Is Aamir Khan India's Bill Clinton on public health?

When Aamir Khan argued for the use of generic drugs in his show Satyamev Jayate, he was both right and wrong in the same breath. Almost entirely right in principle and idea, but a little bit flawed in his suggestion of its practice. He was in fact spot on when he said that generic drugs were the key to affordable healthcare in India. It was an immensely valuable celebrity endorsement of a fact that access-to-medicine and IPR activists as well as ethical public health experts have been campaigning for years. About 80 percent of our health issues can be addressed by generic versions (copies) of the original drugs that are priced several times higher. Where he probably went wrong, however is in suggesting that the doctors merely prescribe the generic name of a drug and let the patients choose the brand they want to buy. Quite tricky for a country such as India where safeguards are notoriously bad. Here the argument is not entirely consistent with the first. Using generics is a philosophy and principle that is pro-people and anti-Big Pharma. It makes medicines affordable and accessible to tens of millions of people in India, who otherwise will have to buy the same drug from the original innovator company at a price several times higher. Without them, most of us will simply perish for want of medicines and the country will be gripped by waves of epidemics that will kill people by the thousands. [caption id=“attachment_352406” align=“alignleft” width=“380” caption=“When Aamir Khan argued for the use of generic drugs in his Satyamev Jayate, he was both right and wrong in the same breath. AFP”] [/caption] The best recent example of the miracle that generics could bring about, in driving down the prices and averting mass-scale deaths, was the way they addressed the HIV epidemic. When Big Pharma invented anti-retroviral drugs, which almost made the illness a chronic manageable condition, they were priced at thousands of dollars for a year’s dose. Even in the beginning of 2000, they were only the preserve of the rich in the West, and the rich in countries such as India. Health economists from World Bank and national public health establishments (including India), mostly borrowing their argument from multi national pharmaceutical companies, were certain that it was impossible to make the anti-retrovirals accessible to people until Dr Jim Yong Kim, the present World Bank President and then the head of the HIV unit in WHO, audaciously declared that he would put three million people on treatment by 2005. He betted big time on generics and succeeded. Now, generics have become the mainstay of AIDS-treatment all over the developing world. People with AIDS in poor countries get their drugs either free or buy at prices less than that of diabetes. The story is similar for multi drug resistant TB (MDR TB) as well. Even when WHO had more or less given up on MDR TB, given the steep cost of drugs, the Boston based Partners In Health (PIH), took to treating people first using the expensive branded drugs, followed by pursuing the generic route. Interestingly, the WHO apparently was not even aware that some of the drugs for MDR TB had outlived their patent periods and anybody could have made the generic versions. But somebody had to compel them and there had to be a market for sufficient supplies. PIH took up that role. The point here is, without the demand and compulsion and a championing voice, we won’t get the cheap copies of the expensive originals to stay alive. We cannot expect our politicians to do that. Aamir, by repeating the call for using generics, is contributing to this campaign. There should be a thousand more voices for such unfashionable causes. Much before Aamir, the Tamil Nadu Medical Services Corporation (TNMSC), had made a highly successful working model of a state-wide drug procurement and distribution system in the 1990s based on generic drugs. Through several iterations, the TNMSC has perfected a process to weed out poor quality and ensure reliable supply. Its bulk procurement offered to buy sufficient quantities that made business sense to suppliers. This is in fact the same technique that Clinton Foundation and other international NGOs would use in future - bulk or pooled procurement. The TNMSC is now replicated in many other states such as Karnataka, Andhra Pradesh, Rajasthan and Kerala. On Wednesday, the Kerala chief minister Oomen Chandy used the same “generic” word in the state assembly when he answered a question on free supply of some medicines. So Aamir is perfectly right in campaigning for generic drugs. But then in India, the same generics come in different brands and that is where he wanted the people and not the doctor to choose the brand - his second point. Here, he is as simplistic on a complex issue as Team Anna is on corruption is. His intent is clear — the doctor doesn’t take a call on the drug because he/she is heavily induced by drug companies; but who does the patient go to with the prescription? The pharmacist, who cannot be any better than the doctor. And the pharmaceutical companies will simply shift the goal post. Instead, what Aamir could do to take his generic argument forward is to argue for a prescription method in which the doctor writes both the generic and branded names of the drug. And the patient, who wants to buy the generic version, then goes to a fair price drug shop run by the government or a cooperative across the state. Fair price drug shops like the PDS? Yes, Kerala is now planning one in every district. Chandigarh has a few. The government drug corporations (eg TNMSC) can set up such shops in district and Taluk headquarters and extend it to even PHCs. Of course, there were exceptions such as the one in Mohali that got into a nexus with the drug mafia. Some media reports carried stories expressing shock at Aamir’s statement while a Parliamentary panel wanted to hear him out. Here is a line that Aamir might do well in telling the panel - this one straight from the WHO: “competition between drug companies and generic producers has been more effective than negotiations with drug companies in reducing the cost of drugs.” Let the drug companies and their crony doctors be shocked, but Aamir should pursue his statement with action. For once, he is not treading on unknown terrains. Dr Kim, Bill Clinton, and many Indian states had successfully traversed this path. Less popular issues such as this need ambassadors like Aamir. After all, 75 percent of our health expenses are from our own pocket and there is considerable push for universal access to health in the 12th plan. Without generics, we wont reach anywhere. Way to go Aamir.