The good pharma or a bad medicare?

The pharmaceutical conundrum is an enigma that has haunted doctors, hospitals, and the general public for years. In India, where steroids can be purchased in any roadside medical store and the friendly pharmacist turns into a highly efficient doctor without going through a tedious five-year medical education costing crores of rupees, poor patients approach him gratefully and swallow each and every tablet he gives in complete trust and faith.

They do not doubt, question, or complain. To them, the pharmacist is a kind god who has saved a doctor’s fee. And, what more? He has identified the patient’s problem, given him the right medicine, and cured him! The patient did not have to wait in a crowded clinic; he did not have to go through blood tests, X-rays, scans, or maybe even a night in an ICU with a needle dripping something into his veins.

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The friendly pharmacist is the god that his tiny shop displays in cheerful colours. Hanuman Medical Stores, Maha Lakshmi Pharma, Sree Rama Medicals, Ishwara Medicare, Sanjeevani Medicals, Sai Shakthi Pharmacy—the list goes on.

Pharmacies like Get Well Pharma, Cash and Carry Pharmaceuticals, Brigade Medical Stores, and Florence Nightingale Pharmacy are popular in English dominated suburbs. The pharmacist in India may not be qualified in pharmacy, but he is a wizard at selling the right medicines with finesse, friendly customer care, and what have you to woo his patients. He distributes boxes of sweets during festivals, packs candy along with children’s medicines, patiently listens to his clients’ complaints, and gives medicines on credit with a tiny concession added. He does not believe in any billing system ("Sir, why pay unnecessary taxes like the GST?").

He simply scribbles the costs at the back of the envelope carrying your medicines. He may shortchange the state exchequer, but he will never fail his customer. He will travel miles at midnight to open his "shop" if you need a tablet urgently. He keeps a mental record of your health and that of your family, goes out of his way in emergencies, and is your true friend in need.

The Indian pharmacist has no counterpart in this world, just like your amazing family doctor, whose very presence cures you most of the time. Our pharmacist can actually decipher a doctor’s prescription (miracle of miracles), get you the medicine from a neighbouring store if he doesn’t have it, and add a few words of advice before you leave. He is your best friend in emergencies and will inquire about your family, keep a mental record of their health, and promise you the moon even if some medicine is in short supply. To the Indian pharmacist, the customer is king.

The Pharmacy Act of 1948 was the first step initiated by the central government to regularise the "business" of pharmaceuticals. It was established mainly to regulate the education of pharmacists, similar to medical education. In 1970, the Drugs and Price Control Order was passed to fix the retail sale price of drugs to avoid the huge profiteering in drug manufacturing and distribution. To prevent malpractice, the government directly controlled the prices of life-saving drugs.

As a first step, a department of pharmaceutical technology was established in the Benares Hindu University, where prospective pharmacists went through a rigorous course just like doctors. This was followed by the establishment of the All India Pharmaceutical Congress Association, which brought all qualified pharmacists together under one umbrella. The main objective of these Acts was to ensure that the drugs sold were safe, effective, and conformed to prescribed standards. The establishment of the Central Drugs Laboratory in Calcutta in 1940 was a huge step in controlling the quality of drugs in the country. The Pharmacy Act of 1948 followed automatically. It regulated the very profession of pharmacy, which was as important as the medical profession itself since the doctor depends on the efficiency and reliability of the pharmacist.

So, if the health of a nation has to be maintained, both medicare and pharmaceuticals have to work in tandem. If the latter overtakes the former, as is happening in the country, we will end up losing a good doctor for a bad pharmacist. Today, with the rising cost of drugs, low-income groups simply cannot afford to buy medicines or even life-saving drugs. It is hoped that with the various branches of the Centre’s ambitious healthcare programme, Ayushman Bharat established a few years ago, the Centre will next concentrate on preserving health in the country rather than treating sickness. The pharmacy will then become a centre for promoting health rather than a business house for selling drugs.