ARUN KUMAR | 20 OCTOBER, 2020
Pharma Companies, our Modern Day Magic Potioneers
The annual turnover of the pharmaceuticals industry tops 1.3 trillion dollars
An important adjunct of healthcare is medicine in some form. The pharmaceutical industry (mainly the segment marketing allopathic drugs) has gained ascendancy in just over 150 years.
The available literature tells us that since ancient times, vaidyas, hakims and physicians were researching, discovering herbs and preparing concoctions to treat ailments. While most of these systems are still in vogue, allopathic medicines have contributed handsomely through a variety of life-saving drugs, diagnostic tools, treatment through surgical and other interventions, life saving devices, vaccines against deadly diseases like smallpox and polio that have saved millions.
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 antihistamine and analgesic drugs have tended to create a pill popping generation.
While rendering yeoman service to humans and other animals, pharmaceutical businesses reap tremendous profits.
In the case of branded drugs, taking shelter under Trade Related Intellectual Property Rights (TRIPS) which permit the discoverer of a drug a patent for 20 years, prices for which are fixed at as high a level as customers can bear. Others are barred from producing the drug, except under licence from the patent holder.
The substantial difference between the prices of branded and generic drugs, which have identical active ingredients, corroborates the charge. Big 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, and need to recover these expenses while the patent lasts.
The argument is specious, as sales don’t stop when the patent expires. And efforts are always on for evergreening the patent, i.e. making insubstantial modifications to the molecule to prolong its uniqueness and patentability.
The global turnover of the pharmaceuticals industry tops 1.3 trillion dollars.
India introduced a system of fixing the 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 that purported to ensure an adequate profit margin for the manufacturer as well as pharmacies.
Nevertheless it was not so satisfactory, as the list of notified drugs left out many important medicines where the profit margins amounted to cheating or usury.
Pharmaceutical businesses are allergic to a price control regime. Over time the process has been simplified, fixing the price and ensuring fair returns for the companies and a margin for pharmacists. It also provides for self-regulation, but companies keep trying to bypass the covenant and fix high prices.
The Pharmaceutical Research and Manufacturers of America (PhRMA) describe their motto as: Treat today, cure tomorrow, and prevent the day after tomorrow. The statement can be interpreted in more than one way.
In one way it admits that treatment is not synonymous with cure. Possibly the first line is symptomatic relief, but even that raises a number of questions. One such is about the safety of drugs approved for sale. The side effects of drugs become apparent after many years and dozens of drugs are banned or withdrawn later.
Yet pharma companies try to market new products at the earliest despite known side effects, usually noted in the 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.
Another question is of the selection of ‘markets’ rather than prioritising those who need treatment. For instance, pharma companies want to promote geriatric medicine acknowledging their motive: to make the most of the opportunity of elderly people’s enhanced need for medication with their life expectancy prolonged, thanks in some measure to modern medicine.
Hardly any thought is spared to research and produce drugs for endemic disease, most of them afflicting the poor, ostensibly because most are too poor to afford them. Sales of these must depend on government largesse, which does not seem to be happening anytime soon.
India, while comparatively quick to introduce a new drug, doesn’t follow suit with the same alacrity in respect of drugs that have been banned or withdrawn elsewhere. These continue to be sold in the market with impunity for a long time.
‘Influencing’ doctors by holding conferences in exotic resorts, with all expenses paid and expensive gifts, is not unknown.
Certain lifestyle diseases like diabetes, cholesterol and cardiovascular conditions have been used as a platform for widening the client base. The safe limits of blood sugar, blood pressure, LDL etc. have been 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 the latest “wonder drug” as one last shot in the dark, while making absurdly high profits on a margin jacked up by arrangement.
Pharma companies are no less responsible for trying to push notoriously expensive and untried new drugs, as are the unscrupulous hospitals, taking advantage of the fact that the likely recipient is terminally ill and their kin willing to take the risk.
If and when the inevitable happens, the medical fraternity knows it will seldom be called to account. Here is a case where the dying goose is laying golden eggs!
Does the current furious rat-race to market covid-19 vaccines by companies around the world, even before they have been fully evaluated, spring from a desire to serve the humanity? Wishful thinking indeed, looking at projections of likely sales and ‘healthy’ bottom lines.
For many chronic and terminal ailments, modern drugs reach the end of the road after symptomatic relief and some improvement. The statement of PhRMA to ‘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 with chronic diseases, therapies under systems such as Ayurveda have proved to be more effective in alleviating suffering and improving patients’ 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 humankind in true spirit of the tenets of the noble profession of healthcare.
Arun Kumar is former Secretary, Government of India
Also read: Hospitals and Hospitality
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