Going with generics

In educated societies, they believe in choice. In India we believe in destiny. Thankfully, in this information age, that worldview of the perennially helpless has been changing. And in critical areas like healthcare, this access to choice could make a difference between life and death.

So it is wonderful that our government — which spends a measly 1.2 per cent of the GDP on health, among the lowest in the world — has finally woken up to the health needs of our 1.2 billion people. In its effort to help the poor access healthcare, it is seeking to bring down costs by offering cheaper alternatives and even free drugs in government hospitals. It plans to sidestep overpriced medicines of big pharmaceutical companies and push generic versions instead. These come at a fraction of the price of branded drugs. And the government plans to legally restrain government doctors from prescribing branded medicine — which could certainly help in making healthcare affordable.
In a parallel move, the government is reportedly setting up a text messaging service to help you find out on SMS about generic alternatives to a branded drug prescribed by your doctor, and their respective costs. In our enormously price-sensitive market, empowering the patient with cheaper options could actually help millions get proper medical treatment instead of turning to quacks or simply neglecting their ailments.
But are generic drugs really as effective as the branded ones? Ideally, yes. The generic version is supposed to have precisely the same salt in the same strength and should be as effective, with exactly the same use, dosage, effects, side-effects and risks. So why is it so cheap, then? Ostensibly because it does not have to bear the expense of all the research and development that the original company had to go through. It simply copies the end result. And in India, we are master copiers.
Give us anything, and we will make an exact copy, proudly print a “Made in India” label on it and hawk it at half the price. Try buying a gadget from any self-respecting neighbourhood shopkeeper in Delhi. He will flaunt all kinds of big brands, then push some unknown model and whisper, “Take this. Cheap and best!”
Sadly, cheap may not always be best. In fact, our cheap copies very often compromise on quality. And that is very likely in drugs as well. Especially because we do not have a strict system of spot checks for quality control. According to the World Health Organisation, almost 40 per cent of India’s medicines are spurious. The fake drug industry thrives on bribe-power and poor scrutiny. Generics are not fake, but may take advantage of this laxity and not pay attention to quality control.
In certain developed countries where it is mandatory for doctors to prescribe generic drugs and not brand names, the government makes sure by law and a system of regulation and stringent checks that generic drug is as safe and effective as branded equivalents. That is not the case in India right now. So here, generic drugs could very well be manufactured in a less than optimal way, making them less effective, even ineffective and unsafe.
So finally, like always, the success or failure of this government plan hinges on accountability. What we seem to forget is that most drugs we use are actually generic, but branded. One company develops a drug, patents it, and sells it for a huge price. When the patent runs out, other brands copy and sell the same drug. So as long as there is accountability, we have no real reason to fear generics. They may be less effective sometimes, because the efficiency of the medicine depends not just on the salt but on the process of manufacturing, and even packaging. But usually, with responsible companies, there is very little variation in efficiency. So as long as there is quality control, a wider and more rational use of generics would be a huge blessing, especially for the less privileged.
No one knows that better than us — since India is a world leader in the manufacture and sale of generic drugs. Till very recently, India did not have patent laws on drugs, and pharmaceutical companies built their brands and fortunes on replicating existing drugs. So almost all our generic drugs are branded.
And we have made our mark in the international arena. Generic drugs burst into world consciousness in 2001, when the idealistic Dr Y.K. Hameid, owner of Cipla, defied Big Pharma norms to put “people before profit”. He pitched in to fight the HIV/AIDS pandemic in Africa where people could not afford the prohibitively expensive antiretroviral drugs by offering generic versions of the patented drugs at less than $1 a day. This led to shock and horror from Big Pharma and an intense debate about intellectual property rights vs the right of people to access essential medication. And finally changed the way the world looks at medication for ever.
Today, the whole world is increasingly depending on generic drugs. The price of treatment for grave ailments like AIDS, drug-resistant tuberculosis and now cancer have been reduced dramatically by allowing generic alternatives. So generic medicines are the future, even if that inconveniences Big Pharma and the doctors and government officials they have so carefully cultivated.
Our problem lies in quality control, which is conspicuous by its absence in India’s health sector. And government centres, including hospitals, are terrifying pools of apathy and callousness. This is particularly shocking in rural areas, where even basic regulation is flouted, and patients are routinely given expired medicine, as well as wrong medication. The cold chain that is supposed to keep serums and vaccines safe is broken with impunity, leading to severe complications, permanent damage and even death. The poor in urban areas are somewhat better off — but they too have very little choice in their treatment; doctors regularly hand out loose, nameless medicines for them to pop unquestioningly.
So the question of choice is limited for most Indians anyway. But new government systems like the SMS on generics would offer a choice to urban, educated classes. And for the underprivileged, free generic medicines could offer a choice between life and death. In short, the government is taking very important steps towards better healthcare for all — but it can only happen with strict quality control and an accountable regulatory system in place.

The writer is editor of The Little Magazine. She can be contacted at: sen@littlemag.com