Medicines for government hospitals in Kerala are bought by the medical services corporation. A comparison of the rate at which a medicine is supplied to the corporation and its MRP will reveal the extent of the profit taken by middlemen. The loot reaches its peak in medicines for cancer, diabetes and heart disease.
Paclitaxel with Codan Set is a medicine injected on cancer patients during chemotherapy. The corporation bought this medicine for Rs 575 per 100 milligram, but its maximum retail price (MRP) was Rs 5,500. The corporation got 260 mg of this medicine for Rs 1,226 while its MRP was Rs 10,850. The corporation buys 500 mg of Amifostine, a medicine injected during the treatment of cancer, for Rs 430 while its MRP is Rs 4,255. Thus, the price difference is more than ten times for each medicine as per the data released by the corporation. Still no steps have been taken to stop this loot. Though Janapaksham and singer Yesudas have moved the high court on this matter, a final verdict is awaited.
No pity for even children
During his stay in a hospital for chemotherapy, Innocent, an actor and a member of parliament, met a mother and her child. The child had undergone two chemotherapy sessions. The mother told Innocent that her child would not undergo another chemotherapy session due to lack of funds. Amid busy treatment schedule and weakness caused by the disease, he could not contact them again. After a few days, he came to know that the child had died. Did the child know that it had to embrace death because there was no money for treatment?
The hospital in Delhi charged Innocent Rs 60,000 for one dose of chemotherapy medicine. The offer was one free dose for every purchase. If the drug manufacturer makes a profit even with such an offer, what would be the real price of that medicine?
Boundless MRP
There is no method to determine MRP, which people notice while buying medicine from a pharmacy. MRP increases if a product’s packing and distribution network are better. In reality, cost of production is only 10 per cent of the MRP printed on a pack of medicine. The remaining 90 per cent reaches the pockets of different people. Even when we swallow paracetamol tablets worth Rs 10, we pay commission to the manufacturer, the carrying and forwarding agency, distributors, retailers, hospitals, doctors, pharmacists, sub-dealers and medical representatives.
Cryptic prescriptions
The medical council has instructed doctors to write generic names in English capital letters while prescribing medicine. But it is not followed. What if even pharmacists in medical stores can’t decipher prescriptions? Recently, the human rights commission heard such a case. The commission demanded explanation from IMA, the association of doctors, and the health department. The IMA replied with a counter question: what can we do if pharmacists can’t read?
If it is mandatory to write generic names, the IMA’s stand is that drug manufacturers must be instructed first to release medicines only under generic names. It was in 2002 that the Medical Council of India brought the amendment which insisted on generic names. Arguments for and against it have been going on for the past 13 years.
Undermining price controls
The National Pharmaceutical Pricing Authority lists medicines under price control. In 1995 the list contained 75 medicines. It was revised only after 18 years. The revised list of 2013 contains only 348 medicines. When many companies withdrew medicines in that list and substituted them with new ones, prices rose further, making the list ineffective.
For example, doctors used to prescribe Ranitidine to treat acid reflux, a common condition. When it was included in the price control list, its price fell to 25 paise per tablet. To overcome this situation, drug manufacturers reduced production of this tablet. Instead, they introduced a generic medicine, Omeprazole, at Rs 5. Since it was not in the list, its price could not be controlled.
Dumping expired medicines
Recently sacks of medicines were unearthed during construction of a building in Pattimattom in Ernakulam district. They were not a treasure but expired tablets, syrups and other bottled medicines. The plot used to belong to a wholesale drug dealer in Ernakulam, and it was used to bury expired medicines. Later that plot was sold. Similarly submerged medicines can be found even in ponds and rivers, and the fish that eat them later end up on our dining table. The government has not put in a system to destroy expired medicines.
No mercy for Karunya
Five years have passed since Karunya pharmacies were opened under the aegis of Kerala Medical Services Corporation. Though the number of Karunya outlets has increased from 13 to 39, its monthly turnover has fallen from about Rs 11.5 crore to about Rs 8 crore. Many important medicines that patients need are not available in Karunya outlets, which operate adjacent to government hospitals.
It is when Karunya is reeling in this condition that CISSIL Group, a retail chain, has come forward to open 100 outlets under the prime minister’s Jan Aushadhi Yojana. Though this project will bring relief to patients, it has to be seen how far it will be allowed to progress by the drug lobby.
System failure
Even among drug inspectors, who should ensure the quality of drugs, there are some bad apples. It is the drug inspector who recommends renewal of the licence of a pharmacy to the assistant drug controller. After recommending renewal of licences of a few pharmacies that come under him, one drug inspector called a pharmacy owner who was his confidant and made him call other pharmacy owners. His coded message was that licence applications have not been entered into computer because of system failure. Pharmacy owners got the message, and when money reached his desk, the system failure was solved.
_(Prepared by Jayan Menon, N.V. Krishnadas, Gayathri Jayaraj and Joji Simon and compiled by George Varghese) _
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