European lab groups may not be physically setting up outside Europe, but the international esoteric test market is soaring.

One source reckons the Middle East alone sends at least $200m of tests to Europe every year. Sonic is probably the largest player here, with Cerba leading in Africa.

The African market is surprising fragmented. Pathway and Lancet from South Africa are active, but so too are Indian pharma companies such as Ranbaxy and Dr Shetty. In fact, Cerba sources reckon that Ranbaxy is number two in Africa. And of course Unilabs and Sonic are also active.

In comparison to Europe plodding along at 2-3% these markets are growing at 10%-20%. And as there are no tariffs they will be extremely profitable.