| |
Mathew Nampudakam looks
after the Consumer Cell in VHAI.
Unbiased information is the corner-stone of consumer
safety and ethical clinical practice. This is important
in all spheres of consumer activity, be it in the case of
a purchase of a product, or in the case of availing of a
service. If by commission or omission the seller of goods
or the provider of service conceals some information
which comes in the way of the consumer making an informed
choice, those acts amounts to cheating. It is nothing but
exploitation of the ignorant consumer. Unfortunately
there is ample evidence to show that drug producers at
times suppress vital information on the products or
deliberately mask them. Who can scan these promotional
literature and monitor prescription guides like MIMS,
CIMS to give out vital pieces of information for the
benefit of the consumers? A Process of Disempowerment
The role of right information in the context of
medical services and drugs needs to be emphasized again
and again, as it still is an area of darkness. The main
reasons behind this phenomenon is the lack of
transparency. Seldom do we see an honest attempt to
explain the situation to the patient on the part of the
treatment providers. Notwithstanding the extreme pressure
many doctors are put in, an ideal patient-doctor
relationship should be based on mutual respect and
understanding. But the general climate is one of absolute
dominance of the latter, which demands unquestionable
obedience and submission from the former. In this process
of mystification of medical care, an equally responsible
ally is the pharmaceutical industry. Indeed they have a
very vital service to offer by providing effective
medicines for the various diseases afflicting human
beings. But unfortunately, many a time they go little
beyond this essential role. When the profit-saving aspect
takes precedence over the life-saving role, they end up
producing and selling thousands of formulations which may
have very little therapeutic purpose or no value at all.
These are the unessential medical preparations, demands
for which are created through advertisements or through
obliging prescribers.
The loss is on two fronts; one, it is a waste of
resources for consumers as they do not get cured and two,
exploitation of their weak position. There are several
groups of these drugs whose efficacy has not been
scientifically established. Both Indian and international
pharmaceutical companies are involved in the manufacture
of these drugs.
Tall Claims -
Small Gains
There are cerebral vasodilators with several
brand names like Arlidine, Clendal, Duvadilan, Flexital,
Kinetal 400, Martispasmol, R.B. Flex, Suprox, Tidilan
etc. Then there are cerebral activators on which adequate
data is not available to justify their use as cerebral
activators. These drugs do not have dilatory action on
the cerebral arteries and they need to be used with
extreme caution as they can cause vasodilatory effects
elsewhere. Some of these drugs are Cerecetam, Encephabol,
Gnkocer, Hydergine, Neurocetam, Piratam, Trivastar LA,
Vasotop etc.
Then there are a host of appetite stimulants for
paediatric use. Brand names include Apilysin, Aptone, Cyp
L.,Cydine, Eptocal, GL, Heptadin, Longifene, Magnadyn,
Paritex, Step Up, Udactin, La Cyp and the like. These
should never be used in newborns or premature infants
lest they should produce hallucinations, central nervous
system depression, convulsions or diminish mental
alertness or even death.
Several products are marketed in the name of digestive
enzymes which are supposed to promote the process of
digestion in the gastrointestinal tract. But only the
preparations that merit consideration are those of
pancreatic enzymes which might act against acid and
peptic activity in the stomach which destroys pancreatic
enzymes. Liquid enzyme preparations become useless when
reconstituted or when given in liquid form as these
enzymes are hydrolyzed when they come in contact with
water. Some of the brand names include Aminozyme,
Bestozyme, Digeplex, Genozyme, Neopeptine, Vitazyme etc.
The number of brands per drug varies greatly from one
country to another. Third world countries, with the least
developed regulatory apparatus and quality control
mechanism, have the highest number of brands. For example
in 1994 Norway had only 2600 brands, UK about 6500 while
Brazil had 20,000 and India over 100 thousand.
The 1983 British Joint Formulary Committee (comprising of
members of the British Medical Association and the
Pharmaceutical Society of Great Britain) found that 22-24
per cent of the available drugs were of ‘uncertain,
doubtful or little value’.
Determined promotion by the drug companies, with
exaggerated and misleading claims for the therapeutic
qualities of their products has led to overprescribing
and misprescribing of medicines by doctors in both
developed and developing countries. Even in
industrialized countries the drug companies manage to
sell their products; how easy would it would be in
developing countries with much less regulations,
illiteracy among consumers and poor access to information
for medical professionals.
Growth without
Fetters
In the absence of coherent policies and the even
more glaring absence of adequate monitoring and control
machinery, India provides a wide open market for
pharmaceutical products. The Government has always viewed
drugs as an industrial product meant to make profit and
prosper. Attempts to regulate the industry and to ensure
provision of essential drugs for the diseases of poverty
have more or less remained feeble, especially in the
event of Globalization of trade and industry. Market
forces are at work in this sector, where competition is
fierce. But this has not helped bring down prices of
essential drugs, which has been steadily going up over
the years. Industry has no inclination or time to
consider ethical alternatives. For the industry,
producing items which sell better make economic sense.
The official stand on the drug industry is that during
the ninth five year plan (1997-2002) turnover of
pharmaceuticals is expected to grow from Rs 100 billion
to Rs 250 billion. The estimated domestic demand for
drugs is expected to be at Rs 160 billion by the year
2000 against the existing production of Rs 95 billion.
The liberation of the industry was expected to encourage
competition among the drug companies which would benefit
the consumer with wider range of products. The number of
licensed manufacturing units in India has increased from
around 6000 in 1980-81 to 23,000 at present. The output
of bulk drugs rose from Rs 2.40 billion to 15.18 billion
and that of formulations from 12 billion to 80 billion
during the same period.
In spite of the above mentioned claims of increased
production in bulk drugs and their better availability,
India’s per capita consumption of medicine is one of
the lowest at Rs 34 compared to 43 in Pakistan, 95 in
Philippines, Rs 159 in Taiwan, Rs 190 in Egypt and Rs 346
in South Korea. Liberal drug policy has encouraged many
foreign companies to increase their stake in their Indian
subsidiaries.
Resounding
Consumer Outcry
Indian consumers clamour in one voice for an
impartial screening of all existing drugs in the Indian
market by an appropriate authority. Those drugs which are
approved for their safety, quality, potency and
affordability should be listed for consumer information
and re-registered with the Government. All those found
therapeutically untenable should be weeded out, withdrawn
and their further production banned. There is a practice
in some countries wherein all registered drugs are
reviewed at certain intervals, say five years. Why
can’t India also follow such a norm?
The rich people have far better changes of availing of
the modern medical facilities at high costs, but for the
large number of consumers living in poverty, chances of a
reasonable and dignified medical care are receding day by
day. The subsequent increase in price of medicines and
the increased use of technology in medical care combined
with the falling purchase power spell doom for the
already vulnerable consumers. In this melee, the pushing
of unessential, hazardous and medicines of doubtful
efficacy can only further destroy the consumer interests.
Their right to health will remain as a mere pipe dream.
THE FLOURISHING
RECYCLING INDUSTRY
Over 78 per cent of the total injectable
dosages in India are given through used and
recycled syringes with the help of the
ragpicker’s network, according to a study by
Core Healthcare Limited, an Ahmedabad-based
healthcare products company. 3700 million
injectable dosages are given every year in India.
The disposable syringe manufacturers can only
supply 800 million units based on installed
capacity and the present capacity utilization
level of various plants. This means 2900 million
dosages are given by used/recycled syringes. Out
of every three injections taken, two may prove
deadly.
WHO has suggested a complete switch over to
disposable syringes as a way to avoid AIDS and
other deadly diseases like Hepatitis. But in
India reusing needles and syringes is widely
prevalent. Retail segment of the disposable
syringe market should be consuming 210 million
syringes a year. Sales figures show that 110
million are either reused or recycled. Needles
and syringes once used by hospitals are disposed
of without being destroyed. These discarded
syringes are then picked up by the organized
network of ragpickers. They are washed, dried and
repacked as new and sold to retailers and
hospitals by small back-alley operators. Police
raids in several parts of the country have
unearthed this racket.
The report said in spite of comprehensive laws to
prevent misuse of medical equipments, the reuse
of syringes is still an acceptable form of
medical practice in India.
Source: Business Standard, 2 May 1998
|
[top] [index]
|
