Heal the pharma sector first

 There is a familiar dilemma dogging drug manufacturing companies. If the medicines produced by them cure patients and root out the disease altogether, their profitability takes a hit and might results in units being closed down. The moral therefore is that creating a perfectly effective drug may cure the disease but will reduce the demand for it. That business practices in the pharma sector are riddled with secrecy, bribery, dishonesty, and corruption are too well known to shock anyone.

The news story covered by this daily in its September 2 issue (“Unapproved drugs, gifts galore: Medical ecosystem plagued with problems”) informing that 37 antibiotic formulations which account for 16% of FDC (fixed dose combinations) are in the market despite the ban by the Central Drug Standards Control Organisation (CDSCO), the nation’s drug regulatory body, should come as no surprise. The story informs that 58% of the FDCs of antibiotics that are being sold throughout the country are on the WHO’s ‘not recommended list’. Medical ethics, as we know, urge the practitioners of medicine that their primary interest should be the health of the patient. Yes, financial gains, prestige, preferences in options of treatment are not illegitimate, but should be of secondary interest. For instance, a kidney patient could be treated with medicine but financial motivation may prompt the practitioner to recruit him for dialysis. Professionalism, according to the charter of medical ethics, demands placing the interests of the patients above those of physicians. But much of these sanctimonious declarations do not extend beyond medical college classrooms.

 The marketing culture of pharmaceutical companies has cast a corrupting influence right from prescribing patterns, to complicity of scientists, doctors and even regulators in supporting the profession and making it driven by profitability of manufacturers of medicines rather than health of the patients. By now it is a well-documented fact that these companies devote about twice as much funds for marketing as they do to research and develop new drugs. In a capitalist environment, the prime motto is more about sustaining the business they are engaged in. It is also widely acknowledged that negative or unfavourable clinical trials results are much less likely to be published than positive findings.

The regulatory scene in the country is also to be blamed for the situation in which drug companies foist substandard, unnecessary drugs on the market and lure physicians into prescribing them for the patients through lucrative schemes of cuts and commissions and foreign jaunts camouflaged as international medical seminars. Chemists too get drawn into the vortex of corruption for the promise of higher commission from overpriced drugs. Reports submitted to Parliament’s Health Committee a few years ago have even documented instances of companies having been caught red-handed writing scientific recommendations of their own products, getting them endorsed by specialists from the medical fraternity and submitting them to the Drug Controller General of India for speedier marketing approval.

Given the current scenario, it is imperative that awareness is created about WHO’s guidelines for rational use of medicine which requires that “patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time and at the lowest cost to them and their community.”