In India, there are a few things that, if taken together, make for a disturbing picture. They are investigations and cases against Opposition leaders, Class rhetoric and heavy-handed interventions in the functioning of the economy and society. Some of these elements might deserve to happen and have their own merits. Could be possible. But, just wondering… Any way, that is a different topic.
But, what made me think really hard are two things. One is the decision to impose price controls on drugs and the second is the contemplation of a proposed legal framework to ensure that, where generics are available, doctors prescribe only generic drugs. ‘Swarajya’ daily brief sent these two news-stories. You can find them here and here.
On the medicine order, it is one thing to impose price controls but it is another thing to bring in a legal framework to ensure that only generic drugs are prescribed.
I fully understand that there is a problem with Pharma companies, world over. But, I am not sure if a blunt instrument such as this is the answer.
Generic drug manufacturers – given such a ‘carte blanche’ – would invest even less in R&D. Can they also cut corners further?
What if Doctors, deprived of their ‘perks’ from the big Pharma, simply become less interested in treating patients and prescribing medicines?
Or, equally, what if generic drug manufacturers engage in the same unethical practices and outcompete each other on ‘perks to doctors’ and not on product quality and efficacy?
The goal is accessibility and affordability to health care and medicines. So, one needs to ensure that one provides competition to the branded medicines and price is an aspect.
Is this the best way to go about it? Wonder if the law of unintended consequences would play out in such a blunt and heavy intervention.
I shared these thoughts with a friend and he responded very thoughtfully. I share three key sentences from his mail and discuss them:
(1) “In practice, if you cannot control drug quality, you shouldn’t try to do away with brands.”
Exactly, that is what I meant too. One cannot ensure that generics will produce medicines of acceptable quality.
(2) “It’s in countries with a weak state that branded generics exist” – an excellent point.
Recently read some other feature of ‘weak states’ – forgot which one. Weak states have too many laws, too many controls and over-regulate, etc. Weak states simply have very low trust quotient between government and stakeholders and within governments and stakeholders.
[A corollary question is whether weak states engender weak societies or vice-versa or is there a mutual co-dependence? By weak societies, I mean societies characterised by low trust and mutually confident engagement with each other?
In any case, that is a digression.]
Weak states do not believe in ‘regulation by exception’ but do believe in ‘regulation as routine’.
India ticks the boxes on many of these.
(3) “And the risk is, which I believe you were hinting at, will the government go ahead with a draconian scheme knowing fully well it won’t work – just because it’s good politics?”
Well, I did not mean that. In fact, you are giving a little bit too much credit here to the government and may be you are more right than I am.
I am worried that they ACTUALLY BELIEVE that this is the answer. In other words, I am worried about hubris driving the decision and not ‘good politics’ driving the decision.
But, as with most things with governance, with life, etc., the truth is that it is a bit of both, I suppose.