Monday, 21 July 2014

The Drug Dilemma

I don't watch "Satyameva Jayate". In fact, I'm surprised how a TV show was allowed to use such hallowed words for a title! I do not watch "weepy" talk shows where the anchor is shown being moved to tears by the stories of the guests on the show. A show which is not live but is rehearsed, recorded and re-recorded. I do not watch shows which ask for donations, but no one knows what happens to their money after they part with it.

Anyways, that's not what I want to talk about today. The reason why the name of this particular talk show figures here is that it came up with a very strong appeal to the general public to start using generic drugs. It preached to doctors not to make money by prescribing branded drugs of companies which pay for their domestic and foreign jaunts. It even went a step further and the anchor was shown setting up a meeting with the health minister of the country, demanding that he get nominated on a panel of "experts" which would decide about legislation on the prescription of generic drugs.

So what is a generic drug? Well, I'm not a doctor, or a biochemist or a chemist even. The last time I had any sort of formal education in chemistry was in Class XII. Of course a subsidiary subject in an Honours course doesn't really count. Yet even a Class XII chemistry student would know what are the basic principles behind any drug. The most important part of the drug is its active ingredient consisting of a single molecule or maybe a combination of molecular compounds. The active molecules act on the symptoms that they are supposed to cure. That is the lead role.

Now, in TV shows and movies, there are supporting actors, crew, make-up man, spot boy etc., who play their own roles. Ultimately a movie is a combination of the efforts of all these people, and their combined efforts decide the quality of the product churned out. Similarly, in a drug, the molecules which form the active ingredient are supported by other molecules in the drug which ultimately decide the efficacy of the drug in treating the illness for which it is being taken. There are various ways in which the supporting molecules act. Some may suppress allergic reactions caused by the active ingredient and make the drug easier to tolerate. Some may suppress immune systems and thus enable the body to accept the active molecule more readily. Some may change the pH of body fluids in the affected parts, so that the active molecule gets an enabling chemical environment for effective action. Some may simply augment the efficacy of the active ingredient by providing some secondary molecules. Some may prolong the half-life of the active molecule so that it breaks down slower inside the body and thus acts for a longer time. Some may react with the active ingredient inside the body, and both may synthesize into a more useful form.

Of course, this is what I can think of as a lay person. I'm sure doctors, biochemists and researchers spending several back-breaking hours hunched over their scopes and petri-dishes (if they are still in use and have not been replaced by some cutting-edge technology for research) would provide us a long, long list of such dual, triple or multiple chemical reactions that are caused by the smallest unit of a drug, which consists of the active ingredient and the ancillary ingredients, and which are a part of the complete package of cure or palliation that the drug provides.

Will generic prescriptions only contain the name of the active ingredient or will they also contain the names of all the ancillary ingredients? Who will help the patient decide which combination is more suited for his/her condition? Let us say a doctor prescribes paracetamol. However depending on the patient's symptoms, the doctor may decide that the patient would do well to have a variant of paracetamol with caffiene. Will the 8th pass boy sitting at the nukkad (corner) chemist shop help the patient decide which brand, and thus which molecule, of paracetamol the patient should take?

Then comes the issue of credibility. On online sites like Healthkart and CIMs, one may be able to compare the prices of various brands of the same drug. But there are variations in terms of the compounds used in different brands. So how does a consumer of a highly technical and vital-to-life product make her choice? SHe doesn't have enough knowledge of her medical condition or of biochemistry in order to make an informed choice. Even if there are two or more brands selling identical generic molecules, is price the only criteria involved in the purchase? Does the reliability of the brand, and the company selling it, enter the picture at all? How does one know whether the cheaper one isn't half chalk and half medicine? Or for that matter, even the dearer one, if a consumer takes price as an indicator of quality? Does the entire production process have no role in the effectiveness of a drug?

Pharma companies making a killing by jacking up prices of drugs is a reality. Pharma companies providing very lucrative incentives and "other"-kinds of incentives to doctors to virtually bribe them into prescribing their company's brands of drugs is also a reality. Prices of essential drugs hitting the roof and putting them out of reach of the hands of the poor is also a reality. Pharma companies dishing out legal jargon in the name of IPRs to protect their pricing policies in the face of the pricing being "anti-poor" is also a reality. But, then, who makes the purchase decision about a vital commodity like drugs? Comparing drugs is not like LalitaJi's balancing scale showing "Keval aadha kilo...... pure ek kilo saadhaaran powder ke baraabar hota hai". (Just half-a-kg of ....... is equal to a full kg of ordinary detergent powder).

And if doctors can be "bribed" into prescribing certain brands of drugs, who prevents the local chemist from being so "bribed" when faced with a generic prescription? Or who knows, in a strategic forward integration policy, pharma companies may start formally and legally keeping doctors on their payrolls, and opening their own chain of pharmacies, which would prescribe and sell their own brands of drugs? And cartels will ensure uniform pricing so that the consumer will suddenly have practically no choice.

So, the issue of generic prescriptions and the sale of drugs by generic names is not so simple. Nor is it easy to answer all questions and address all concerns by gate-crashing into a panel of experts with no expertise on the subject. The issue needs a lot more thought. Thought by people who know their biology and their chemistry, beyond the use of a chemical compound called glycerin.

In case anyone has a doubt, let me put a disclaimer. I do not work for any pharmaceutical company. I do not work for a rival production company. I am just a humble employee of the real "Satyameva Jayate".

PS: Ever wonder who finances domestic, foreign and all other jaunts, or even basic bread-butter of various dramatis personnae of Bollywood? Or even Tellywood? I wonder too !!!

Sunday, 13 July 2014

On Rape : Part V

Hello Friends!

I'm back after a rather long hiatus, but duty called, and so.....

When I had started this series of putting down my thoughts on rape, I'd hoped for something positive to put as a concluding footnote. Something that would keep our hopes alive that at some point of time violence against women would see an end.

Alas, in between my last post and this one, Badayun happened. It left me frozen with a trauma so horrific that there weren't any tears that would flow. They had frozen with my blood. They had frozen with the basic sense of being civilized that our society pretended to be. All that was left was an artic winter of numbness and silence.

Hence, I find myself unable to write on this issue further.

There may be another sunrise of humanity sometime.

Until then,
I remain frozen.