on
diphtheria-tetanus-acelluar pertussis (DTaP)
the increased costs of production to con-
vaccine simply ceased production; another
sumers in the form of higher prices except
had to change its packaging from multi- tosingle-dose form, reducing its output of the
See “A Wartime FDA”, Wall Street Journal
(Eastern Edition), November 15, 2001, p. A.26;
addition, producers staying in the field had
AIMS Commentary
ifying drug companies and complaining that
they devote too much effort to developing
costs of production, and it’s no wonder prof-
“me-too” drugs. Somewhat ominously, fed-
agreed, at their most recent meeting, todevelop ways to use their combined pur-
Conclusion
chasing clout to drive drug prices down. Setting aside the vanishingly small likeli-
The US flu vaccine shortage is not a case of
hood that federal and provincial ministers of
market failure. Rather, the US government
health can work together on anything, the
is sending vaccine producers a very clear
ministers should take a close look at how
message: If you produce an important vac-
precisely that sort of policy has worked out
cine, especially one of the required child-
Like it or not — and a lot of people do
diminishing profits and a high risk of law-
not — government intervention in health
suits. If you are sued, do not expect the fact
care markets does more harm than good.
that you followed FDA rules to be a defence
And like it or not, government cannot guar-
or that FDA testimony on your behalf will
antee supplies or access to essential medica-
do you any good. On the other hand, if you
tions of any kind. Ultimately, the market is
you can make as much profit as you like. Is
valuable drugs are produced and supplied to
health policy types) that the market favours
failures of vaccine supply the United States
has experienced regularly over the past sev-
eral years illustrate, not market failure, but
are getting just as prone as Americans to vil-
A forthcoming AIMS paper by Brian Fergusonhas a more detailed look at these issues. AIMS Commentary References
ABPI (Association of the British Pharmaceutical
Access and Availability. Washington, DC:
Industry) and Department of Health. 1999. The Pharmaceutical Price Regulation
Noah, Lars. 2002. “Triage in the Nation’s
Medicine Cabinet: The Puzzling Scarcity of
Bandow, Doug. 2003. “Demonizing Drugmakers:
Vaccines and Other Drugs”. South Carolina
The Political Assault on the Pharmaceutical
Law Review 52 (2): 371–403.
Industry”. Washington, DC: Cato Institute.
Pollack, Andrew. 2004. “Vaccines are good
Bartlett, Donald L., and James B. Steele. 2004.
business for drug makers”. New York Times,
“The health of nations”. New York Times,
Shea, Kathleen Brady. 2003. “Glaxo settles
Foulkes, Arthur E. 2004. “Weakened Immunity:
Lyme disease vaccine suit”. Philadelphia
Caused Recent Vaccine-Supply Problems”.
Tucker, William. 2004. “La Grippe of the Trial
Independent Review 9 (1): 31–54.
Lawyers: Guess Who’s to Blame for the Flu
Grady, Denise. 2004. “With few suppliers of flu
Vaccine Fiasco”. Weekly Standard, October 25.
shots, shortage was long in making”. New
United States. 2002. General Accounting Office. Childhood Vaccines: Ensuring an Adequate
Henderson, Diedtra. 2004. “Shortage in flu
Supply Poses Continuing Challenges. GAO-
vaccine teaches lessons”. Seattle Post-
IOM (Institute of Medicine). 2003. FinancingVaccines in the 21st Century: AssuringSelected Publications from the AIMS Library Fisheries & Aquaculture Commentary Series Who Should Own the Sea and Why It Matters, by BrianLee Crowley
Fencing the Last Frontier: The Case for Property Rightsin Canadian Aquaculture, by Robin Neill
Locking Up the Pork Barrel: Reasoned EconomicDevelopment Takes a Back Seat to Politics at ACOA, by
Canadian Aquaculture: Drowning in Regulation, byRobin Neill and Brian Rogers
Taking Ownership: Property Rights and FisheryFollowing the Money Trail: Figuring Out Just HowManagement on the Atlantic Coast, edited by Brian Lee
Large Subsidies to Business Are in Atlantic Canada, by
Allocating the Catch Among Fishermen: A PerspectiveFirst, Do No Harm: What Role for ACOA in Atlanticon Opportunities for Fisheries Reform, by Peter H. Pearse
Behind the Cod Curtain: A Perspective on the PoliticalEconomy of the Atlantic Groundfish Fishery, by Leslie
Research Reports Financing City Services: A Prescription for the Future,
Making the Oceans Safe for Fish: How Property RightsCan Reverse the Destruction of the Atlantic Fishery, byElizabeth Brubaker
“Smart Growth”: Threatening the Quality of Life,by Wendell Cox
Do Cities Create Wealth? A Critique of New UrbanThinking and the Role of Public Policy for Cities,
How to Farm the Seas II: The Science, Economics &
Politics of Aquaculture on the West Coast, February
Doing Business with the Devil: Land, Sovereignty, and
15–17, 2001, Vancouver, British Columbia
Corporate Partnerships in Membertou Inc., by Jacquelyn
How to Farm the Seas I: The Science, Economics &
Politics of Aquaculture, September 28–30, 2000,Montague, Prince Edward Island
Framing the Fish Farmers: The Impact of Activists onMedia and Public Opinion about the Aquaculture
Rising Tide? Rights-Based Fishing on the Atlantic Coast,
November 7–8, 1996, St. John’s, Newfoundland &Labrador
You Can Get There from Here: How Ottawa Can PutAtlantic Canada on the Road to Prosperity, by Brian LeeCrowley and Don McIver
Grading Our Future: Atlantic Canada’s High Schools’Retreat from Growth: Atlantic Canada and the Negative-Accountability and Performance in Context, by Rick
Road to Growth: How Lagging Economies BecomeDefinitely Not the Romanow Report, by Brian Lee
Crowley, Brian Ferguson, David Zitner, and Brett J. Skinner
Looking the Gift Horse in the Mouth: The Impact ofFederal Transfers on Atlantic Canada, by Fred
Rags to Riches: How “The Regions” Can and Should BeLeading Canada’s Productivity Push, by Brian Lee Crowley
These publications are available at AIMS, 2000 Barrington St., Suite 1006, Halifax NS B3J 3K1
Telephone: (902) 429-1143 Facsimile: (902) 425-1393 E-mail: aims@aims.ca
They can also be found on our Web site at: www.aims.ca
2000 Barrington St., Suite 1006 Halifax NS B3J 3K1 Telephone: (902) 429-1143 Facsimile: (902) 425-1393 E-mail: aims@aims.ca Web site at: www.aims.ca
AUTORIZACIONES (AUT) Y DECLARACIONES DE USO La LEY ORGÁNICA 7/2006, DE 21 DE NOVIEMBRE, DE PROTECCIÓN DE LA SALUD Y DE LUCHA CONTRA EL DOPAJE EN EL DEPORTE , establece unas sanciones que van de los 3 meses a los 6 años de privación de licencia o inhabilitación, dependiendo su posible no imposición de la correcta tramitación y solicitud, por parte de los deportistas de las llamadas
Socialstyrelsen klassificerar sin utgivning i olika dokumenttyper. Detta är uppföljning och utvärdering . Med detta avses uppföljningar och ut- värderingar av reformer, lagstiftning och/eller verksamheter som kom- muner, landsting och enskilda huvudmän bedriver inom hälso- och sjukvård, socialtjänst, hälsoskydd och smittskydd. Innehåller analys av insamlade data och i förekom