No Medicines, Blame It On Govt!
Indian markets are far more mature and have given their thumbs down to the controversial Food Security Bill. But the UPA government will do all it takes to indulge in such populist measures even going to the extent of driving the country down the fiscal drain. Fiscal deprivation just adds on to the long list of pitfalls of the UPA government including corruption, apathy, indecision and pseudo secularism. Its time for the people of India to fight back. Otherwise its the middle class and the hapless poor who will pay the price for supporting such a corrupt and inept regime. Come 2014 and the people of this country will set all the wrongs right and usher in a true era of peace and secular growth with Namo
Price cut makes drugs scarce
Cardiac surgeons these days make it a point to give two or three options to drugs they prescribe. Or the surgeons write down the components of a drug instead of its brand name. These steps are being taken because majority of patients come back to their doctors with the complaint that the prescribed brand is not available.
“Something as basic as betadene has vanished from chemists’ shops,” said Dr Anil Jain. “The situation will only get worse as the existing stocks dry up.” The sale of branded drugs in India is based on doctors’ prescriptions and most patients are usually reluctant to buy substitutes for prescribed drugs.
However, the new Drug Prices Control Order (DPCO) 2013 seems to be forcing doctors and patients to turn to substitutes, courtesy a silent protest by chemists across the state. Chemists are unhappy because with the DPCO retail chemists are losing 7% commission while wholesalers, about 3% on each drug sold. Chemists claimed that only 40% of pharma companies in the state have so far agreed to match their margins.
In a landmark decision, the DPCO has lowered prices of 348 essential drugs to bring them within the reach of every patient.
After TOI’s report on medicines for blood pressure and heart diseases disappearing from the shelves of chemists as a result of chemists’ protest against the DPCO, a review meeting was held between the Gujarat Food and Drug Control Administration (FDCA) and the Federation of Gujarat State Chemists & Druggists. In the meeting, the chemists had assured the FDCA that they would ensure there was no shortage of drugs in the state.
However, it seems a tough time is looming for patients. For instance, Aman Patel, suffering from high viral fever has been prescribed two medications – Calpol and Fevagon, substitutes for each other, as there is a problem in the availability of drugs. “The doctor told me that he was prescribing the medicines as options to make sure that I get at least one of the drugs if the other is not available,” said Patel.
Jashvant Patel, president of the Federation of the Gujarat State Chemists & Druggists, said: “Majority of leading pharma companies have not agreed to match our commission after the introduction of the new DPCO. We have assured FDCA that there will be no shortage of drugs but under the Drugs and Cosmetics Rule, the pharmacist has the freedom to sell substitutes. In order to make sure that the consumer is not harmed, we will substitute drugs of companies that have agreed to give us our margins.”
According to Jashvant Patel, chemists will talk to doctors to prescribe drugs of companies that will match margins from the current 13% to the original 20% for retailers.
H G Koshia, commissioner, FDCA, said, “As of now, the situation seems under control. However, chemists cannot substitute drugs on their own. If the chemists do so without doctors’ approval, we will have to take strict action, if required.”
Koshia said that pharma companies will see a major impact because of the 20-50% reduction in ceiling prices.
“Our profits and turnover will certainly be affected but we have continued the old margins for our chemists,” said an executive of a pharma company whose drugs fall under the 348 drugs whose prices have been slashed.
An unhealthy future for the Indian pharmaceutical industry?
In the following analysis of the Indian pharmaceutical industry, KM Gopakumar and MR Santhoshexamine the many challenges facing the industry and the policy options open to the Indian government to avert an impending crisis in its capacity to continue the production of cheap generics.
THE government of India implemented a series of policy measures in the 1970s to achieve self-sufficiency in pharmaceutical production. The first step was to revamp the colonial patent legislation and abandon product patent protection for medicines. Hence, the Patents Act 1970 allowed only process patent protection for pharmaceutical inventions. As a result, Indian companies could produce new medicines which had been introduced in the international market but were not available to needy patients in India. This made possible the production and sale of new medicines at affordable prices.
Secondly, the government introduced control measures on foreign ownership under which foreign companies were not allowed to hold more than 50% of equity.
Thirdly, the government introduced direct price control on all formulations of about 347 bulk drugs.
Fourthly, pharmaceutical multinational corporations (MNCs) were forced to start production of both formulation and bulk drugs in India.
Fifthly, public sector production of bulk drugs encouraged the small and medium enterprise (SME) sector to start formulation.
Within a span of some 20 years, these policy initiatives cumulatively made India not only self-sufficient but also a net exporter of generic medicines.
The Indian pharmaceutical industry currently ranks third in terms of volume of production (10% of global share) and is the 14th largest by value (1.5%). Its turnover has grown from a mere $0.3 billion in 1980 to about $21.73 billion in 2009-10. The industry consists of more than 5,000 small, medium and large manufacturers. The domestic market is valued at $9.44 billion, while pharmaceutical exports in 2009-10 amounted to some $8.79 billion in value terms.
The Indian pharmaceutical industry plays a critical role in supplying medicines to various global treatment programmes. For instance, Indian generic drugs accounted for approximately 50% of the essential medicines that the United Nations Children’s Fund (UNICEF) distributes in developing countries. Besides this, 75-80% of all medicines distributed by the International Dispensary Association (IDA) to developing countries are sourced from India. Similarly, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR) also source a substantial percentage of their medicine procurement from Indian manufacturers.
While the Indian pharmaceutical industry recorded spectacular growth from 1991 till the first half of the 2000s, it is now facing serious threats to its self-sufficiency and ability to compete in the generic medicines market. Any development that impacts the generic production capabilities in India would compromise access to affordable medicines not only in India itself but also in other countries, developed and developing alike.
There are multiple challenges before the Indian pharmaceutical industry emanating from internal and external sources. The most important challenge is the growing control of the Indian pharmaceutical industry and market by MNCs and their ruthless exploitation and abuse of the product patent protection afforded by India’s current patent regime. How did this situation come about? What were the developments that have contributed to this undermining of the country’s self-sufficiency in medicine production and the future availability of generic medicines for its people?
Two policy decisions by the Indian government can be identified as crucial in the emergence of the present crisis facing the industry. The first of these was the change in the government’s policy on foreign investment, and the other was the radical change in the country’s intellectual property regime to comply with World Trade Organisation (WTO) treaty obligations. Together, both these changes set the country on the present destructive course.
Foreign acquisitions and strategic alliances
In 2001 India liberalised foreign direct investment (FDI) norms for the pharmaceutical sector. As a result, 100% FDI was allowed through the ‘automatic route’ (without prior permission) in pharmaceutical manufacturing (except in sectors using recombinant DNA technology). The FDI policy did not make any distinctions between ‘greenfield’ (new facilities) and ‘brownfield’ (takeover of existing facilities) investments. However, during the last 12 years MNCs did not make any major effort to undertake greenfield investments in India, largely opting for brownfield investments, i.e., acquisition of Indian companies.
In recent years there have been a number of high-profile MNC acquisitions of Indian pharmaceutical companies, starting with the takeover of Matrix Laboratories by US generic manufacturer Mylan Inc in 2006. This was followed by the Japanese corporation Daiichi’s acquisition of India’s largest pharmaceutical company Ranbaxy. At times MNCs offered purchase prices which were many times higher than the actual sales turnover of the acquired firms. For instance, Abbott paid $3.7 billion for Piramal Healthcare, whose sales revenue was reported to be approximately $400 million. Table 1 provides details of several high-profile acquisitions of Indian pharmaceutical companies.
The same period witnessed a series of strategic alliances between MNCs and Indian pharmaceutical companies. Table 2 provides a list of selected strategic alliances. Generally speaking, these strategic alliances take place in any one of the following areas: research and development (R&D), marketing and contract manufacturing. Of the three categories, the dominant form is in the field of contract manufacturing.
MNC acquisitions and strategic alliances should be understood and analysed in the context of changing dynamics in the international pharmaceutical market (see below). However, to appreciate the full impact of such foreign takeovers and tie-ups, it is necessary to take into account the far-reaching changes introduced by the Indian government to the country’s intellectual property laws.
Product patent protection
In 2005 India reintroduced the product patent regime to comply with the obligations of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This replaced one of the important policy tools used for the development of the Indian pharmaceutical industry. In the absence of product patent protection prior to 2005, the Indian pharmaceutical industry was able to introduce new medicines in the Indian market and abroad within a short period of time at a fraction of the originator’s price. Further, competition was generated among Indian pharmaceutical manufacturers because, with no product patents, many companies introduced the same products in the market. This competition, coupled with price control on essential medicines up to the mid-1990s (a 1995 order limited the number of medicines under price control to 74), resulted in the availability of medicines at low prices.
The reintroduction of product patentability takes away the freedom of Indian pharmaceutical companies to introduce generic versions of new chemical entities (NCEs) in the normal course because NCEs often come with product patent protection. Thus, a company like Cipla, for example, can no longer see a repeat of its historic announcement in 2000 of making available generic first-line HIV/AIDS medicines for just $350 per person per year against MNC prices of $10,000-12,000. Under the product patent regime, a generic version of a patented NCE can be introduced in the market only by having recourse to flexibilities in the patent law, viz., patent opposition, compulsory licensing or parallel importation.
Seven years after the introduction of product patent protection, there is ample evidence of growing control of MNCs in the Indian pharmaceutical market. Figures released by the Indian Patent Office reveal that out of 3,488 product patents issued from 2005 to March 2010, 3,079 were granted to MNCs.
Further, an unpublished study by one of the authors has found that, out of 413 NCEs approved by the US Food and Drug Administration (FDA) in 1995-2010, only 240 obtained a marketing licence from the Indian drug regulatory agency. Out of these 240 NCEs registered for marketing approval in India, only 160 are available from generic manufacturers. This shows that there is no generic availability for some 80 NCEs. Moreover, more than 170 NCEs are not even available in India.
Even if these 170 non-available NCEs and the 80 NCEs without generic versions may not be important from a public health perspective, it is a clear indication of the growing gap in the availability of new medicines. This is also evident from the fact that out of the 108 NCEs approved by the FDA for marketing in 2005-10, only 52 are available in India. The drying up of the generic pipeline is further illustrated by the fact that out of the 52 NCEs, generic versions are available for only 14.
A recent study by Prof. Sudip Chaudhuri from the Indian Institute of Management provides ample evidence of the growing control of MNCs in the Indian pharmaceutical sector. According to the study, from 1995 to 2010, there were 180 NCEs and new biological entities (NBEs) in India in terms of value. Of these 180 new medicines, MNCs are marketing 92 in India and enjoy a monopoly over 34 medicines. [The monopoly status is based on the actual monopoly in the market (single source producer) and not on the patent status in India.] These 34 medicines, which account for 31% of their sales of the 92 medicines, fall into the following therapeutic areas: anti-cancer (11); cardiac (7); anti-infectives (5); analgesics (3); neurological (4); anti-diabetic (3); and ophthalmological (1). The study lists the exorbitant prices charged for the 34 monopoly medicines.
The study also reveals a growing trend of importation of patented medicines by MNCs. Even though there is an export surplus, ‘importation has grown at a faster rate than exports, leading to a decrease in formulations trade surplus’ (Chaudhuri, 2011). The value of formulation imports expanded from $69.5 million to $1,096.1 million between 1995 and 2010, at a compound annual rate of growth (CARG) of 20%. During the same period, exports grew at 17% CARG.
Against this background, Prof. Chaudhuri considers direct price control of patented medicines. According to him, ‘Price control is not forbidden under TRIPS or any other agreement of the WTO. The Draft National Pharmaceuticals Policy, 2006 (p. 15) recommended mandatory price negotiations of patented drugs before granting marketing approval and stressed the importance of studying the experiences of Canada, Australia, France and other countries believed to have a good system.’
Comparing price control with compulsory licensing, Chaudhuri says that price control, ‘if properly implemented makes drugs more affordable but does not provide any room for the generic companies. [Compulsory licensing] not only makes the prices more affordable through competition. It also ensures some space to the generic companies, which is vital for their long term sustenance’.
A study by Dinesh Abrol et al. (2011) examining the post-TRIPS behaviour of MNCs in India states, ‘Strong IPRs [intellectual property rights] have not favoured India with the claimed benefits of increased access to good quality FDI, technology transfer, overseas product R&D and stimulation of domestic investment in R&D for product innovation for local needs.’ On the technology transfer front, the study says, ‘During the pre-TRIPS era foreign pharmaceutical firms often exhibited in India an almost near complete aversion to technology transfer in bulk drug production. Evidence collated on the recent patterns of technology transfer from foreign firms to domestic companies shows that the results are not very encouraging for pharmaceuticals.’ Regarding investment in R&D for drug development, the study finds that Hoechst and Astra, which carry out limited drug discovery operations in India, still remain, ‘while others have closed down the units that had the mandate to develop products for the benefit of local markets’.
These studies in fact provide further basis to support the argument for using flexibilities allowed by the TRIPS Agreement to introduce generic versions of patented medicines. In this regard, the Indian Patents Act’s provisions on compulsory licensing provide an effective tool to curb the abuse of patent monopoly.
Recently the Indian Patent Office issued domestic drug company Natco Pharma with a compulsory licence (CL) to produce pharmaceutical MNC Bayer’s anti-cancer medicine sorafenib tosylate. As a result of the CL, the medicine would be available to patients in India for Rs8,800 per month, against Bayer’s price of Rs280,000 per month. (See the article ‘The compulsory licence on sorafenib: A right step to ensure access to medicines’ in this issue.)
This decision of the Patent Office is expected to generate more applications for CLs in the coming days. There are many medicines under product patent protection in India which are prohibitively priced. These medicines are ideal candidates for CLs.
However, currently there are no pending CL applications before the Patent Office. Indian companies are believed to be adopting a wait-and-see stance by keeping track of the developments with regard to the sorafenib CL. Further, there is a need to finetune both procedural and substantive legal provisions on compulsory licensing, especially the time period for the disposal of CL applications, royalties and conditions for granting CLs.
However, the most important threat against the use of CLs in future comes from MNC acquisitions of Indian pharmaceutical companies and strategic alliances. These have the potential to eliminate the possibilities of using flexibilities in the Indian Patents Act to ensure access to medicines. The dominance of MNCs over the Indian pharmaceutical market resulting from acquisitions and strategic alliances would neutralise the use of flexibilities like compulsory licensing.
Acquisitions, alliances and adverse effects on access to medicines
The global pharmaceutical industry is undergoing unprecedented levels of transformation. The ‘blockbuster drugs model’ followed by the pharmaceutical MNCs is now under severe crisis. The R&D pipeline has dried up to a great extent and the number of NCEs has come down significantly. Moreover, the MNCs are also expected to be hit by the expiry of patents on existing molecules. In fact, almost all the blockbuster drugs of pharmaceutical MNCs are going to be off-patent in the near future. In addition, Indian generic companies started challenging the patents on blockbusters. As a result, the global generic market, especially in the regulated market, is growing rapidly.
Another important problem facing the industry is that, with the global financial crisis, the developed countries have begun cutting social security spending as part of their economic austerity measures. This is expected to have implications for out-of-pocket drug expenditures as well as public procurement of drugs.
In order to meet these challenges, MNCs have resorted to various strategies, one of which is to control the generic medicine market. Acquisitions of and strategic alliances with generic companies should be understood in this context. The following are among the strategies adopted by the MNCs to face the ongoing crisis in their business model:
* Set up standalone generic companies to cash in on the growing generic market (see Table 3). This is a clear departure from the earlier business model, with MNCs now focusing on both patented and off-patent medicines. This would enable MNCs to gain dominance over the generic market and control the introduction of generics.
* Get into strategic alliances and contract manufacturing deals with generic players from the developing countries in order to source products in a cost-effective manner. This would deter the generic companies from entering into R&D activities which would result in the development and marketing of new drugs or the aggressive introduction of generic versions of patented drugs.
* Establish stronger intellectual property regimes to ensure and extend monopoly in the market. This is sought to be achieved through ‘TRIPS-plus’ measures (which go beyond the standards set by the TRIPS Agreement) imposed by free trade agreements (like the Trans-Pacific Partnership Agreement) and stricter intellectual property enforcement standards (through initiatives like the Anti-Counterfeiting Trade Agreement).
* Enter into emerging markets through acquisitions and strategic alliances.
As indicated above, such acquisitions and alliances have far-reaching consequences and can potentially compromise access to affordable medicines. Judging from previous takeovers, it is evident that the MNCs are mainly targeting Indian companies with a high level of technological capability. If the takeover drive is left unchecked, India would suffer severely especially in the realm of innovation. Since Indian companies would get locked into the lower end of the value chain, India would be forced to compromise on need-based R&D and become completely dependent on MNCs for meeting the country’s drug needs in the long run.
Secondly, such acquisitions would neutralise the flexibilities permitted under the TRIPS Agreement. The presence of an active domestic sector with technological capabilities is needed to make use of the TRIPS flexibilities such as compulsory licensing and patent opposition. MNC acquisitions of domestic generic companies would either fully eliminate or restrict the use of flexibilities. For instance, immediately after its takeover by Daiichi, Ranbaxy withdrew all the patent challenges against Pfizer’s blockbuster cholesterol drug Lipitor.
Thirdly, these acquisitions would result in the capture of the marketing and distribution networks of Indian generic companies. Takeovers are an easy way to establish a marketing and distribution system in a country and substitute low-cost medicines with higher-priced, including patented, versions. For example, the main objective of Abbott’s acquisition of Piramal Healthcare was to acquire the latter’s marketing and distribution network, as Abbott acquired only one manufacturing facility from the Piramal group. With this takeover, Abbott now ranks first in market share in India. (Abbott has also made it clear that there is no plan to start exporting from India.)
Fourthly, the MNCs are seeking to buy and kill off the competition in a global generic market which is growing at a fast pace. MNCs want to restrict the Indian companies from getting into the regulated markets with their low-priced generic products. At the same time, the MNCs are also devising their strategies to capture the Indian market, which, while relatively small in global terms, is one of the fastest-growing pharmaceutical markets.
Fifthly, these acquisitions would result in high medicine prices. According to the Indian Pharmaceutical Alliance, an association of Indian pharmaceutical companies with R&D activities, Abbott increased the prices of medicines produced by Piramal immediately after its takeover. For example, the price of Haemaccel was Rs99.02 in May 2009; by May 2011 it had gone up to Rs215 – a 117% increase in the space of two years. In another instance, the epilepsy drug Gardenal registered a price hike of 121% during the same period.
The issues relating to takeovers and high drug prices have triggered considerable debate and discussion among policymakers and commentators in India. Some of the concerns discussed above were shared by the parliamentary standing committee on health, which in a July 2010 report referring to the acquisition of Indian pharmaceutical companies stated: ‘These developments would result in MNCs gaining market supremacy and essential medicines are bound to become costlier. The Committee would appreciate if the Ministry of Health and Family Welfare takes up this issue with the Ministry of Chemicals and Fertilisers without any delay to come up with policy options to ensure that major Indian pharma companies remain in Indian hands.’ Likewise, the Ministry of Health and Ministry of Commerce and Industry opposed such acquisitions.
A High-Level Expert Group Report on Universal Health Coverage for India released in October unambiguously stated that ‘we also need to urgently revisit India’s FDI regulations to amend the present rules of an automatic route of 100% share of foreign players in the Indian industry to less than 49%, so as to retain predominance of Indian pharmaceutical companies and preserve our self-sufficiency in drug production’. Similar concerns were also expressed by many public interest organisations such as the All India Drug Action Network, the Centre for Trade and Development (Centad) and the Delhi Science Forum. The parliamentary standing committee on commerce is currently examining the issue in detail.
Responding to these concerns, a high-level meeting chaired by the Prime Minister in October adopted, with a slight modification, the recommendations of the Arun Maira Committee which had been appointed to consider a policy response to the issue of FDI in the Indian pharmaceutical sector. The decision amends the existing policy which allows 100% FDI in the sector under the automatic route, and differentiates between greenfield and brownfield investments. Further, brownfield investments will be routed through the Foreign Investment Promotion Board as a transitional arrangement for six months. The Competition Commission of India (CCI), which regulates mergers and acquisitions, has also been charged with overseeing such investments. A six-month transition period is also provided to amend the Competition Act and Rules to equip the CCI with the powers to effectively perform the function. This shows that the government has decided to use only competition law to address the concerns emerging out of acquisitions of Indian generic companies by the MNCs.
The power of the CCI to inquire into mergers and acquisitions is already enshrined in Section 20 of the Competition Act. Sub-section (4) of Section 20 states: ‘For the purposes of determining whether a combination [mergers and acquisitions] would have the effect of or is likely to have an appreciable adverse effect on competition in the relevant market, the Commission shall have due regard to all or any of the following factors’; it goes on to list 14 factors. Hence, the focus of the Commission is to approach the issue from a competition point of view. The Competition Act and the Commission are not equipped to deal with the abovementioned issues which are completely out of the purview of the competition law but which are crucial to access to medicines. Another important shortcoming of the competition law approach is that the decisions of the Commission would be subjected to judicial review and may be overturned by the courts.
Therefore it is important for the government to put in place a policy-oriented approach and the appropriate tools to address the policy concerns stemming from the acquisitions of Indian pharmaceutical companies.
Conclusion
Any development that affects the Indian pharmaceutical industry would impact on developing countries’ access to medicines. The introduction of a product patent regime took away the freedom that had previously been available for Indian pharmaceutical companies to introduce generic medicines. Generic versions of patented medicines can now only be produced by invoking the TRIPS flexibilities which have been incorporated in the Indian Patents Act.
However, only a few Indian pharmaceutical companies are making use of these flexibilities to introduce generic versions of NCEs. The legal provisions should be finetuned to simplify recourse to these flexibilities. Further, the government has to encourage the use of these flexibilities through policy tools and capacity enhancement.
Importantly, there is a need to address MNCs’ growing control over the Indian pharmaceutical market, which poses a major threat to the use of TRIPS flexibilities and can undermine access to medicines. The Indian government’s policy response to this threat so far has fallen well short of what is required, especially in dealing with acquisitions and strategic alliances. The need of the hour is to develop multi-level policy responses to curb direct and indirect acquisitions of domestic generic companies with the objective of creating an enabling environment for the generic industry to stay in business and move up the value chain. In doing so, access to affordable medicines must be safeguarded at all times.
KM Gopakumar is a senior researcher with the Third World Network. MR Santhosh is a research associate with the New Delhi-based Centre for Trade and Development.
The authors acknowledge the valuable help extended by Vinay Singh and Surbhi Kapur, LL.M. students at the National Academy of Legal Studies and Research (NALSAR), Hyderabad, India, in compiling data.
References
Abrol, Dinesh, Pramod Prajapati and Nidhi Singh (2011), ‘Globalisation of the Indian Pharmaceutical Industry: Implications for Innovation’, International Journal of Institutions and Economies ,Vol. 3, No. 2, July, pp. 327-365.
Chaudhuri, Sudip (2011), ‘Multinationals and Monopolies: Pharmaceutical Industry in India after TRIPS’, Working Paper Series, WPS No. 685, November, Indian Institute of Management, Kolkata.
Government of India (2010), Forty-fifth Report on Issues Relating to Availability of Generic, Generic-Branded and Branded Medicines, Their Formulation and Therapeutic Efficacy and Effectiveness, Department-Related Parliamentary Standing Committee on Health and Family Welfare, Laid on the Table of the Lok Sabha on 4 August 2010.
Santhosh, MR (2011), ‘A Critical Evaluation of the Implications of TRIPS on Pharmaceutical Industry and Access to Medicines in India’, paper presented at the National Consultation on Public Health, Innovation and Intellectual Property in India: Status and Proposals, NISTADS, New Delhi (unpublished).
India is the place to be, say home-bound doctors
After technology sector, it’s the health sector in Bangalore that is witnessing a reverse brain drain. Across fields-nephrology, general medicine, pathology, orthopaedics and oncology among others, doctors are returning to India in general and Bangalore in particular.On an average big medical hospital chains in the city each get 8 to 10 applications every month from Indian doctors in the US, the UK, Canada, Australia and Singapore. “I interview one doctor a week. And in the last six months I have got 12 applications for jobs from doctors abroad. They are all in their 30s,” says Dr H Sudarshan Ballal, medical director, Manipal Hospitals.The scene is no different at Sparsh Hospital on Narayana Health City campus where chief orthopaedic and hospital head Dr Sharan Patil scrutinizes at least 10 applications every month from doctors in the UK, Australia and the US.”There is no bigger canvas to paint yourself than in medicine. Two decades ago when doctors left India, the opportunities were few. Today opportunities outweigh frustrations. After the training, they want to return,” says Dr Patil, who himself spent five years in the UK before returning to the city to become a doctor-entrepreneur.Ten of the 40 orthopaedicians at Sparsh are those who have returned from abroad. “I began to feel I was making no difference in my job and decided to leave Australia. I find it more satisfying here. But it is good to study and train abroad for some time,” says Dr A Thomas, spine surgeon, who practised for five years at St George Hospital, University of South Wales.Hospital honchos are seeing the trend only in the past five years. In many hospital chains of Bangalore, the entrepreneurs are doctors themselves who left practice in the dream country where they were and came back home.
For Dr Ajai Kumar who worked at the Anderson Cancer Hospital in the US, India is evolved and it’s an experience doctors don’t want to miss out on. “The country I left in the 1970s is astounding now. It has all the infrastructure and there is no dearth of training. So what is the excuse now?” says the oncologist, who started the HCG chain of hospitals in India after spending nearly two decades in the US.The alarming growth of cancer is also one factor drawing doctors to Bangalore. Dr Ajai gets about 15 applications from doctors in the 30-40 age group every year. From paediatric oncologist to hepato biliary surgeon at HCG, the specialists who have returned to Bangalore are from across the spectrum.
Ask Dr Pallavi Rao, pathologist, who got back to Bangalore from the UK with her radiologist husband Dr Srikanth Narayanaswamy, why she took the call. “We were there from 2005 to 2012. We chose to come back home as it stopped exciting us there,” she says.Ditto with Dr Rekha Bhatt who joined the Manipal hospital after winding up her practice in the US. “Go there to study but get back here. India is the place to put your studies to use,” says the pathologist.For many, it is the learning experience that matters. There is no TB, dengue or malaria in western countries. “For doctors, especially youngsters, treating diseases that are prevalent means more exposure. India is a great lab for doctors because of the sheer size and the number of surgeries we do,” says cardiologist Dr Devi Shetty.”Coming back was no compromise for me. I began to feel that Bangalore was in no way inferior to other countries, especially in my area of specialization,” says endocrinologist Dr Karthik Prabhakar who left for the UK in 1998 only to get back to the city.For many the dream of foreign shores is over. As a child, one of India’s top nephrologists Dr Ballal dreamt of going to the US and working there. He worked towards his dream and at 21, got his green card to do his MD in nephrology and critical care. “I was not keen on coming back. In 1991, I reluctantly returned. I told myself I will give two years to decide if I want to go back. The first few months were miserable. Twenty years on, I have no regrets. I will never leave India.”
GENERIC MANIA
Now government doctors would prescribe only those medicines which were available in essential drug list (EDL) of government health centres, while giving consultancy at their residences.Till now they were bound to write medicines from EDL in hospital only but this rule would be applicable during their private practice also.Not only this, doctors would be asked to refer their patients to government health centres for all the diagnostic tests instead of any private diagnostic centre.The proposal for the same has been prepared and orders would be released by the health department soon.
The motive of starting this system is to promote generic medicines among common people.Principal secretary, health, Praveer Krishn said this would help poor people to get good treatment in less cost.He said this was to assure that government doctors should write only generic drugs.This system would also help in promoting health facilities of government sector, he added.He further said with the help of this system people visiting private clinics of government doctors would be able to get their pathology and other diagnostic tests done in government health centres.Government doctors would refer their private patients to government health centres for diagnostic tests, he added.This system would save lots of money of government as large amount of money was invested by the government on reimbursement of cost of medicines of retired government employees.The retired government employees used to prefer private clinics for treatment, where doctors used to prescribe open market medicines.It will also help those people who wants to avoid rush of government hospitals but wants to take medicines from government hospitals.Several people feel that doctors at government hospital does not give sufficient time to patients so they prefer to go to their private clinics for treatment but with this system they will have a choice to get generic medicines at private clinics also.One more patient was diagnosed with dengue in Bhopal on Monday.The 34-year-old man was resident of Haryana, but was in Bhopal for the past few days.Till now, total 24 patients have been diagnosed with dengue in Bhopal this year. The health department team is regularly conducting fogging in those areas, where cases of dengue have been identified.
AIR OF PESSIMISM : India lacks quality medicines, report says
Quality is the biggest when it comes to GENERICS In India. In western world generics have to ensure specific quality checks before marketing but here generics are sold without any regulation. Any company can sell their generics even at premium price and getting rebate on the formulation as it is not branded.
India lacks access to good quality generic medicines for heart problems and non-communicable diseases like diabetes, a report said on Tuesday.The report, Health and Healthcare in India, was released by the University College London (UCL) School of Pharmacy in the capital.”India currently spends only a little over one per cent of its Gross Domestic Product (GDP) on publicly funded healthcare and only about 0.1 per cent of GDP on publicly funded medicine,” said David Taylor, co-author of the report.
“These are very low figures even by the standards of the world’s least developed countries,” added Taylor.The report also highlights that the harm caused by non-communicable diseases will rise if tobacco consumption does not fall and the use of medicines for hypertension and Type 2 diabetes is not increased.”There are no easy answers as to how the poor in the world can gain access to essential medicines without over supplying products like antibiotics or undermining provisions like patents. We need strengthened mutual understanding to achieve better care to sustain innovative research,” said Jennifer Gill, co-author of the report.As per the report, the potential solution to the problem is to allow public healthcare providers in low income countries to obtain essential patented medicines at affordable costs from producers
