CDT test

As the CDT test works

Transferrin – one of proteins of blood which is synthesized by cells of a liver. He is responsible for transfer of ions of iron and neutralization of its toxic properties. The molecule of a transferrin looks as a polypeptide chain on which "naveshana" several shoots of so-called sialovy groups. These shoots in the transferrena can be from zero to six, and in blood serum, most likely, there will be all options, but in different proportions. Most of all those transferrin at which sialovy groups at least three, such options of protein are called vysokosialirovanny. Transferrina which from zero to two shoots – karbogidrat scarce, or CDT, at the healthy person have their less than a percent from the total amount of transferrin.

According to researches if the share of CDT in the analysis is higher than 1.3 percent, it can indicate abuse of alcohol (more than 40 grams of alcohol a day, for example, beer slightly less than a liter are about the use of an equivalent). However, the increased maintenance of CDT in blood can be connected also with other factors – genetic features, liver diseases, pregnancy. The threshold value of maintenance of CDT – too a discussion subject, its determination should consider both a measurement error, and features of population.

CDT as a marker of alcohol intake was described still in the late sixties, but as the clinical analysis began to use it in the 21st century.

2019: Drivers in Russia will oblige to take "the test for chronic alcoholism"

On November 28, 2019 it became known that since July 20, 2020 in Russia changes in rules of medical examination for all who get the driver's license for the first time, change them in connection with expiry date will become effective or return after deprivation. These rules, among other, provide obligatory blood sampling for the subsequent "test for chronic alcoholism", or the CDT test.

Such test doing obtaining the reference from the narcologist several times is more expensive, had to become an obligatory part of driver's medical examination still on November 22, 2019, but the Ministry of Health transferred entry into force of rules after before narcological clinics huge queues from persons interested to receive the reference for medical board at the old price were built. Radio Freedom found out that behind introduction of the obligatory CDT test for drivers there can be a network from more than 10 formally independent, but in reality of the companies connected with each other. They implement this technology using lobbist efforts of the chief narcologist of Russia Evgeny Bryun and earned from it, in turn receiving government contracts, millions of rubles. Since July, 2020 revenues of this network of the companies can grow in tens of times, and the volume of government contracts on supply of equipment and supplies for the CDT test will be, by rough estimates of Radio Freedom, up to five billion rubles for the next five years.

The analysis of CDT – a karbogidrat-scarce transferrin which increased content in blood can indicate abuse of alcohol – appeared in Russia at the end of the 2000th. It was used in Russia by the scientific groups studying a situation with alcohol intake, then Evgeny Bryun, the president of "MNPTs of narcology of DZM", the chief non-staff specialist narcologist of the Russian Ministry of Health became interested in it. At that time the Russian firm "Galen" representing among other, the interests of the French producer Sebia was the only supplier offering devices for the analysis of CDT. Most likely, the chief narcologist of the Russian Federation could test the office of this firm on blood tests of patients of the Center.

In any case, in 2011 Bryun issued methodical recommendations "A technique of diagnostic testing regarding chronic abuse of alcohol". This document approved by the first deputy head of the Moscow department of health care describes and recommends a technique of a research of markers of CDT for use. In it possible scopes of such analysis are specified: it and control at treatment of alcoholism, and medical examination of pilots, seamen, oil industry workers, migrants, tutors of kindergartens, doctors and for some reason producers of vitamins. There is in the long list and such point: "Medical examination of the persons getting the car driver license or the weapons permit". It was recommended to carry out such survey when receiving the rights and before each replacement of the car driver license. Separate point of recommendations – to use the analysis of CDT at return of the rights to the drivers who are earlier deprived of the certificate for driving in state of intoxication.

One more point of this text is remarkable: he persistently recommends to use for a blood serum research offices of Sebia company – either Minicap, or more powerful Capillarys. Authors recognize what can be used and "analog", but only if it corresponds to a set of the criteria specified in recommendations and Sebia products to these criteria, of course, ideally satisfies. At the same time in the world market there are about one and a half tens producers of devices of a capillary electrophoresis from Europe, the USA and China.

Since 2011 Evgeny Bryun began to use actively Minicap at treatment of the patients in the Center of narcology, tell two sources of Radio Freedom. Experience was recognized successful. If in 2011 the analysis of CDT became a subject not of really obligatory recommendations at the level of the Moscow health care, then in 2015 it was included already in the federal order of the Ministry of Health signed by Veronika Skvortsova "About the statement of the Order of delivery of health care on the psychiatry narcology profile and the Order of dispensary observation of persons with the mental disorders and (or) disorders of behavior connected with the use of psychoactive substances".

The order orders to clinics on the psychiatry narcology profile at least every three months to carry out "high-quality and quantitative determination of a karbogidrat-scarce transferrin (CDT) in blood serum" at patients. In the annex to the order there is "A standard of equipment of narcological hospital (a narcological clinic)", at number 6 among devices "The device for a capillary electrophoresis" – "not less than 1 piece" is specified.

Already throughout the following, 2016, tens of Russian narcological clinics of regional and edge level got such devices – all of them were one producer, Sebia, and one of two models – Minicap or more "advanced", Capillarys. Explaining these purchases, local officials directly sent to the order of the ministry and Evgeny Bryun's experience.

For the next years the Russian state clinics spent for devices of a capillary electrophoresis and supplies of one hundred millions rubles to them. Almost at all of them not only brands of devices match, but also suppliers are 13 Moscow companies connected among themselves which some founders, in turn, are connected with Evgeny Bryun through "The Russian narcological association". There is no Galen company which once brought the first Minicap to Russia among them.

Radio of Svoboda analyzed practically all state procurements of the systems Minicap, Capillarys and supplies to them. According to the edition, to the address Academician Korolyov Street, 13, building 1, according to data of " circuit.focus ", Narcotic league, Association of narcologists, Media trade LLC and also five companies which are regularly winning tenders for delivery of the Minicap systems and supplies to them are registered: Amtela LLC, Ligafarm LLC, Impulsmed LLC, Narkolab LLC and Madzhesti LLC. At most of these firms in registration data also same phone numbers are specified, and head them and the same people are founders: the former deputy from a batch United Russia in the rural settlement Gas-pro-Votic the Moscow region Pavel Aleksandrovich Loshakov, Sergey Aleksandrovich Vasilyev and Denis Vladimirovich Shachenkov.

In total on the deliveries connected with the Minicap system, the Russian State spent nearly 600 million rubles since 2014. Total amount of net profit of the companies mentioned in this investigation and, presumably, connected among themselves performing these deliveries only for 2018 was nearly 250 million rubles. Count as far as this profit with entry into force of the order of the Ministry of Health on obligatory CDT tests for drivers will increase, it is possible very much approximately. For example, in 2016 only about 1000 people voluntarily underwent CDT testing in the Amur region. It is unknown how many driver's licenses are issued annually in this region. If to take as a basis a ratio of inhabitants and the issued driver's licenses in Moscow and in Russia in general, the speech can go approximately about 10 thousand people. Of course, this ratio will be a miscellaneous in different regions, however it is obvious that turnovers and the profit of suppliers of Minicap will grow not less than much, and for the next five years after introduction of obligatory CDT tests expenses on them can make more than 5 billion rubles – it is necessary to compensate them to the citizens wishing to get the driver's license claim in Radio Freedom.^[1]

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