Public health groups have a supportive voice in American surgeon-author Atul Gawande in their fight to break “secondary patents” that drug companies seek on existing medicines.

“The effort by public health organisations to fight ….to break the secondary patents, I think, is the right fight..even though I’m (from) a country that’s trying to enforce those kind of secondary patents,” Gawande told BusinessLine , during a whistle-stop India tour in India to promote his latest book “Being Mortal”.

“You need enough incentive that the drugs can be created and innovation can happen but then there has to be that release point where it then can go out into the world as a generic,” says the cancer-surgeon, whose book was among American President Barack Obama’s recent buys.

“Being Mortal” takes a critical view of treatment beyond medicines and how ill-prepared doctors are to handle mortality.

“Patents can be respected to allow companies to invest in innovation. But then when companies create secondary patents where they make a little tweek that means that the drug is given with a slightly different milligram dosage or slightly different formulation that you can get a secondary patent - that prevents it from ever becoming generic and widely available,” Gawande says, responding to a query on patents and the price monopolies it could bring in.

His observation comes even as India and the US engage in intense discussions on patents that give the innovator exclusive rights on an invention for a period of time.

Better birth

On quality issues plaguing locally made medicines, he points out, the recent death of women during mass sterilisation was “concerning” in many ways. The mass sterilisation is a concern, use of drugs reportedly of poor quality and the fact that there was no follow-up to see and catch what was happening to people, he explains.

“India reminds me of where we were in our industrial revolution in the US. The creation of our Food and Drug Administration…a very weak body in the beginning, but had to develop the standards and processes that made sure …..medications were safe for people,” he says.

The US parallely created pensions for people, as they lived longer and needed support post 65 years. “As the Indian economy improves that pressure will start to come, to have a tax-based system, like our social security system, like pension systems in Europe. That will be a transformative thing ….for the elderly, as well as family. I see these kind of things happening in India … and I pay attention to them because they strike me as the patterns of how societies develop and cope with health.”

Varanasi visit

Gawande’s India-visit includes filming a documentary in Varanasi based on the book, besides overseeing a pubic health project in UP. Along with the Government, World Health Organisation and Gates Foundation, the “Better Birth” project is about improving survival when women go to facilities to deliver. “Being Mortal” is about end of life, this is about the beginning of life, he says.