The Hindu Business Line : Hard-sell...

Healthcare activists charge that pharma companies are more interested in bringing lifestyle products into the market, thereby ignoring `poorer' diseases.

Infectious diseases, public-health related vaccines, and low-cost diagnostics for infectious diseases are just some of the areas that drug companies need to research.

SALES PITCH: Are people in a reasonably good state of health being enticed into popping pills? -- Picture by A. Roy Chowdhury

From a large yellow hoarding on South Mumbai's skyline, a model breathes down on passers-by. "Sorry if you would no longer experience those hair-raising moments," reads the ad for a laser clinic that promises women a smooth, hairless look. It also tells prospective customers of other new-age therapies like Botox, the injection globally sought after for banishing wrinkles.

Scepticism notwithstanding, a spokesman for the Botox-maker Allergan insists there is a local clientele keen on erasing crow's feet, or wrinkled skin near the eye, never mind the cost.

Not too long ago, the famous diamond-shaped blue pill for male impotence — Viagra — officially came to India. And drowning out the voice of sceptics, Pfizer's high-decibel launch of Viagra in India underlined the demand for the pill — about 90 million people suffer from erectile dysfunction, claimed company officials. And with one blue pill sold globally every six seconds, the hard-sell on the need for the pill was complete.

As drug makers bring medicines and expensive therapies to India claiming there is a market for these, not everyone seems to be buying into their sales-pitch. In fact, say some representatives in the healthcare industry, drug companies are chasing superficial diseases rather than treating the critical ones. From an era where most Indians got along pretty well without too much medication, India, too, is now going the way of the developed world — popping pills for all kinds of conceived disorders, they observe with concern. They charge that drug companies are investing their energy in bringing lifestyle products into the market, ignoring critical illnesses and neglecting `poorer' diseases.

Only 10 per cent of the world's investment in health is focused on diseases that affect 90 per cent of people; this bit of statistic is oft touted by healthcare activists. The last dedicated drug for Tuberculosis (TB), for instance, was about 31 years ago, points out Dr Amit Sen Gupta of the People's Health Movement (PHM). Infectious diseases, public-health related vaccines, and low-cost diagnostics for infectious diseases are just some of the areas that drug companies need to research, he says.

P.K. Lakshmi, Director - Drug Information Centre, Karnataka State Pharmacy Council (KPC), feels that drug-makers should work more in critical areas where they can make a difference. Instead, they focus on hard-selling therapeutic areas such as depression and anxiety, erectile dysfuntion and skin-related disorders like acne.

Such perceptions may not be entirely misplaced, admit top officials of drug majors operating in India. But, like all other companies, pharmaceutical firms too run on commercial lines, they point out.

If the Government wants to engage drug-makers in mass access programmes, it should give them incentives, rather than place obstacles in the way, one of them says.

Drug-makers' defence

"It is not true that critical illnesses are being neglected by the industry. In fact, many companies have programmes specifically aimed at such diseases," says Ranjit Shahani, Vice-Chairman and Managing Director of Novartis, speaking in his capacity as President of the Organisation of Pharmaceutical Producers of India (OPPI).

Novartis, for example, under its Comprehensive Leprosy Care Project, has adopted many districts in Gujarat to eliminate leprosy. It has also started an Institute for Tropical Diseases in Singapore with an investment of $122 million. The institute works to find a new cure for TB, dengue fever, malaria etc, he says.

Astra Zeneca's spanking research centre in Bangalore is working on new-generation drugs for TB. Other companies such as Lupin, Johnson & Johnson, Pfizer, Organon, GSK, and Ranbaxy are working towards providing medicines and newer products for treating diseases prevalent in this part of the world, says Shahani.

Dr Shoibal Mukherjee, Pfizer's Senior Medical Director in India, says that drug companies are researching "real diseases." But the piquant situation in India, he says, is that incentives lie in going after lifestyle illnesses. For example, medicine is reimbursed in Europe only if it is for a critical need and not lifestyle related. In the US too, insurance companies do not reimburse a superficial sort of illness. But in India, a drug for a serious ailment is brought under price-control.

The Government even plans licensing out rights on the innovative drug to other local companies to bring down the price, he says. But if the innovative company made a fairness cream, it would sell like hot-cakes and with no controls; this pushes drug companies to look at more cosmetic and lifestyle-oriented drugs.

Curing the ailment

Drug companies should be given incentives for researching medicines for real diseases. The mismatch between the need for medicines and their availability can be bridged by protecting intellectual property and with more incentives, says Pfizer's Dr Mukherjee.

Defending the company's launch of Viagra, he says that the blue pill was initially being researched for a cardio-vascular application when its benefit in impotency was discovered. Besides, erectile dysfunction is a real problem, he adds. The private sector walks the extra social mile despite being a commercial entity, he insists.

Instead of flogging just the private sector, the Government should be held accountable on its promises of raising healthcare budget. At one per cent of the GDP, the healthcare budget in India is among the lowest in the world, he adds.

KPC's Lakshmi illustrates how drug companies can make a difference. Singling out TB, given the country's high incidence of the illness, she says that though the Government has a programme to give free TB medicines, research needs to be done to produce medicines that have a shorter administration cycle and better compliance.

PHM's Dr Sen Gupta's prescription is quite different. Present-day dynamics in the pharma sector are too intellectual property-dependant, besides relying heavily on big companies for the marketing of medicines, he says.

In the US, the world's largest pharmaceutical market, basic research is done by public institutions and drug companies pick up potential lead molecules that can be developed into a medicine, he explains.

The big companies sponsor human trials of the drug, often outsourced, before taking it through to commercialisation. Big companies merely acts as middlemen in taking the medicine to the market, he concludes.

The solution lies in public institutions taking control of the entire process from basic research in the laboratories through trials to finally bringing a drug out into the market. Only this could change the rules of the game, adds Dr Sen Gupta.

Recently, one of the main governing bodies of the World Health Organisation approved a global frame-work to spur research to meet public healthcare needs.

Pill for every ill

OPPI's Shahani disagrees that drug companies are interested in pushing pills to people who may be in a reasonably good state of health. He thinks the pharma industry tries to get patients, access to the best medicines and promotes "responsible self-medication" to reduce or eliminate the need for more costly treatment at a later date and this improves the patient's quality of life.

And as the population in India greys, there is an increase in lifestyle diseases such as hypertension and diabetes, creating a huge demand for medicines to treat these conditions, which the industry is trying to meet.

"The future will see more medication, as there is the knowledge now to deal with the growing demands of people," says Dr Mukherjee. "We have the human genome and the number of targets that can be pursued (for treatment purposes) will go up from 300 now to about 30,000," he says.

And it will be the consumer who will benefit and drive this demand for more pills, he forecasts.

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