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The Drug
Scenario: A Consumer Perspective
Quite a lot is written and lot more
discussed in the health circles, these days, on
‘Drugs’. Not without reasons. Because the
issues at stake are very important. There is a wide range
of opinions, ideas and apprehensions on the specific role
of drugs in health care as a curative agent. Debates on
drugs can broadly be of two types; one that is aimed at
promoting their use and the other for curbing the
unregulated proliferation and indiscreet use of drugs.
Both groups have their on valid grounds for argument. The
former looks at drugs purely as a product of business,
and economics is their driving force. The buzz-words in
this circle are increase in productivity, wider markets
and larger profits. But the latter looks at drugs from a
very different angle. The backbone of their campaign is
health, i.e. drugs in relation to the consumption needs
of patients. Production and use of drugs for them should
mean disease-specific and target-oriented. The strength
of the drug industry or the income they generate are
issues put in the back burner. Thus, the value systems of
these two groups are poles apart.
The Drug Economics
In a liberalized economy more production, better
employment opportunities, more industrial growth,
improved export performances etc. are the yardsticks of
‘prosperity’. But this economic prosperity
concept is a subjective term which has to be interpreted
in a context, measurable in qualitative terms. Left to
itself, without a human face, prosperity will only mean
concentration of economic power in few hands. This is an
antithesis of a wholistic development approach. The
purpose of development is necessarily not concentration
but equity. It goes far beyond limited segments of the
society, individuals, communities or regions.
The health status of a community is an indicator of the
effects of the development process unleashed over a
period of time, seen from a national perspective.
Economic activities with regard to drug production and
distribution has to be necessarily seen in the context of
creating an ambience for maintenance of good health. The
bane of modern drugs production, promotion and marketing
is its total alienation from the health needs of people
based on the disease prevalence pattern in the country.
Drug business is big business. That is why the
pharmaceutical industry is the second most powerful
industries in the world, after the defence industry.
Governments also give lot of importance to the growth of
this industry. In comparison, the priority given to
health would be negligible. This proves why the growth of
the drug industry has not directly helped improve the
health status of people in any significant way. The drug
industry has a fast forward march, whereas the general
health situation of the people are on a steady decline.
This is the result of overriding emphasis on the industry
at the cost of people’s health. The potentials of
the Indian drug market has very well been understood by
national and transnational conglomerates who now vie with
each other for a bigger piece of cake.
Drugs for
Consumers
As far as the health consumer is concerned, drug
is a very essential commodity available in the market. In
very simple terms, a consumer would expect such products
to meet the following criteria:
- Drugs should be of
acceptable quality
- Drugs should be of
affordable prices
- Drugs should be
easily available
Quality
The first concern necessarily points to the
safety aspect of drugs. This is a major concern for
consumers like in the case of other products as well.
Because, absence of this will result in several unwanted
exigencies. It can also lead to wastage of resources,
disability, prolonged morbidity or even death. The Right
to Safety is recognized under the Consumer Protection
Act 1986. It means that if an unsafe product is in
circulation or is being given to consumer from which the
individual or community suffers injury or damage, action
against the supplier/manufacturer can be initiated. It
can range from simple claim for compensation, to class
action for withdrawal of the dangerous product from the
market or even a libel suit under Article 21 of the
Constitutional Right to Life. Several cases have
come up in various courts in India on this matter.
But there are some grey areas. The consumer may know that
about 40 per cent of drugs available in the market are
either substandard, spurious, hazardous or worthless.
Even then it may not be very easy for him to identify
these wrong medicines and reject them. Consumers’
problems are compounded by the fact that the
doctor’s prescription is usually never questioned.
If the names of the medicines tally, the consumer assumes
he/she got the right thing. The efficacy of the drug can
be judged only when the impact of the same is assessed.
Even this assessment can be properly evaluated only by a
qualified doctor. Seldom do doctors identify wrong
medicines and warn the patients accordingly. Generally
the patient (in outpatient situations) uses the
prescribed medicines and may or may not report after the
completion of the course. This way, there is no mechanism
to assess the quality of medicine taken by the patient.
Of course in very bad situations, the patient may develop
adverse reactions, and may seek medical help from the
same doctor or from others. What I mean to emphasis here
is that most of the wrong drugs may escape scrutiny,
which is the reason why they proliferate.
Price
The second concern is the price of drugs. Of
course prices cannot be decided by the paying capacity of
the consumer. It never is. But the consumer cannot be
denied the right to get the product for whatever it is
worth for. This is a demand for a proper relationship
between the manufacturing cost and purchasing price. All
what the consumer could expect is application of the
principles of reasonableness while fixing prices. Drug
pricing is indeed heavily loaded against the interests of
the consumer. Apart from absolutely no say or control in
matters of pricing, consumer is additionally handicapped
with ignorance of the whole system, which severely
restricts his power to make an informed choice.
Prescribing expensive branded drugs may mean the consumer
paying even upto 10 times higher cost than their generic
equivalents.
Hardly any ordinary consumer would know about the
potency, purity, cost, or technical details of the drugs.
Even if they know little bit, the choice is not largely
in their own hands. Unfortunately!
This has serious implications. As events have proved, it
is turning out to be one of the most serious dangers to
the interests of consumers. Because the people who
decides on their behalf make questionable decisions,
little too frequently. The consumer pays for their
omissions and commissions. Yes, in stray cases with the
help of litigations and public exposure, these
decision-makers may be asked to explain their conduct and
if found wanting, made to compensate the victims. But the
problem is that such cases are far too little.
Availability
Easy availability of goods and services is
essential to consumer well-being. As far as drugs are
concerned, availability of appropriate medicines will
definitely mean cure for diseases and restoration of
health. Absence of drugs will mean threat to life.
Non-availability of medicines in primary health centres
and Government hospitals is a common complaint. If at all
the patient has access to such centres, all what he may
end up with will be a slip of paper, written illegibly by
the doctor. Then the hunt for medicines outside the
hospital starts. There is no use getting a high value
prescription for the poor who cannot afford. Buying the
medicines may mean the family getting into debts. Drugs
costs represent 40-60 per cent of the total health care
expenditure in the developing countries compared to 10-20
in the developed countries.
What use India having the best pharmaceutical industry in
the Third World, when there is high rate of infant
mortality, hundreds of deaths from various epidemics,
having over 10 million TB patients, six out of very ten
children becoming blind due to Vit. ‘A’
deficiency. This reflects a very sad situation where
essential drugs for the diseases of the masses are not
available. This is because 80 per cent of doctors and
health budget cater to 20 per cent of population. The
massive infrastructure of over 132730 subcentres, 21854
primary health centres, 2424 community health centres (as
per 1996 figures) district hospitals and over 100 medical
colleges, research centres and the crores invested
therein, have not really changed the situation for the
poor to get medicines for their health problems. When
costly patented drugs are purchased by the Government,
the health budgets rapidly gets exhausted. The poor
patients will have to ultimately bear the brunt as there
will be scarcity of resources for rural dispensaries to
purchase vital life-saving drugs.
On the other side of the spectrum we see the mushrooming
of medical shops in large numbers not only in the cities
but also in other smaller places as well. The business in
medicine and medical products is sufficiently lucrative.
It is said that there is a need to get proper licence to
start a small grocery shop, but not for starting a
medical shop! Uncontrolled drug marketing and sale of
drugs over-the-counter in the absence of consumer
vigilance, can seriously endanger the health of the
people. The problems of ignorance about the dangers and
misconceptions about medicines create very conducive
atmosphere for consumers to get fleeced.
Is it not the time for the consumers to take a closer
look at the drug scenario. Glossing over the issue may
prove to be very costly for them. Even if the
liberalization process cannot be reversed, there is
nothing to prevent consumers from seeking product
information and price rationality. Liberalization
does not mean no need for social responsibility and the
offenders can get away with any unethical drug marketing
practice. If these measures are leading to unnecessary
use of medicines or self-medication, the guilty cannot
claim immunity. If transparency and accountability is
expected from producers of goods and providers of
services, there is no better area than drugs to push
forward these ideas in the larger interest of consumer
protection.
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