An important adjunct of healthcare is medicine in some form. Pharmaceutical industry (Reference here is mainly to segment marketing allopathic drugs) has gained ascendancy in just over 150 years. Available literature tells us that since ancient times, vaidyas, hakims and physicians were researching, discovering herbs and preparing concoctions to treat ailments. Most of these systems are still in vogue, but allopathic medicines have contributed handsomely through a variety of life saving drugs, diagnostic tools, treatment through surgical and other interventions and use of life saving devices. Vaccination against deadly diseases like small pox, polio, whooping cough etc. has saved million from these scourges. Dentistry has its own niche.
On the flip side, broad spectrum antibiotics get prescribed indiscriminately, often causing undesirable side effects. No wonder they are among the highest selling group of drugs. Similarly anti histaminic and analgesic drugs have tended create a pill popping generation.
While rendering yeoman service to humanity and animals as well, Pharma sales yield tremendous profits. In case of branded drugs, taking shelter under Trade Related Intellectual Property rights (TRIP), which permit discoverer of the drug a patent for 20 years, prices for which are fixed at as high a level as market can bear. Others are barred from producing the drug except under licence from patent holder. Substantial difference between the prices of branded and generic drugs, having identical active ingredients, corroborates the charge. Pharma companies argue that they spend millions of dollars in discovery, development and multi-stage trials of a new molecule before the drug administration approves its marketing. They need to recover these expenses while the patent lasts. The argument is specious; as the sales don’t stop with expiry of patent; plus efforts are always on for evergreening the patent.
Global turnover of pharmaceuticals industry tops 1.3 trillion dollars. India introduced a system of fixing prices of notified drugs in any dosage form to make them more affordable. Initially, all drugs were placed under price control in 1979. Changes were made over the years and the number today stands at around 384 including medical devices such as stents. A formula was devised purported to ensure adequate profit margin for the manufacturer as well as the pharmacies. It was nevertheless not so satisfactory, as the list of notified drugs left out many important medicines where margins were usurious.
Pharma companies are allergic to price control regime. Over time process has been simplified fixing price ensuring fair returns for the companies and margin for pharmacists. It also provides for self regulation introduced, but companies keep trying to bypass the covenant and fix high prices.
American Pharmaceutical Manufacturer’s Association (PhRMA) had described their motto as: Treat today, cure tomorrow and prevent day after tomorrow. This statement can be interpreted in more than one way. In one way it is an admission that treatment is not synonymous with cure. Possibly the first line is symptomatic relief, but it does raise a number of questions. One such may be on safety of drugs approved for sale. The side effects of the drugs become apparent after many years and dozens of drugs are banned or withdrawn later. Pharma companies try to market new products at the earliest despite known side effect, usually noted in fine print. In all fairness, they must unequivocally explain the likely collaterals to the physicians concerned who in turn are duty bound to caution and guide the patient.
Pharma companies want to promote geriatric medicine acknowledging their motive of utilising the opportunity of enhanced need for medication of elderly with prolonged life expectancy, thanks in good measure to modern medicine.
Hardly any thought is spared for research and production of drugs for endemic disease, most of them afflicting the poor, ostensibly because most are too poor to afford them. Sales must depend on government’s largesse, which does not seem to be happening anytime soon.
India, while comparatively quick to introduce a new drug, doesn’t act with same alacrity in following suit in respect of drugs banned or withdrawn elsewhere, which continue to be sold in the market with impunity for a long time. Influencing doctors through technique of holding conferences in resorts at exotic locations, all expenses paid and expensive gifts are not unknown.
Certain life style diseases like diabetes, cholesterol and cardio vascular conditions have been used as a platform for widening client base. Safe limits of blood sugar, BP, LDL etc were reworked to induce larger numbers to start medication.
It saddens one when extreme rapacity plays out in all nakedness, when a visibly dying patient is administered latest “wonder drug” as one last shot in the dark, while making absurdly high profit on jacked up margin. Pharma companies are no less responsible for trying to push notoriously expensive and untried new drug, as are the unscrupulous hospitals, taking advantage of the fact that likely recipients is terminally ill and their kin willing to take the risk. If and when the inevitable happens, the medical fraternity knows that it will seldom be called to account. Here is a case where the dying goose is laying golden eggs!
Is the current furious rat-race to market COVID-19 vaccines by companies around the world, even before they have been fully evaluated due to a desire to serve the humanity? A dreaming indeed, looking at projections of likely sales and “healthy” bottom lines
In chronic and terminal ailments, modern drugs reach end of the road after symptomatic relief and some improvement. Statement of PhRMA of ‘treat today’ rings true, as there are limitations, total cure is elusive, and the patient has to come to terms with the ailment. In such cases and chronic diseases, therapies under alternative systems such as Ayurveda, have proved to be more effective in alleviating suffering and improving the comfort level. Would it not be more humane to provide palliative care, in collaboration with other systems? There is much merit in systems coming together to jointly serve mankind in true spirit of tenets of the noble profession of healthcare.