'NEML will eliminate unwanted medicine'

Medical expenses are generally a burden for most people, more so for lower strata of society. In a large number of cases, people prefer not to approach a doctor to get cured of their diseases.

One report by the National Institute of Public Finance and Policy states that nearly 27 per cent of the sick never consult a doctor because they do not have required financial resources.

The Planning Commission’s working group on drugs and food for the 12th  Five-Year Plan estimated that the country’s government public health sector caters to only 22 per cent of the population.

As much as 65 per cent citizens do not have access to essential medicines. More than two thirds of the expenditure for healthcare is borne from out of pocket. It accounts for an average increase in poverty by 3.6 per cent and 2.9 per cent for rural and urban India respectively.

As a result, medical treatment has emerged as the second most common cause of rural indebtedness. Equally disquietingly, some 39 million people are pushed into poverty every year because of illness.

By sticking to the concepts of Essential Medicines and Generic Medicines through government policies, and by revitalising public sector it is possible to reduce much of the catastrophe that is hurting the common man on street.

The Supreme Court has expressed strong displeasure over the government’s attitude.
The World Health Organisation (WHO) is very clear in its definition on essential medicines

According to WHO, essential medicines are “those medicines that satisfy the healthcare needs of the majority of the population; they should, therefore, be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford.”  WHO has been publishing periodically, since 1978, a model list of essential medicines. Each country is encouraged to prepare its own list by taking into consideration local priorities. At present over 150 countries have published their official essential medicines list.   

The core list presents a list of minimum medicine needs for a basic health care system, listing the most efficacious, safe and cost-effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment.

The compilation of a National List of Essential Medicine (NLEM)  enables health authorities, especially in developing countries, to optimise pharmaceutical resources. The list is important because it forms the basis of national medicines policy in many countries, both developed and developing.

The first NLEM by the Government of India was released in1996. The list was subsequently revised in 2003 and 2011. In  2004-2005, the Karnataka government announced its first EML.

By sticking to the concept of NLEM policy, we will with one stroke get rid of several unwanted and useless medicines that flood our healthcare, especially the private sector. In fact, they contribute greatly to the economic burden of the consumer.

A study conducted a few years  agorevealed that of the top selling 300 medicines accounting for Rs 19,000 crores sales, majority of them were outside the EML. Of the 300, only 116 (38 per cent) were mentioned in EML, clearly indicating that majority of the top selling brands are outside the EML.

Iron deficiency anaemia is very prevalent in India but not even one preparation in the top 300, which has the ingredients for an anaemia preparation is mentioned in the NLEM.
Irrational combinations of medicines, which only add to the cost but no healing value, are advertised as effective remedies and promoted aggressively.

A brief analysis of the top 300 brands suggests that the Indians are prescribed medicines without adequate concern for evidence of their efficacy, safety and cost. This is because of poor access to unbiased information on medicines, compounded by the aggressive and often misleading medicine promotion by the pharma industry. The result is increased health care costs for the patients.

The term “Generic Medicines” is often used in the media and also by politicians as well as policy makers without fully understanding its meaning. It is interesting to note the term has different meaning in the Indian context and globally.

A generic medicine is one on whose patent period has expired. The patent period is for 20 years. None can make or manufacture the medicine without the permission of the company or person holding the patent on the medicine. During this period, the company will market the medicine under its own “brand-name”. When the patent period expires, other companies are allowed to produce their own “generic” version of the medicine.

As the patent period expires, then generic medicines become available and often at substantially lower prices. It is the market competition often that leads to substantially lowering the prices for both the original brand name product and the generic forms.
This is the global picture of “generics” but in India the term generic is used in a totally separate context.

Generic names (also referred to as INN) are intended for use in labeling, product information, drug regulation and scientific literature. For example Paracetamol is a generic name (also referred to as INN – International Nonproprietary Name) while is sold by different companies under different brand names. All the text books which medical students study and all standard medical journals, including WHO, use only INN or generic names.

By using Generic Medicines much of the cost of the health care can be minimised.

(Writer is Co-convener, All India Drug Action Network )

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