MERCHANTS OF DEATH?

 

 

Malay Chaudhuri



Chief Consulting Editor

The Sunday Indian The first and foremost responsibility of a civilised society towards its citizens is giving them a good health system (followed by education, employment and judiciary, in order to have an ideal democracy), that too in a country like India, where an estimated 17% of the population dies before the age of 40. The reality, however, is shockingly quite the contrary. On 29 August 2006, there was a news report in the Ananda Bazaar Patrika on how, ‘Medicines for treatment of cancer patients (5,50,000 morphine and 52,00,000 morcontin tablets sent by the World Health Organisation) to be distributed free at hospitals in India, were dumped in the stores of Chittaranjan Cancer Hospital beyond their expiry dates’. It left me completely numbed. These are costly medicines and morphine is typically meant to relieve patients from intense pain. It meant that basically patients who could not afford to buy such costly medicines from the market, must have suffered from immense pain and some of them must have died without proper treatment.

The WHO has of course demanded an explanation, failing which, they will not send medicines any more. What is of greater significance to the masses is, I am afraid, that the medical mafia did this to enhance the profit of the pharmaceutical establishment.

I can easily cite scores of such examples from reports on miserable conditions existing in hospitals all over India. Though examples to the contrary are becoming rare by the day, it gives me immense pleasure to write about one such example. Shramjibi Hospital in Belur, West Bengal, is one such hospital. When they admit a patient, they never ask him or her to deposit money. Patients are almost always surprised to receive a very low bill (almost always one-fifth of the amount charged in other hospitals), when the treatment is concluded. For example, a heart bypass surgery costs Rs 25,000, inclusive of pre and post-treatment surgery. The management of this hospital never presents a bill to the relatives of the patient, if the patient dies during treatment. Elsewhere, heart bypass surgery may cost upwards of Rs 1,00,000 and upto Rs 3,50,000. Since surgery in a hospital and other services are not burdened with transport and distribution costs, charges to be paid by patients should not exceed 100% of the basic cost. But these charges are unfortunately 500% to 1,000% of the basic cost, since patients can easily be blackmailed, due to their critical condition.

I am aware and proud of Shramjibi Hospital. Yet, the service rendered by many private doctors and by private and public hospitals is of such a miserable standard that one gets the impression that these places are infested with ‘merchants of death’. Since patients can easily be blackmailed, life saving drugs are priced exorbitantly. AIDS patients in the US and Europe are charged upto $30,000 for a year’s treatment. Cipla in India, for an equally effective medicine, charges only a dollar a day (for this, I believe that Yusuf K. Hamied, the Chairman of Cipla, should be awarded the Bharat Ratna). It is so unbelievable and noble a cause that Bill Clinton, erstwhile President of the US, has negotiated an annual supply of drugs per patient to a mere $100. To cite another example, the production cost of a pack of 10 tablets of anti-allergic medicine Cetirizine (Zyrtec) is under Rs 1.50. The retail price, with normal margins at the level of retailers and wholesalers (inclusive of transport cost) should not exceed Rs 4.50. It is however sold at Rs 28 to Rs 31.

These examples are indicative of the kind of machinations indulged in by the multinational pharmaceutical industries, using monopoly patent rights. Generic drugs (medicines which are non-branded, but exactly similar and legal) often cost only a 100th of the branded medicines supplied by the top pharmaceutical companies. However, doctors rarely ask a patient to buy a generic drug. In West Bengal, for example, Health Minister Surya Kanta Mishra has been repeatedly requesting doctors to prescribe generic medicines, but to no avail. The drug industry spends on an average Rs 1,10,000 per doctor a year in soliciting business and promoting branded medicine. It is a small wonder that branded medicines are so costly and doctors love them. They are often paid commissions on drugs sold directly or indirectly through reimbursements of various kinds, e.g., participating in international conferences. Similarly, investigations for diagnostic purposes are often superfluous and are priced exorbitantly. One of the reasons is the commission (often 40% of the price) paid to the doctors who recommend such investigations. Even surgeons, whatever the degree of skill acquired by them, do not hesitate to extract a price, which can only be described as ‘brutal, ruthless, merciless and heartless’.

This is the only plausable explaination as to why the costs of hospitalisation are beyond the reach of not only the common man, but also of the upper middle class. Only the super rich and the rich dare to be treated in super speciality private hospitals.

Since foreigners from the developed countries are coming in droves for treatment in India, globalisation has led to an increase in the cost of treatment in Indian hospitals. The average cost of hospitalisation has increased by more than five times in a span of 10 years. Students for Equality, who are leading the agitation for reservation of seats in medical colleges for Other Backward Castes (OBCs) will do well, if they also take up the cudgels against reservation of treatment in modern hospitals for the creamy layers of Indians, whatever their caste.

The only way to get rid of the ‘merchants of death’ is to devise a National Health System geared towards Indians of all castes and classes, including people at the starvation level (at around 40% of the current official poverty level), destitution level (the official poverty level) and poverty level as defined by the IIPM Think Tank (which is 50% above the official poverty level).

Almost a lifetime (60 years) of an average Indian has passed after achieving Independence. It is about time we do away with the famine of food as well as of medicine. It is high time we built at least one hospital at the level of each block, modelled on the humane and efficient lines of the Shramjibi Hospital. Time has come for us to humanise our health system and make it efficient and provide for a budgetary allocation for the same. We must achieve it now. One may think of adopting the model of the Cuban National Health System, where health service is comparable to the same in UK, though at around a 10th of the cost.