Most stories about Einstein and his idiosyncrasies are, I suspect, merely apocryphal. But that doesn't diminish their innate charm.  You have perhaps heard of the story of the chauffeur who ferried Einstein on his innumerable lecture tours around the US when he spoke on the theory of relativity.

But of the many not so well known anecdotes, there is a delightful one about his superstitious beliefs. One day, Einstein stepped out of his house accompanied by a university colleague and fellow scientist. On spotting a horse-shoe lying on the lawn, Einstein picked it up, turned back to his house and nailed it on the front door frame. Seeing this, his colleague exclaimed: “Surely Mr Einstein, you don't believe in this nonsense that a horse-shoe nailed to the door-frame brings luck to the occupants of the house?”  Einstein is supposed to have replied, ‘Oh, I don't know. I am told it brings luck even if you don't believe in it.'

Does this offer a pointer to the correct answer in the current controversy about whether multinational pharma companies should be allowed to pick up stakes in domestic drug companies, with its implications for drug prices in the country?

As an aside, I must say that the way the debate has been going on, you would think someone put a gun to the heads of Mr Ajay Piramal, who sold the formulation business of the company managed by him to US drug major Abbot, or the Singh brothers, who sold their stake in Ranbaxy to Daiichi Sankyo of Japan, and made them sign on the dotted lines.

If we turn the debate around to why pharma MNCs are making a beeline to Indian shores, there is greater clarity, and with not a little help from the Einstein story narrated earlier.

What works for me…

We can never really know if the horse-shoe does bring luck, whether the occupant of the house believes in the phenomenon or not. If Einstein is to be believed, it doesn't matter what you are (believer or agnostic), good fortune is a certainty. That pretty much used to be the case with drugs.

They would bring relief whether the patient believed in them or not. Well, not with the same degree of success or, at any rate, not for all ailments. Still, it was there. However, that is changing as our lifestyles bring about newer complications to our health. You could, for instance, be suffering from hypertension and your doctor's prescription may work like a dream. I could be afflicted with the same condition and the same medicine dispensed by the same doctor may not work for me. Is it because you are a tall, handsome bloke, married to an accomplished woman and, to top it all, have a wonderfully understanding boss?

While I, poor me, am short and dark, a guy no woman would like to be seen with, and with the added misfortune of being stuck in a dead-end job?   Or is there some other reason we don't know yet? The drug industry doesn't know.

Mind you, for certain types of ailments such as bacterial infections the hit rate is quite impressive. When it comes to lifestyle-related ailments (diabetes, hypertension, etc.) the challenge facing the industry is higher by a manifold order.

Research scientists in drug companies get around the problem by formulating a slightly different hypothesis. If the end result is a net reduction in the ultimate risk (a ruptured vessel from heightened blood pressure) in the group taking the medicine as opposed to the group exposed to a placebo, the industry argues that the medical fraternity must be allowed to prescribe the new drug as it promotes overall public health in the society.

Obviously, if the new drug works on so few people that there is no significant difference in the incidence of a fatal risk between the two groups of patients, the new drug will not be cleared. There is obviously a minimum number on whom the new medicine has to work so that it results in a statistically significant positive outcome. The industry refers to this as the ‘Number Needed to Treat' or NNT.

Murkier environment

The strategic environment has got murkier for MNC pharma companies in recent times. The industry now finds that the new molecules of drugs introduced by it work for fewer and fewer people than has been the case in the past.

You might argue that this should be perfectly acceptable as, after all, everybody knows there can be only one winner in a lottery but that has not prevented millions among the public from buying it. People suffering from asthma regularly make a pilgrimage to a hakim in Hyderabad to partake of a tiny fish that he administers. If it really worked on each and everyone that consumed it, the country should by now have been rid of the asthma scourge.

Life is not so simple for pharma MNCs. There are the adverse side-effects of litigation to contend with too. If your new blockbuster medicine works for fewer and fewer people and there are potential side-effects to all those who consume it, then at some point the economics must turn adverse.

Research reports on the pharma industry present a grim picture. The share of revenue from new drugs is falling. The R&D expenditure is declining. The bulk of the money is devoted to finding a cure for cancer and success in the fight against cancer is proving elusive.  Cheaper generic versions of soon to be off-patent drugs are snapping at the MNCs' heels.

The only thing that can excite the stock market about a drug company stock is a big-ticket acquisition, and India fits the bill very well. After all, we have more than our fair share of cholera, typhoid, dengue and malaria infections — diseases that consumers seem to need treatment for as frequently as they get the urge to consume pizzas.

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