The Dehi High Court has quashed the ban of over 300 fixed dose combinations (FDCs) announced by the Indian government in March this year. This has left health activists and other drug safety proponents sorely disappointed. The Union Ministry of Health’s decision to ban what it termed “irrational” drug combinations – drugs that either need not or should not be combined into a single formulation – counts as one of its most sweeping, and decisive actions on drug safety in recent memory. However, judging by news reports, it appears to have stumbled on procedural grounds – on mere technicalities.
It is in human nature to look for silver linings to clouds. Or at least, it is in mine. So I tweeted that at least many FDCs had gone off the market after this notification. Then, I reckoned to myself that perhaps doctors might now think twice before prescribing dodgy FDCs. And I am sure, there are others thinking, “Well, at least the government tried.” (Including the government itself).
But then, I stopped short and went back and mentally obliterated all the silver linings. For, when it comes to fighting for drug safety, you have to win. Continue reading
Correct me if I am wrong but I do believe that the Union Ministry of Health and Family Welfare just acknowledged that when prices of a product are fixed, manufacturers are discouraged from entering the market. And that competition brings down prices. Yes, you read that right, competition, and not price control. Continue reading
The central government, through the office of the Indian drugs regulator, has done away with the cap on the number of clinical trials per investigator. This is after it was pointed out by clinical research stakeholders such as sponsors and investigators, that this could lead to under-utilisation of clinical trials infrastructure, and investigator expertise.
The decision is now left to the Ethics Committe (EC) of the institution where the trial is to be conducted as was recommended by the Expert Committee set up by the government under the late Ranjit Roy Chaudhury. This is clearly a great relief to those involved in the conduct of clinical trials.
But at the risk of sounding like a wet blanket, I have to say – this sounds suspiciously like one of those on-again, off-again decisions that pretty much leave you where you started off with, wondering what really was achieved. Continue reading
Last June, I wrote about the burgeoning online pharmacy business on this blog.
Taking off on a column that I had authored for the Indian Express, I pointed out that while India’s regulation of brick-and-mortar pharmacies (or chemist shops) has been slack, online pharmacies would be held to higher standards. That in the absence of a clear-cut legal pathway for online pharmacies to follow, friction with regulators could not be ruled out. And that these uncertainties would adversely impact e-pharmacies’ ability to raise funds from investors.
At a recent event organised by the Indian Internet Pharmacy Association (IIPA), it became clear that all this and more had come to fruition.
What intrigued me is that the e-pharmacy’s enemy number one appears to be India’s foremost chemist association AIOCD. IIPA members allege that they have had to endure regulatory harassment triggered by complaints from AIOCD members. These complaints have led to police investigations, regulatory raids, and the cancellation of licences of chemist shops supplying Internet pharmacies culminating in the IIPA openly accusing AIOCD members of instigating the administration to launch unnecessary probes against them. And of pressuring those chemists who do supply e-pharmacies to back off. Continue reading
As a doctor , I was very hopeful when digital health start-ups entered India a few years ago. I am a big believer in Information Therapy, and I felt that these start-ups would use technology to help connect patients directly with doctors. They would remove the middleman and reduce information asymmetry, thus making it easier for patients to find a doctor who’s right for them.
This is one of the reasons I’ve been an angel investor in health start-ups, and have followed Practo closely, since it is the poster boy of a successful digital health start-up in India. I was optimistic that once they had raised so much money, they would be able to make a dramatic difference to the way medicine is practised in India. Unfortunately, it’s been a long time and I’m extremely unimpressed by what they accomplished so far. Continue reading
Clinical trials, that hot-button subject hogging headlines up until a year ago, appears to have quietly slipped into the realm of business-as-usual. However, there are still some knotty issues to be resolved. Chief among them is the oversight of Ethics Committees (ECs) as was evident at a recent event I attended.
ECs – which are a mix of experts and lay persons – are the gatekeepers of ethics within their institutions. Just as a strong EC can blow the whistle on unethical behaviour, a weak or careless one might inadvertently abet it. Continue reading
On Friday, May 13, India committed close to a million dollars to help create a benchmark document for training and practice of Ayurveda, Yoga, Unani, Siddha and Homeopathic medicine. It is indeed a significant commitment and the reinforcement of ongoing efforts by the World Health Organisation (WHO) to promote traditional health systems strengthening around the world.
What started with the Delhi declaration in 2012-13, with a consortium of South-East Asian countries is now slowly growing into an international collaboration. The Indian government used a country-by-country approach to sign bilateral agreements, starting with information centres in Mexico, Nepal, Malaysia, Russia among others. Continue reading
I’ve been quite vocal in my views about the ban on fixed dose combinations on Twitter. So here’s a selection of my key tweets (and some retweets) on the subject. Good way to get a quick summary of the subject while I hem and haw over a longer article (if it ever gets written). Latest tweets on top. Continue reading
The abnormally high margin that trade channels are believed to earn on a relatively small portion of the Indian pharmaceutical market has become the latest painpoint for the central government. The margins in question even cross 1000 per cent in some cases, according to a new report by a committee set up by the Department of Pharmaceuticals (DoP) in the Union Ministry of Chemicals and Fertilizers to investigate the matter.
The committee has now recommended capping trade margins on not just such meds which go by the moniker of ‘trade generics,’ but all drugs.
A cap on trade margins is not only difficult to implement but will do precious little to lower the price that the consumer pays. It might even lead to disputes and litigation between companies, trade, and the government. Besides, trade generics constitute not more than 15 per cent of the overall pharmaceutical market – and that is an outside estimate. Yet, this is being done in the name of the consumer. Continue reading
Last week, the Indian Express published my column on the urgent need for hospitals – big and small – to follow infection control norms. Click here to read.
While researching the column, I spoke to officials at the National Board for Accreditation of Hospitals and Healthcare Providers (NABH) to understand how the issue might be addressed. While hospital-acquired/associated infections (HAIs) have been a concern for some years now, the spectre of drug resistance makes addressing their occurrence that much more of an imperative. For that, hospitals need to take infection control seriously.
NABH, as its name suggests, sets up and operates accreditation programmes around quality-of-care at Indian hospitals. One of the things that piqued my interest was Safe-I, a handholding programme for hospitals, that is focused on infection control. Since 2012, NABH runs this in partnership with the healthcare company Becton Dickinson. Safe-I hopes to eventually become a robust source of HAI data through a network of participating hospitals. Excerpts from an e-mail interaction with NABH CEO Dr K K Kalra. Continue reading