Last month on a visit to Bangladesh, a doctor was contacted to prescribe some medicine for a toothache. The doctor prescribed a pain-killer which, when arrived, turned out to be a generic drug with a local name. It did the job fine, although when compared in terms of price to what is offered by multinationals in the Pakistan market, it was at a fraction of the cost.
Further inquiries to my friend Kaiser Kabir, who runs the Bangladeshi pharma company Renata, showed how the industry in that country has made great strides over the years not only in terms of producing generic medicines at affordable prices but how it has also invested heavily in research. Leave aside that, Bangladesh has been exporting pharma raw material to a number of developing countries including Pakistan as well as exporting cancer fighting drugs to the West and the US.
One is reminded of Sheikh Mohammad Rashid, one of the founding fathers of the Pakistan Peoples Party (PPP), who was regarded as an ideologue by thousands of PPP activists and was committed to a socialist cause. This had earned him a reputed nickname in Lahore as Baba-e-Socialism. Rashid wanted to introduce the system of generic drugs so that Pakistanis could have access to cheap and quality medicines and not be held hostage by multinational pharma companies. Sadly this was not to be.
This week, pharmaceutical companies in Pakistan have once again started a campaign to push for an increase in the already inflated price of common medicines. And given the corruption that we see in the ministry of health and the notoriously corrupt Drug Regulatory Authority of Pakistan (DRAP), we can expect yet another price hike anytime soon.
Hitler’s minister of propaganda once said that if a lie is repeated time and again, the people would start to accept it as the truth. This is the case in terms of the points that the pharma companies are making to press for an increase in prices.
In its media campaign the pharma industry insists that the price of drugs in Pakistan is cheaper than in neighbouring countries. This is false. Iran, India and Bangladesh produce and sell drugs at a fraction of the cost at which we do. The argument that they have a bigger market is also untrue, because the market in Iran and Bangladesh is smaller than ours.
While control prices remain static in some instances, it is also not true that they have gone unfluctuated for 13 years. Ask any chemist and they will tell you how prices are regularly changed and also how shortages are created so that some drugs are then sold at black market rates. Drug names are changed and medicines are re-marketed, and in some instances discontinued only because the government does not agree at times to exorbitant price increases.
There is almost no investment in pharma research in Pakistan. Drugs are more or less imported in bulk raw material and re-packaged and sold here at high profit margins. There is no transfer of technology either and the argument that drugs produced by certain companies have more efficacy is not usually the case.
The government looks the other way. DRAP does not investigate the unethical marketing policies introduced by some pharma companies under which doctors are given bonuses and incentives to prescribe one drug over another. Such incentives include overseas trips for “conferences.”
Almost no effort has been made by the ministry of health to stop the manufacture of fake drugs. One estimate says that one in every three drugs sold is fake. In fact, when chemists go to make bulk purchases, they have the option to buy original or fake medicines. Many opt for the second category as it assures them higher profit margins. To add to this in many chemist shops, we also see unqualified persons dispensing medicines with no check or fear. How long will this continue?
If there is any progress made, it has been by local producers. But it has been patchy and much of this has come from imports and not through indigenous effort. It is time we shamed ourselves into framing a pharmaceutical policy that allowed Pakistanis access to quality medicines at cheap and competitive prices. We cannot continue to support the corrupt system that is in place right now. Someone has to take a stand.
Published in The Express Tribune, March 21st, 2016.
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