The Hindu Business Line : Ads and drugs

IN THE PAST, medicines were either prescription drugs or those bought over the counter (OTC), mostly for minor everyday aches and pains. The former were called `ethical'; it was unethical for the manufacturer to advertise them to the consumer and for the chemist to sell them without a doctor's prescription. Only the physician knew what was best for whom, under what conditions. OTC marketers could advertise their brands, like any other household product. Distribution was similarly demarcated. Chemists required a licence to sell prescription drugs; the supermarket or grocer could sell the others anyhow. Three developments, originating in the United States and spreading elsewhere, have changed this picture. First, the variety and number of molecules are growing faster than the regulators' capacity to cope, distinctions between the two types are blurred, and so regulation has been patchy. Next comes patients' right to know. They can no longer be kept in the dark `for their own good'. Empowerment is in vogue everywhere, and patients and care-givers are no exception. Last, advertising is no longer the sole medium; the Internet and TV are accessible to a significant section of the relevant audience.

While the medical profession struggles with this exploding knowledge, surely non-specialists cannot be better placed to make informed judgements about side-effects, cross-effects between drugs, and precautions for use. Advertising directly to the consumer could well encourage self-medication, with serious consequences. Half knowledge in this case is more dangerous than ignorance. Yet in the US, home to a powerful pharmaceutical industry lobby, a campaign is on for a more relaxed view towards advertising. The fierce debate uses political arguments — free speech and democratic rights — but the economic motivations are obvious. The narrowing time-spans available to manufacturers for recovering the research and development costs of new molecules, which can soon be overtaken by less expensive look-alikes and even generics, is a major factor.

In India, however, drug legislation is outdated, cumbersome and not effectively administered. Spurious and substandard drugs, and chemists who do not respect rules, are not uncommon. Greater freedom for consumer advertising under these conditions is far more problematic. The general awareness level of Western science and the capability to examine critically all aspects of a drug are relatively low. More consumers would be tempted to self-medicate, save on visiting the doctor, and even skimp on dosage — a notorious habit. This could be a serious hazard, if not fatal, in the case of patients using critical drugs. A further complication is the emergence of a whole new range of alternative therapies and hybrids, which are difficult to classify, seldom subjected to the rigour of scientific testing and have little independent research in support of their claims. For all these reasons, Indian pharmaceutical regulators would be well advised not to rush into opening up consumer advertising. Interestingly, even the head of the Pharmaceutical Research and Manufacturers of America recently recommended a voluntary code of ethics, describing this as a serious business because "we're not making ice-cream."

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