India’s smaller pharmaceutical manufacturers appear to be stealing a march on their bigger competitors in terms of growth. Though competition is desirable, caution is necessary when medicines are involved. First, the regulator should ensure that all pharma players follow good manufacturing practices. Cutting costs in this regard to engage in price competition should be frowned upon.
Second, the challengers are reportedly offering large discounts to retailers (pharmacists) to push sales. This is not healthy since pharmacists push drugs that fetch them huge margins irrespective of quality. Smaller manufacturers rely heavily on such marketing practices. Pharmacists do wrong in two ways. When a drug that has been prescribed is not in stock, they offer a substitute saying it is the “same”. They also recommend medication to poor people who ask for “some medicine” to avoid visiting a doctor to save on consultation fees. Thus, pharmacists often sell prescription drugs without prescription, acting as de facto doctors. Naturally, pharmacists’ trade bodies have zealously fought against reduction in trade margins, and small discounts to individual shoppers are now beginning to take off.
Third, the incumbent pharma leaders are said to feel safe in the long run since they are strong when it comes to doctors writing prescriptions. Again, this is not a happy situation. Doctors are influenced by armies of medical representatives (marketing plans of challengers invariably speak of rolling out large medical representative networks) who offer freebies from free samples to exotic vacations in the name of attending conferences. Such has been the need for vigorous marketing that Chinese pharma companies have taken the lead in deploying women for the job. Now, women make up a small, but not insignificant, proportion of medical representatives in India. Ideally, doctors should keep track of drug developments by following leading medical journals and not rely on literature and word of mouth from medical representatives. In India many doctors who treat less demanding, poor patients in urban or rural areas have lost touch with what they learnt in medical school. Even those who know better and cater to a supposedly more informed clientele regularly prescribe things like cough syrups and supplements (for example, calcium and vitamins) — articles in leading journals have reported findings of meta studies that cast doubts on the efficacy of such ingestion.
Thus, the drug controller (manufacturing practices) and Medical Council of India (medical ethics) have a huge task ahead of them. Centre-state relations play a big role here. States are loath to give up their right to approve marketing of drugs or supervise their manufacturing, though few have the resources or the inclination to do the job effectively. The medical council, with its state chapters, imposes ethics very lightly. Massive regulatory progress has to be made on these fronts if Indians are to get the benefit of their country being a leading pharmacy to the world, by being able to access affordable drugs under proper supervision.
