The TRAI's recent efforts to re-negotiate certain cell-phone tariffs would not have escaped notice. The general public rarely complains about TRAI-regulated call rates. But somehow, such regulation of drug prices is not acceptable to medicine manufacturers in India.
One can extend this comparison to include the IRDA and the RBI. The former regulates insurance rates and the RBI, the lending rates of banks.
But the booming pharma sector, as also the health and hospitals sector, are considered to be above any kind of regulation.
When patients complain about high medicine prices, there is intense pharma lobbying to prove it is not more than the inflation rates. Or, formulas to regulate prices are proffered that let the drug prices remain high.
One such was the recent National Pharmaceutical Policy 2011, in which ceiling prices of medicines were to be decided on the basis of the weighted average of the top three selling brands of a medicine. It was pointed out by public health professionals that this will not work in most cases, as the ceiling price will still be too high. Indeed, some have asked as to why one should not take the weighted average of the lowest priced three brands of a medicine.
Price regulation is not acceptable to the pharma industry in India. The ‘Indian' pharma sector does not oppose price regulation on the face of it, but is constantly pulling the rug under the carpet by throwing up “analysis” to show how prices of medicines have been “stable” over the years.
This is something discerning observers find hard to agree. When doctors prescribe medicines, one rarely sees them doing so keeping in mind the patient's capacity to pay.
MANY-FACETED CRISIS
When my late father, healthy 85 out of 87 years, was sick last year, I had a first-hand experience of the disruptions caused by seeking medical care in India.
I could temper some of the damage because I knew something about medicines — as I have been making them for the last 30 years and had access to conscientious doctors.
One respected doctor gave my father 10 medicines in a prescription. And declared he had TB. He had low sodium or hyponatremia.
Doctors could not make out how the low sodium was occurring – so he got medicines to cover for all possibilities. He was started on TB drugs without a second X-Ray or a sputum test.
Somehow, I felt he did not show other symptoms of TB. A pulmonologist examined him and declared that he had pneumonitis, not TB.
He was also diagnosed with diabetes in the last two years. His sugar levels went up and down and he was on anti-diabetics where most of the medicines he was prescribed were not under price control.
And there was not much consensus on what levels of blood sugar were acceptable for old men over 85. Some of the other medicines that he was on would affect blood sugar levels. And some of the diabetes drugs could cause low sodium. The doctors said there was no evidence to point to these connections.
This experience is repeated several times a day in different parts of the country: Insensitive doctors, confused diagnosis, over-prescription and high prices of medicines and resulting indebtedness if you are a poor person.
There is no regulation of medical costs and little control over drug prices in India. Fortunately, we scraped through because my generous brother in America picked up the tab of over Rs 6 lakh in 15 months. And we did not go to the “best” hospitals. (Oh, my father also broke his hip due to a fall and was operated upon after a leading senior orthopaedic of Chennai told us it is best not to operate on him at “his age” as that would surely kill him. I happened to mention this to another public-spirited orthopaedic and he told us that not operating at his age, and keeping my father immobile, would send him to the other world in a month. My father was operated upon, thereafter.)
I could not make out whether it was the excess medicines, or exhaustion from a relentless medicalisation and pharmaceuticalisation of his problems, that killed him. My mother thinks it is the latter.
IRRATIONAL FORMULATIONS
India currently regulates about 74 medicines and some assorted packs of brands — most of which have no relevance to scientific medical care.
India is awash with combinations of more than two medicines sold in innumerable brand names that even doctors have problems remembering. Totally, they add to more than 50,000 brands. Many of these brand names sound similar, but are for entirely different problems. And many of these branded combinations have no scientific basis, no evidence to back them up.
It is these unscientific combinations, usually overpriced, as well as some unscientific top-selling tonics, and nutritional “supplements”, highly overpriced, that add to the cost of healthcare and wipe out the savings of entire families (remember we are not even talking of costs of treatment and procedures, which also need regulation, and which blow another big hole in the pocket).
Whenever we talk of price regulation, people point out how some government agencies are procuring medicines at rock bottom prices. That is like adding fuel to the fire.
I check out the price of paracetamol (sold as brand Crocin, Calpol) procured by the TN government's procurement agency, TNMSC, and you are in for a shock. What the leading brand costs for 10 tablets is available for 100 tablets. Well 10 times more or 1/10{+t}{+h} of the market price. Maybe it is an exception. So you decide to check on other medicines (http://www.tnmsc.com/tnmsc/notification/ApprovedL1Rates2012-13.pdf): atorvastatin 10 mg (for BP, brand Atorva) sells at 45 times (or 4,500 per cent) more than the government procurement price. This is getting worse. Clopidogrel 75 mg (used in stroke, brand Noklot of Zydus) sells at almost 20 times (or 2,000 per cent) more than the government procurement price. And then you see this is a trend with few exceptions. Maybe this is because government procures in crores of tablets, you say? You wonder whether, if the government procured the latest version of iPad (around Rs 50,000) for 1 lakh students, Apple would supply for 20 times less — at Rs 2,500 per iPad?
Steve Jobs would roll in his grave. One sorely wishes for a TRAI-type of agency for medicines — and medical treatments and procedures.
(The author is associated with medico friend circle and LOCOST, Vadodara.)