The recent comments of Prime Minister Narendra Modi in London once again raised the topic of malpractices in the medical profession and government’s efforts at stamping them out. Rather than discussing the propriety of the country’s chief policymaker to pass such comments in front of the world media on foreign soil, I will focus on the issues. Just like every other important profession—be it judiciary, the police, media, politics or even the armed forces—Indian medical profession, too, has its own share of rotten apples and no one will deny that. However, the heavy-handed policies and oversimplification run the risk of throwing the baby out with the bathwater.
Let’s examine the three points the prime minister raised in his comments in London. He spoke about the government promoting ‘generic medicines’ in a bid to replace the branded medicines. On the face of it, this might reduce the medicine cost to patients, but is it indeed such a great idea that it is being made out to be? If one goes to the bottom of it, the answer would be a resolute ‘No’.
It is a fact that India lacks sufficient and efficient quality control mechanism when it comes to pharmaceutical manufacturing. Medicine brands are created when doctors prescribing the drugs are assured of their consistent efficacy over a period of time. In the world of generics, how can anyone ensure the quality of medicine? What if the doctor prescribes medicine and dosages assuming a particular level of efficacy, but the generic fails to deliver? These are problems at a very practical level and can lead to extreme and unwarranted consequences.
I will share my experience on how inconsistent efficacy for the same medication with different manufacturers can lead to unnecessary complications. In a civil hospital I worked at for several years, the medicines were procured through tender process going by the lowest bidder. These were akin to the generic medicines that we talk of today. The doctors would routinely prescribe a certain dosage, say 20 units of insulin, to chronic diabetes patients, which they were administered separately by the hospital staff. On days when the hospital had no stock of insulin, the patients had to get insulin injection administered outside according to the prescription. On such days, the patients would invariably revisit the hospital with symptoms of hypoglycaemia or low blood sugar.
Their regular insulin dosage would suddenly turn into an overdose, when taken outside the hospital– with potentially life-threatening consequences. All this, because of different efficacy levels in the same drug across various manufacturers. Now imagine a hospitalised patient on life-saving drugs and the havoc the unpredictable efficacy of generic drugs can create.
In the world of generics, the doctor won’t prescribe brands, but only the pharmacological names of the drugs. Naturally, what a patient buys and consumes will be influenced by the chemist, who will push the products that offer him the best margins or commissions. What impact that can have on the patients’ health is for anyone to guess. The government’s brouhaha about ‘generic drugs’ focuses only on the cost angle, but entirely ignores the quality angle of medicines. Unfortunately, it will be the doctor who will be held responsible if a patient suffered from failed medication.
The second point the prime minister made was about doctors’ sponsored overseas visits. ‘They don’t go there to examine patients," he quipped. Of course, no Indian doctor will be allowed to examine patients overseas where they are not registered practitioners. Doctors attend overseas conferences and workshops to update their knowledge, to know about innovative products and procedures, to attend lectures, to discuss case studies, and also for networking. This is common across various industries: from car dealers, interior designers, insurance agents to newspaper editors, everyone goes out on sponsored trips. What good is achieved by singling out doctors for public shaming?
Today, the use of robotics has gone up substantially in medical instruments and procedures, which are not available in India. A doctor willing to learn these new techniques has to visit and get trained abroad. At the same time, few doctors would willingly spend to take up such training. But, the robotic equipment company will be interested in expanding to India and would hence be ready to sponsor such doctors. If we object to such interactions, we will be stalling the flow of technology and innovation to our society.
The honourable prime minister also boasted about how controlled stent prices have brought down treatment costs. What he didn’t mention, however, was how medical treatment has suddenly become impossible for certain types of heart patients. The government has conveniently classified stents into two categories—drug-eluting and non-drug-eluting—and capped their prices. Unfortunately, this is too gross a classification. You need specially designed stents for complex blockages or where normal stents can’t go. Such stents are now no longer available in India and a patient suffering from such block no longer has angioplasty as an option, but needs straightaway to undergo a bypass surgery.
‘Covered stents’ is one such example. They are used in exceptional emergency situations where a patient’s artery ruptures during angioplasty to plug the leak. They were available at Rs 70,000 in India previously, but thanks to the price caps, the manufacturer has withdrawn the product. Non-availability of this life-saving equipment means a patient’s death is certain, if such an emergency arises.
The price control over stents and the rule that hospitals can’t charge any profit on them is also leading to hospitals destocking. This means the necessary type of stent may not be readily available for a patient in an emergency.
It is unfortunate that today the discussions surrounding India’s healthcare industry and the government’s actions are progressively alienating patients from doctors and discouraging young talent from taking up this noble profession. Unless the policymakers, as well as media, urgently revisit their deep-rooted bias that doctors work only to make money, the healthcare industry will suffer irreparable damage. The fact that a doctor has an inherent interest in curing his patients needs to be upheld.
Today nearly 70 percent of India’s healthcare needs are being taken care of by the private sector. For an ordinary citizen, a private establishment is the first choice when in need of medical attention. A person would consider visiting a public hospital only when a private healthcare option is no longer viable. This is today’s reality and it speaks volumes about the state of public healthcare in the county.
Policymakers have to bear in mind that their zeal to over-regulate the private healthcare sector can only bring disaster in the long run. In his London dialogue, Modi was perhaps right in pointing out that the previous governments ruined industry by over-regulating. Yet, what his government is today dealing out to the medical profession is nothing different.
Our prime minister is a studious person with the ability to go to the depths of any problem. The medical profession is a complex one with too many variables. And, as such, simplistic solutions to its problems are more damaging than helpful. I am sure our prime minister and his team would come out with real, rational and reasonable solutions to weed the ill out of our industry and ensure social welfare.
It will be worthwhile to start Indian Medical Services, akin to IAS or IPS, to build capacity among policymakers to understand the nuances of the medical profession and form better regulations. Another thing they should try to achieve at the earliest is improving the public healthcare system to acceptable levels. The competition from public healthcare system will be the best way to keep private sector in check.
The author is an interventional cardiologist and head of the cardiology department at Ashwini Co-operative Hospital, Solapur
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Updated Date: Apr 25, 2018 19:47 PM