Making vital drugs affordable

When sickness strikes, all caution is thrown aside and the patient becomes the victim of exploitation.

Mid November should be a time to rejoice. Especially for sick persons. The Union government has informed the Supreme Court that it will put in place a  drug price control order with the cabinet’s approval.

This after the highest court in the land had issued a notice to the centre to spell out a time frame for the implementation of such an order. If the government stands by its declaration, some 348 essential drugs will be included in the Drug Price Control Order (DPCO). These will include drugs that are prescribed by private doctors which patients buy over the counter at their own cost.

Like many other Acts and rules, we have a Drug Control Act passed in 1950, which is supposed to control the minimum and maximum prices of all drugs sold in the country. According to this Act, every dealer has to display a price chart, and so should every chemist who dispenses drugs. But, the reality is somewhat different. Taking advantage of the urgency with which a patient requires the drug, both dealers and chemists have their own methods to shortchange the government and fleece the ‘beneficiary’- in this case, the patient.

Bureaucratic procedures

If the department of drug control were to examine the methods employed by them, he would be dealing with thousands of cases of fraud and exploitation. The redressal machinery is so bogged with bureaucratic procedures that very rarely does a patient or his relatives take action in these matters. So, desperate patients continue to flock chemists’ shops to collect medicines prescribed by their physicians.

Sometimes, the expiry date of the medicine may be over. Sometimes, it may be an alternate drug prescribed by the chemist himself as the one the doctor ordered is out of stock. Or, a drug which needs to be refrigerated at a certain temperature is casually pulled out of a shelf with the assurance that it is still usable.

    The callousness with which drugs are dispensed in this country defies all medical precepts. The worst victims are poor and illiterate patients who regard the chemist as a doctor and collect their medicines –including antibiotics – after narrating their ailments.
They are happy to have saved the doctor’s fee. The chemist is happy to be elevated to a position where he can sell drugs prescribed by himself. Even state run hospitals prescribe drugs that are not available in their dispensaries. It is a common sight to see patients covered by the central government health scheme (CGHS) carry prescriptions of drugs not available in those centres and buy them at exorbitant prices from local chemists.
The public interest litigation filed by an NGO nine years ago in the Supreme Court was very timely, although the law’s delay in taking up the case defies imagination. As one of the SC judges pointed out, this case has been adjourned for some reason or the other, that the government has not acted in the matter. The reason for the delay is obvious. One must remember that the drug lobby in India – as in many other countries – is a powerful one involving doctors, drug distributors and government departments controlling drugs. A recent article in the New York Times mentioned that 2,000 lawsuits had been filed in that country over the prescription of powerful antibiotics of the fluoroquinoclone family (brand names Levaquin and Ciproflaxacin) which, if misused, could aggravate blinding retinal detachment or worse.

So, misuse of drugs is prevalent in all countries where this lobby works and where unscrupulous doctors and gullible patients are there to sustain it. When sickness strikes, all caution is thrown aside and the patient becomes the hapless victim of exploitation. It is the responsibility of the medical profession to ensure that this does not happen. A few bad apples can ruin the reputation of the profession itself.

It must be said that there are any number of doctors in this country who would like to end such exploitation. This writer’s own experience with the life saving cancer drug Tarseva originally quoted at Rs 75,000 for a box of ten tablets, and then reduced to Rs 31,000 through the kind intervention of oncologists, is a case in point. I mention this to expose the mind boggling profit margins that multinational giants exercise in this area.
Drug control has to be implemented at all levels including the departments/officials responsible for the same; hospitals and physicians who prescribe them to patients; distributors and chemists who dispense them to a trusting public; and lastly, patients/relatives who have to be vigilant while buying drugs. But a single Act passed in Parliament will not be effective unless there is a vigilant public awareness about such exploitation. Sick persons constitute one of the most vulnerable sections of society. If sickness is compounded with old age and poverty, the scenario is even more depressing. The Supreme Court judge who spoke about the common man “who must either die or buy the drug” could not have put it more effectively.