-By Dr Naresh Purohit ( Executive Member- Federation of Hospital Administrator )
New Delhi : From demonetisation to Liberalised Remittance Scheme (LRS),
laptop curbs to generic medicine mandate, there is an emerging pattern in the government of the day. Decisions are railroaded without thinking through or adequate deliberations on the likely fallout. They are later discarded. The inexplicable haste to rule by executive orders hurts governance, creates unnecessary anxieties among sectors.
The medical mafia organized crime syndicate, a sector that includes the pharmaceutical industry, physicians, dentists, hospitals, home healthcare and nursing homes are the largest and fastest growing sector of the Indian economy.
This growth is entirely dependent upon and is directly proportionate to the collective growth of disease, pain and suffering of society.
Currently there is a battle between the government and the medical establishment over prescribing generic drugs. Generic drugs are known by their chemical composition unlike branded drugs known by the names assigned by manufacturers. Technically there is absolutely no difference between them.
A generic drug is a medication that has exactly the same active ingredient as the brand-name drug and yields the same therapeutic effect. It is the same in dosing, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Generic drugs do not need to contain the same inactive ingredients as the brand name product.
Although generic drug active ingredients are chemically identical to their branded counterparts, they are typically sold at a cheaper price than the brand-name drug. Generics are less expensive because the drug manufacturer does not have to duplicate the original clinical trials for effectiveness and safety, which lowers the cost to bring the drug to market.
The Government has set up a large chain to sell generic drugs. It empanels manufacturers who supply the drugs to the stores known as Jana Ausadhi stores. The drugs are 8 to 10 times cheaper, sometimes more. This is a direct challenge to the pharma business set up.
The branded drugs in private stores are costlier, not because they are better in quality but because the manufacturers have to pay a slew of commissions to the dealers, the retailers, hospital chains, and the doctors. The big companies also have high overheads and have to generate high profits. All of this is passed on to the consumer.
The generic drugs sold through the Jana Ausadhi stores do not have that baggage. Only the manufacturers need to profit. As the set up is controlled by the Government, the manufacturer and pharma shops cannot violate the standards set and operate according to fixed margins. The shops are also subsidised by the Government. Consequently the prices are much lower.
The base chemicals the manufacturers procure are extremely cheap. If medicines are procured at cost, they will be cheaper by another 5 to 6 times. Therefore there is scope for profit even at low prices. The suppliers to the generic stores earn handsomely. The branded market creates a false aura of quality to loot the public.
Even branded drugs have dubious quality. We cannot be sure if generic drugs are of equal quality as branded drugs until our drug control machinery is working efficiently.
Chemicals are chemicals whether they are sold as branded or as generic. The generic system has two tires of quality testing. The drugs are tested after manufacture and also after supply when they reach the government stores. The inspectors can also conduct random testing at the retailer level. The systems in place are more than adequate and the persons violating them can run into trouble. Quality testing in the branded drugs sector is mostly about the inspectors signing on the dotted line. The incentives are alluring and nobody has the guts to challenge the big players.
Currently there is the menace of spurious drugs. Such things are difficult in the generic market that is controlled by the government and currently has a fool proof system of checks and balances.
The current system comprising of medical mafia that is used to the huge targets, commissions, incentives showered by the big manufacturers is alarmed by the move towards generic drugs. There is thus a concerted campaign to throw aspersions at the sector alleging that the drugs are cheap because they are of low quality. This is a false allegation.
The doctors should have no difficulty prescribing generic drugs as they are not taught brand names in their college education. They are taught about generic names. There is the allegation that in the generic drug set up, it is the pharmacist alone that profits as, in the private stores, the pharmacists will provide the brand that gives him the highest profit. The hospital chains will suffer as they earn whopping profits through various means from the manufacturers.
The move towards generic drugs and ethical practices will drastically slash the unethical commissions and profits. This will deter opportunists from entering the system. Therefore the private medical set up will be squeezed and the demand for government medical colleges and hospitals will increase.
The fight against generic drugs reflects the sorry state the medical profession is in. Everything is about income and profits. Nobody is thinking about the patient. Nobody. The manufacturer controlled system keeps everyone happy. The patient is the one who is robbed of his health and wealth. It is the most sadistic set up in world history and all efforts must be made to dismantle it.
The generic stores are all set to also sell a wide range of supplements, devices, ayurvedic and homeopathic drugs. This will be a boon for the consumer.
The government can do better. It can arrange to have a doctors chamber in these clinics to serve the rural/ semi urban population. Doctors of various modalities can treat patients and the patients can procure the medicines at much lower rates. The insurance companies can also gain by allowing only generic drug prices. The government funds invested in health can be well utilized and stretched to do more. Insiders reveal that the government is frustrated as it knows that its budget is being eaten away by greedy stakeholders.
In an ethical set up the number of medicines prescribed will plummet, as prescription surveys point out that only about 1 in 4 medicines are necessary. The issue of irrational drugs being rampantly manufactured and prescribed will also be solved. Ethical doctors are also known to advise their patients about nutrition and exercise. Currently many mainstream doctors are running naturopathy clinics and camps resulting in healthy people. The number of well greased lobbyists will also go down as they will not find the going profitable.
Nobody in a right frame of mind should oppose this system. It is a game changer and offers the exploited public a way out of the quagmire.
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