Merchants of death are angry!

Doctors are angry! Why? Aamir Khan has targeted them in two of his first four shows! And why not? After all, the show is called Satyamev Jayate! And the first and most important responsibility of a civilised society towards its citizens is that of giving them a good healthcare system (followed by education, employment and judiciary, in order to make a good democracy), that too in a country like India where an estimated 17 per cent of the population die before the age of 40. The reality however is shockingly quite worse. The reality is that in this country, medicines for treatment of cancer patients – in one of the cases, 550,000 Morphine and 5,200,000 Morcontin tablets sent by the World Health Organization – that were supposed to be distributed free at all the hospitals in India, were dumped in the stores of hospitals beyond their expiry dates. These were costly medicines and Morphine is typically meant to relieve patients from intensive pain. It basically meant that in this particular case, patients who could not afford to buy such costly medicines from the market must have suffered immense pain with some of them dying too without proper treatment. WHO, of course, demanded an explanation. But what is more important for the masses is that the medical mafia keeps doing such acts to enhance the profits of pharmaceutical establishments.

I can easily cite scores of such examples from reports on miserable conditions existing in hospitals all over India. Although examples of the opposite nature are becoming rarer by the day, there are sparkling exceptions; and it gives me immense pleasure to write about one such example – the Shramjibi Hospital in Belur, West Bengal. When they admit a patient, they never ask him/her to deposit any money. Patients are almost always surprised to receive a very low bill (almost always one-fifth of the amount charged in other hospitals) when the treatment is over. For example, a coronary bypass surgery for heart costs Rs 25,000 at the hospital, inclusive of pre-and post-treatment charges. In the unfortunate case of the patient expiring during treatment, the management of this hospital never presents any bill to the relatives of the patient. Elsewhere, a bypass surgery may cost upwards of Rs 100,000 to Rs 350,000. Honestly speaking, since the surgery in a hospital and other services are not burdened with any transport and distribution costs, charges to be paid by patients for such surgeries should not exceed 100% of basic costs. But charges these days on operations are unfortunately 500% to 1000% of basic costs, and patients also can easily be blackmailed because of the prevailing threat of death. I am aware and proud of Shramjibi Hospital. Yet, on the other hand, services rendered by many private doctors and by private/public hospitals are of such miserable standards that one can even label them with the choicest of invectives; one reason I get the impression that these places are infested with 'merchants of death'.

Since patients can easily be blackmailed, life-saving drugs are priced exorbitantly. AIDS patients in USA/Europe are charged up to $30,000 for one year of treatment. Cipla in India, for an equally effective medicine, charges only one dollar a day. For this very noble deed, I do believe that Mr Y Hamied, the Chairman of Cipla, should be awarded the Bharat Ratna. It is so unbelievable and noble a cause that even former US President Bill Clinton negotiated an annual supply of drugs costing around only $100 per patient. This is exactly what Aamir Khan tried to point out. His contention was, 'When a student sits for the MBBS exams and is asked what the prescription medication for a patient suffering from diabetes is, he might write Glimepiride. This is the salt commonly used to treat diabetes. When this student becomes a doctor – and a patient who has diabetes comes to him for treatment – he might write the medicine’s name as Amaryl. So is that young doctor prescribing the wrong medication? No. Amaryl happens to be one of the brand names by which the salt Glimepiride is sold. So what is the difference between the two, apart from the names? Well, a strip of 10 tablets of Amaryl costs around Rs125, while a strip of 10 tablets of the salt Glimepiride costs Rs 2. Both are essentially the same. We pay approximately Rs 123 more for the brand name.'

Such examples are indicative of the kind of machinations indulged in by multinational pharmaceutical industries, using monopoly patent rights. Generic drugs (medicines which are non-branded but are exactly similar in constitution and legal) often cost only one-hundredth of the branded medicines supplied by the top pharmaceutical companies. However, doctors rarely prescribe a generic drug to a patient. In West Bengal for example, the earlier Health Minister Surya Kanta Mishra used to repeatedly request doctors to prescribe generic medicines but to no avail. The drug industry spends on an average Rs 200,000 per doctor per year in soliciting business and promoting branded medicines. It is no wonder that branded medicines are so costly and doctors love them. They are often paid commissions on drugs sold directly or indirectly through quid pro quo reimbursements of various kinds, e.g. sponsorships to participate in international conferences. Aamir Khan again rightly points out, 'We have to applaud the efforts of the Rajasthan government. It has set up shops selling generic medicines across the state in an effort to make good quality medicines available to people at the lowest possible rates. Roughly 25 per cent of all ailments go untreated in India because of financial reasons. Think of the difference generic medicines can make to every Indian! If the Rajasthan government can do it, why can't other state governments do the same?' He further shares this interesting piece of information that the Ministry of Chemicals and Fertilisers 'offers Rs 50,000 to anyone wanting to open a shop selling generic medicines, and at their discretion they sometimes offer space to open such a shop.' Aamir ends by making the most rightful request, 'Can our doctors please write out the generic name of the medication when they write out our prescription, and allow us to choose the brand... or not?'

Similarly, investigations for diagnostic purposes are often superfluous and are priced exorbitantly. One of the reasons is the commission (which can even be up to 40 per cent of the total amount) paid to the doctors who recommend such investigations. Even surgeons, whatever the degree of skill acquired by them, do not hesitate to extract prices that can be described only as brutal, ruthless, merciless and heartless. Also, since foreigners from developed countries are coming in droves to get treatment in India, globalisation has led to an increase in the cost of treatment in Indian hospitals. The average cost of hospitalisation has increased by more than five times in a span of just ten years. This can explain surely why hospitalisation costs are now beyond the reach of not only the common man, but also of the upper-middle class. Only the super-rich and the rich can dare to undergo treatment in super-specialty private hospitals.

We must take up the fight against reservation of treatment in modern hospitals for the creamy layers of Indians, whatever the caste. The only way to get rid of our very own 'merchants of death' is to devise a National Health System geared to Indians of all castes and classes, inclusive of people at starvation level (at around 40 per cent of present official poverty level), destitution level (our present official poverty level) and the true poverty level as defined by IIPM Think Tank (which has a poverty benchmark that is 50 per cent above the present official poverty level). Here, one may think of adopting a variant of the National Health System in Cuba, where health services are comparable to that in UK, though at only around one tenth of the cost.

More than a lifetime of an average Indian has passed after India achieved Independence. It is high time we did away with the famine of food as well as of medicine. It is high time we built in each block-level unit at least one hospital, modeled on the lines of the Shramjibi Hospital, humanised and efficient.

No doubt, Aamir Khan's show is garnering a TRP of only 3 or so and even the masses want him to be more combative than the 'now school teacher, now teary' mode of his, since unlike an Oprah (or various other fabulous women hosts of similar shows on different news channels in India), Aamir is known to be an actor and is not a woman, so his tears will often be looked upon by the public as melodrama. Also, his program almost looks like a deglamorised version of
The Oprah Winfrey Show
with poorer looking Indians vocalising their pains; Indians who give the TRPs now appreciate glamorous looking shows, especially if they have to get up early on Sunday morning! But Aamir’s case against the doctors is absolutely praiseworthy and specifically so in the light of our existing health system! Instead of taking it negatively, it’s time for the doctors to be true to their profession and support the cause of generic medicines and it is time for us to humanise our health system and make it efficient and provide for budgetary allocations for the same. We can do it and we must do it now.

Author is a management guru and Honorary Director of IIPM Think Tank.
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