In many countries including India, it is commonplace to hear people moaning about the steadily increasing prices of most medicines. Newspapers and television reporters have a field day criticizing the government of the day for the same thing. The latest of these "bleeding hearts" kind of article has appeared in the Times of India this week and I don't mind admitting that it provoked me into writing this piece. For I am going to present a counter-view - I propose to show that it is good for medicines to be expensive!
Why do I say this? There are two reasons: first, the quality of medicines invariably go down when you try and fix the prices by administrative diktat. Secondly, both doctors and patients tend to use medicines far oftener than they should - simply because the patients " can afford it."
When the prices of medicines are controlled, commercial firms both big and small will try to control their own costs. So they get the product manufactured "under license" by a much smaller company, buy the entire produce and sell under their own brand name. This is known as "loan licensing" and is legally permitted. So there is nothing underhand about it per se. All the big companies use this mechanism, because the small scale companies get a lot of concessions from the Central and State Governments, and are thus able to manufacture the same product at a much lower cost.
So far so good. In theory, the big multinational is supposed to put stringent quality checks in place in order to protect its own brand image if nothing else. In fact, the records of the Maharashtra State Food and Drug Administration (FDA) show that the largest companies are pulled up regularly for marketing "substandard" medicines.
Some five years ago, the FDA used to issue press releases announcing these findings. I had collected the press releases over 12 months and analyzed them - Pfizer, Glaxo, Lyka, Lupin - all the big names of the Indian drug industry were there. The Indian Express had published an entire series on this subject. If anything has changed in the intervening years, will someone please educate me?
Now the other aspect of misuse by doctors. Even if the quality of medicines could be maintained by some miracle, the fact remains that doctors prescribe far more medicines than they should. Just last month, a young 12 year old girl living near my house developed a fever, the cause of which was not immediately apparent. She also had a severe headache (no surprise at all), and being a mummy's darling, she created a terrific ruckus over it. A doctor (possibly not an allopathic physician) at the well known Bhaktivedanta Hospital in Mumbai was consulted and he recommended 800 mg of ibuprofen to be given at a single shot! For a young underweight girl, who wasn't eating very well (because of her fever), would any responsible doctor prescribe such a heavy dose of medicine? And if the medicine would have cost Rs 200 instead of Rs 20, would the girl's mother not have given it a second thought?
This is just one instance. I have a whole collection, and so I imagine does everyone who has lived in India's metros. World famous child specialist Dr Raj Kumar Anand, who helped the Indian government to draft the Infant Milk Substitutes Act, 1993, has often found strong antibiotics prescribed to babies suffering from ordinary diarrhea. The WHO recommends that the only treatment such kids require is plenty of liquids!
Similarly, the Medico Friends Circle, which has branches in several Indian cities, has carried out prescription audit studies in the past and found that a majority of prescriptions given out by family physicians contain too many medicines in too much quantity. Here, too, the main culprit is the Drug Price Control Order (DPCO) and the whole ideology of "affordable drugs."
Now if the medicines were to be available at their commercially viable prices, and if they were out of reach of many people, they would still be used - only when they were really required. Obviously this sea change would not take place in a day, or even a year, for the prescribing habits of half a century would have to be jettisoned. Several other things would also have to change, like the expensive paid holidays that doctors have come to expect from most pharmaceutical companies.
Instead, what the governments should do is persuade the companies to invest some of their earnings in developmental projects in specific areas. Some companies are already doing this - many more need to follow suit. And doctors have to understand that their main job is not to treat the sick but to maintain their clients in good health!