Sunday, 13 October 2019

Doctors Loot! Really?! Part 3


If anybody really loots in the health care Industry [?], hands down it’s, the pharmaceutical industry in India. Reasons are varied and multiple, some justifiable some totally freak! It’s most disorganized  industry though having many strict rules and regulations, our ingenious traders always find so many loopholes, some even big enough for an elephant to pass through!
India has neither invented nor manufactured so far a single molecule [apart from Ayurvedic medicines, which do not stand any scientific test on any account,!] on its own. All the medicines used by Modern Medicine practitioners,[ i.e. pain killers, antiallergics, and last but not the least antibiotics, which have brought infective diseases mostly under control], have been researched and invented by First World scientists, except few by Chinese who have been successful in beating whites in their own game.[They made a very effective drug for resistant Malaria using their knowledge of ancient Chinese medicinal system, that has been accepted by the entire world, of course including Western world!]. So we have to depend on the western world for molecules as well as for the technology thereby pushing the cost of the end product. medicine skywards!


All the Indian Pharmaceutical companies import raw materials, mostly from China,[Though besides the point,  it would be pertinent here, to know, for those who shout from the rooftops  against the use of Chinese goods, that it’s not about the Diwali lamps or two rupee toys, it’s about the import of Medicinal raw material from China if stopped, our Pharmaceutical industry will be defunct, the next second!], [Also stands for heavy goods like the machinery required to build the factories, Metro coaches etc] And these imports are in crores!  

Fortunately, the Indian Government has acted firm and wisely and stoically refused to patent the molecule but not the process, keeping the loophole that the molecule can be processed by any another method! Thus all these Ranbaxys, Reddys, Sun Pharma, Cipla and so many other Indian companies import raw material at the penultimate stage, process it differently and sell in India at much lesser price by the world standard! Had it been molecule being patented, a simple fever lowering pill, Paracetamol which costs only a few rupees, would have cost so much, almost breaking the ceiling and would have been well beyond the reach of a common man. And it’s the cheapest medicine!
The reason being given by the Western pharmaceutical companies, Mostly from the US of A, is really relevant. To bring out a single molecule useful for the mankind, at the same time financially viable, the company has to invest millions of dollars in research for hundred other molecules which may not turn out to be useful so the entire expenditure goes down the drain. Here it includes the remuneration of hundreds of researchers working on the molecule, ancillary staff, cost of the equipment, cost of raw material, taxes, oh so many other aspects. So the company has to recover the cost of this colossal waste from THE only “Molecule” that’s financially viable!  India at this stage just cannot afford such a sophisticated research system, at the most, she can buy the ready-made research and/or the technology and so the COST!
Another malady that plagues our Pharmaceutical industry is Authenticity. On this point, the score on the board is ZERO, big ZERO!
Many big names in the market, do not manufacture their own drugs. They outsource! So if you are buying a drug at an astronomical price because it’s branded, coming from a reputed a company, you are getting cheated, maybe, because THE Company outsources it to a smaller unit to cut the costs, but in the bargain compromising on the quality because the smaller manufacturing unit just doesn’t have the “Quality Control”. The flack may not stop here, Next It very well may be manufactured in a Gala, having a Horse stable next to it!  And the big companies? They are outsourced by their counterparts in Europe, mostly Italy because the labour is cheap in India!
I got to know from a very reliable source that out of 100s drug manufacturing units, he examined all over India, hardly 5 passed the muster!
And I believed him immediately. To show the transparency in dealings, every government institution has to float tenders to buy even the paper pins. By my misfortune I always had to be the part of it, being the most senior. Once a carton of Vit ‘B’ tablets arrived where there were no tablets in the strips, but if you open it, some yellowish powder flowed freely! [It must have come from some dubious firm having 'understanding' at the top levels, otherwise how would you explain?] On refusing to accept the indent; I was told bluntly that I was the one who had signed the final document! Even then I put my foot firmly on terra firma and said ‘No’! Maybe they showed the repent, which was façade! Definitely! RMO in charge of the drug purchases made student nurses peel off every strip and store the powder in a glass jar. The instruction doled out was, “whenever Dr Benurwar writes T. Vit B, give the patient a spoonful from the jar!” Aghast is a very mild word. After years of doing the job in a semi-government organization, I had realized that the nexus so vast and deep, was beyond me, the best option would be to keep mum! And I kept mum thereafter in every such dealing! In a juggernaut, if you are a small wheel, you have to rotate with the bigger one, if not, you are just deaxeled!
Barring few, 90% Indian pharmaceutical companies are small scale. They operate practically on the clandestine level but charge marginally less than the big sharks! None of the big operators is ready to bring out the medicines/drugs under Generic category fearing that they will lose the monies. The companies who have come out with generics, their credentials are a big question mark? All the government hospitals dispense medicines which are made available to them by someone sitting higher up [and having the hand in the deals], so if a patient is getting drug ‘X’ for his hypertension, next month he will get antihypertensive no doubt,but from a totally different group ‘G’ No consistency of supply, no authenticity, poor bioavailability, to be born in India as poor patient is a curse!
All in all, if entire expenses for the medical emergency are scrutinized, Doctors’ charges are always less than 10%. Majority of the chunk is taken away by the medicines, the investigations, hospital charges and other sundry expenses and the allegation is ‘Doctors Loot!’ If you have read the above blog carefully and with heart, you too would say,' Really?'
  

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