June 23, 2012 3:10:58 am
Satyamev Jayate has dangerously over-simplified the generic versus branded drugs debate
When a prominent person makes statements in the media,there are usually two results: people take those statements to be gospel truths (even if the subject matter is outside the area of expertise of the person making them),and it starts a debate.
Any complex issue with innumerable variables needs careful scrutiny,not judgements passed on the basis of quickly assembled pieces of information. Consider an episode of Aamir Khans show Satyamev Jayate,as well as a newspaper article written by him that discussed medical malpractice and the issue of generic versus branded drugs.
This is not a claim based on hard evidence,but based on 30 years of experience at AIIMS and then five years in a corporate setup,I can assert that doctors do not want to harm patients. If patients come in harms way due to an operation or other medical intervention,it is attributable to chance. On the show,the case of Seema,who was operated on without permission appears to have been presented in haste and without checking the facts. For example,according to a rejoinder by the Indian Medical Association,in this case,informed consent was taken and was examined by an independent agency,the Karnataka Medical Council,which reportedly found no negligence on the part of the doctors. These facts were apparently not divulged by the husband. If the counterclaims are accurate,there is a major lapse on the part of the research team of the show,and labelling the doctors responsible for Seemas care maut ke saudagar and dhokebaaz is uncalled for and probably defamatory.
It is true that issues such as the mushrooming of private medical colleges and paucity of government-funded medical colleges and in particular,major gaps in primary healthcare in remote areas,need strong regulatory measures and consistent follow-up actions. But there are many more government medical colleges than Khan mentioned on his show. It was stated that since 2001,the government has opened 31 medical colleges and 106 private institutes; however,a total of 181 private and 152 government medical colleges exist in India. To take up these issues in a progressive manner,multilevel action,political will,administrative firmness,regulatory action on corruption,grassroots efforts and crusaders in the middle (not those appearing for one show or writing one article,but consistently devoted to the cause) are required. These issues need more thoughtful discussion,rather than emphasising capitation fees in private medical colleges.
Khans article initiates debate on the issue of generic drugs admirably,but does not finish it smoothly. Treatment by generic drugs is an excellent way of decreasing the cost of medical therapy,provided these generic drugs,sometimes made by firms with dubious records,have the same bioavailability and quality as drugs made by major pharmaceutical companies. Glimepiride is not a frontline drug for diabetes,domperidone is not a drug for diarrhoea and cetirizine is often not needed for a self-limiting common cold,all of which were stated as examples of expensive drugs in the article. These mistakes notwithstanding,if quality-controlled generic drugs are available,doctors would welcome it. However,if I had a heart attack,and have the choice of being given the generic streptokinase another example cited in the article or the same drug made by a pharma company with strict quality controls,I would choose the latter.
Corruption in medical practice is a worthy subject for discussion,and the show was able to initiate this successfully. Discussions of corrupt practices in the medical profession are often avoided within medical circles,signifying a refusal to deal with these important issues head on. The scams,the nexus with Big Pharma and other incorrect practices do,indeed,exist. Nobody should pardon such unsavoury practices,but many of them emerge from weak supervision,little regulation,lack of cohesion,an absence of hard administrative action and a lack of firm political will. These factors must be addressed to contain corruption in medical services.
I agree that there is little point in achieving high GDP growth if,as a society,we remain unhealthy. But health is determined by several factors: genes,individual habits,environment,regulations and medical care. Thus,it is not the sole responsibility of the government or doctors,both of which Khans show and article targeted,but also society at large. Given that many people will follow celebrities blindly on all issues,how about doing a couple of shows on regular exercise,diet and healthy habits,and health education? Such shows,not highlighting the negative but intending to build on the positive,would help all of us to become healthier.
The writer is executive director of the Fortis-CDOC Centre of Excellence for Diabetes,Metabolic Diseases and Endocrinology,New Delhi
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