Pills that kill
DRUGS are big money. And it is not hallucinogens or drug peddlers that are being discussed here but drug peddling by the pharmaceutical industry. In absence of a rational policy the world over, these companies are having a field day. And all of them have the same motto: to hell with your health, lets rake in the moolah.
While on the one hand there is a shortage of essential drugs, on the other there is evidence of money spent on production of drugs in exotic combinations, most of them unnecessary. The patient sits smug, confident that he will get well soon since he has spent so much on "new and more potent combinations". But, if at ail he does recover, it would not be wrong to say that it is because of the "placebo effect" or supernatural powers.
Modern drugs are chemicals that prevent and treat diseases - one of the most advanced and scientific means to overcome ill health in a society. Per capita drug consumption has become a status symbol of sorts and is even considered an indicator of modern development and also the ability of a society to overcome ill health. What is being forgotten is the age-old "prevention is better than cure" way of thinking. Medicine, though vital, could perhaps be avoided if non-medical measures - for instance, keeping the environment clean to prevent malaria - are undertaken to control ill health and disease. In India, most of the infectious diseases would disappear as a public health problem if drinking water quality, sanitation and nutrition levels were to improve. In the West, long before the intervention of antibiotics, most of the infectious diseases disappeared due to improved standards. Diseases like tuhercolosis, malaria or typhoid no longer ail the advanced countries. While in the Third World nations, thousands fall prey to these every year.
There is not a pill for every ill person, though the drug barons would prefer the public to think otherwise. If drug consumption were to be an indication of health, its consumption in the industralised countries should have declined a long time ago. But drug sales are on the rise. It is being prescribed and purchased with impunity.
Oestrogen is being supplied to menopausal women for cosmetic reasons. The newly-produced wonder drug, Viagra, has opened up endless options for impotent males, and men well into their last beats of life. Never mind if the drug is a strict no-no for heart patients on nitro-glycerme. It could be fatal, warn concerned cardiologists. "But, what a way to go," sigh the septuagenarians. And some have. God bless their souls. Meanwhile, there is no space in the cash registers.
The book gives a glimpse of the world scenario and, against this background, the pattern of drug supply and use in India. The second part of the book is a case study of Satara district in Maharashtra. It details the supply and use of drugs, their availability and awareness among doctors, nurses and other health professionals in this district.
Thanks to the reverse engineering strategy followed by the Indian companies, drug production in India increased from a mere Rs 10 crores in 1948 to a phenomenal Rs 6,900 crores in 1994. Once a drug enters the market, companies are capable of synthesising it. It is this strategy that is getting the country into trouble with the World Trade Organisation (WTO) because of the ruckus kicked up by the patent-holding drug companies. One would naturally assume that this growth in production would translate into the availability of necessary drugs. But that is not to be. The Indian patient continues to suffer from. non availability of the right kind of medicine in government set-ups or at affordable prices from the private sector. The public health centres are sick themselves, suffering from a chronic shortage of drugs.
And by no account can the existing drug policy in India today be termed consumer oriented. It is totally irrational and does not cater to the needs of the majority of Indian people. It also grossly violates medical principles by continuing to allow the production of all kinds of irrational, obsolete and hazardous drugs.
In 1979, the government of India produced a Drug Price Control Order, a hazy piece by all accounts. It aimed at controlling the price of essential and life-saving drugs. The effect: the industry stopped producing them while increasing the production of other drugs with higher profit margins. There are about 50,000 brand products, most consisting of unnecessary combinations. Take the case of the pain killer paracetamol. It is available under at least a dozen different brand names. To be one up on the competition, manufacturers now produce "new and stronger" paracetamol, in combination with irrelevant chemicals.
A number of over-the-counter drugs, ranging from iron-containing multivitamin tonics to anti-diarrheal drugs, are also available, ail making unusually tall and usually misleading claims. Cough mixtures are no different. Most of these medicines contain one useful chemical and a host of other unnecessary ones, all with an eye towards boosting the manufacturers coffers only.
Drug Supply and Use also highlights the cheating that takes place under the garb of ayurveda. It also calls for the need for more research, quality control and inquiry into manufacturers' tall claims.
The book also exposes the level of knowledge of doctors, nurses and other medical professionals. It is critical of the near-total lack of, and need for continued medical education of these professionals once they have obtained their degree. Most doctors rely on the information provided by medical representatives of drug companies, who are all out to earn their commission on the sales that they make. Strict control on the ethics of doctors accepting gifts and attractive holiday packages from these representatives also needs addressing.
On the lighter side, the book has a number of interesting medical facts to reveal. Did you know...
• E Bobst, former president of Hoffmann LaRoche was "heavily involved" in the supply of morphine to the underworld during the two world wars?
• At the turn of the 20th century, Bayer was promoting heroin as a panacea for respiratory ailments?
• That a chairperson of Bayer and another of Hoescht were sentenced to imprisonment at the Nuremburg war crime trials?
• That leading multinational drug companies suppress self-damaging results of trials?
The book is an eye-opener. While the first half is absorbing, the second part on the supply and use of pharmaceuticals in Satara district is tedious. The book cries out for the long overdue need of a rational drug policy.
Going by the records provided in the book on the roles enacted by various players - drug companies, Drug Controller of India, concerned drug action groups and the courts, the slogan "health for all" is a good Joke on the consumer. Instead, as matters stand today, all that they should be saying is "happy reading and pill popping."