The capital of spurious medicines

Replying to a query in Assembly, the health minister Bali Ram Bhagat startlingly revealed that over the past two years 83 drugs have been found to be sub-standard and misbranded in the state. He admitted that nexus between “doctors and the private pharmaceutical companies in the State, has led to medicos prescribing medicines of a particular company with whom they have tacit understanding”. This is perhaps the first time that any health minister has made this revelation in the house and it should alarm us all. It lends  credence to the long held view that Kashmir is the capital of the spurious medicines in India. And the biggest factor that makes it so and as the minister himself highlighted is the doctor-pharma company nexus.  Thousands of doctors— including the hundreds who are employed by the state and are paid with taxpayers money — routinely supplement their salaries with income from pharma companies, many of them shady, obscure fly-by-night enterprises. They do “take money”, to prescribe drugs, as the minister has candidly implied.

The minister’s admission has a salutary value. For it confirms for us what otherwise can’t be established through an official investigation even while the practice is a common knowledge.  Doctors in the state do receive inducements in lieu of helping pharma companies sell their products. The practice as such leads to a huge conflict of interest, compromising the interests of patients.  The problem, however, is not unique to Kashmir. It has a universal dimension.  Anywhere in the world, pharma companies need the medical professionals to prescribe their drugs. And it is the form that this necessary interaction takes place that should be of grave concern to one and all.  It could be cash payments, gifts, free meals, travel, including foreign trips and other perks.  And doctors repay their benefactor companies by prescribing their medicines. They could also prescribe unnecessary and expensive drugs or multiple medicines for the same complaint. And this practice is not something that is unusual in Kashmir.

Kashmir, as was pointed out once also by India’s leading cardiologist Naresh Trehan at a seminar in Srinagar, has become the hub of the spurious pharma companies in the country. How do these companies survive in the state. This is because their products are prescribed in Kashmir. And doctors – a section of them, at least – are culpable for it. At the same time, the government can hardly absolve itself of its
dubious role in the process. If Kashmir is the hub of the spurious medicines, isn’t Drug Controller Department responsible for it? Why do spurious companies make it to Kashmir in large number in the first
place? And once they are allowed a toehold in the state, it is but natural they will try to sell their products and in pursuit of this objective build dubious relationships with medical professionals. It
is about these relationships that the minister  Bhagat was probably talking about but stopped well short of outlining how government was going to tackle it

How does one address this problem? Certainly Drug Controller Department has a huge role but the doctors themselves can’t absolve themselves of their responsibility. It is incumbent upon the heads of health institutions to check the practice and conduct intermittent prescription audit and the doctors’ associations to formulate voluntary guidelines and sensitize their tribe.  To begin with, what is needed is a wider public awareness about this menace  so that the doctors involved in the practice feel a sense of accountability towards the society.

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