Wednesday, 19 February 2014

Illness, Money and Treatment

It was a Tuesday afternoon; I had been at home for the past 2 days as was feeling under the weather with a mild fever, and a total lack of appetite. At around 2 pm - 3 pm, I got hit by severe chills and a sudden escalation of temperature to the high 104s. My doctor had already ordered a precautionary blood test, results awaited. But I couldnt even wait that long, and collapsed on the way to the Doctor's clinic. The results: Recurrent Typhoid. I was admitted, to the nearest hospital for in-patient treatment - an experience that opened my eyes, and exposed me to both the good and the bad side of Corporate Medicine

I had luckily kept a few thousand in my home for once(I stay alone), which was critical. One day's total medication alone turned out a princely sum of 2077/- only. This was to me, a first time in-patient, a jaw-dropping number. But at the same time, it was a very very disturbing number: this was for Recurrent Typhoid, which though admittedly severe and dangerous, is certainly not one of the most dangerous diseases around. Furthermore, I was fortunate enough to have a Job, Friends, Family for support. What about those who dont have these benefits? 

It gets worse; much worse. My total expenses on Medications alone for 5 days as an in-patient and 3 days for treatment at home was well in excess of 10,000 bucks. 10,000 large numbers there. I traced a sample drug - Piperacillin and Tazobactam 4.5G, which I am still taking thrice in an IV injectible. This costs 200 for the drug alone for the Brand I purchased; IV and administration costs separate. The Multinational variant for this drug costs more than 2.5 times that. Work it out  for yourself - at three doses a day, the full course sets you back by a cool 5000 Grand more than the Generic

Now just pause a minute and think : how many people in India can afford a line of treatment that costs 2000 Rupees a day in drug costs alone - not counting Doctor Fees, Nursing and RMO Charges and other expenses like bed charges? How many people can afford to shell out the extra 5000  on one Drug alone? I am a person employed in Corporate India; I understand the need for protection of investments made, and the importance both to the corporate as well as to the economy - as profits generated impact both positively, as also the employees engaged in these companies. I also appreciate the need to protect the hard work of some researchers, and the need to ensure monetary reward to these workers, so that their ilk continue to be motivated in the search for life saving solutions

As per the World Health Organisation, the Pharmaceutical Industry is worth US$300 Billion, with some firms enjoying profit margins of upto 30% : WHO Page. Pause here and think for a minute : on one side of the world, you have humongous profits on the back of drug sales, and on the other side of the world you have a situation where people cannot even afford the basic price of a Dispirin Tablet! As per the Huffington Post, the Big guns of Pharma made a combined profit of 711 Billion US$! Not only that, research also lays bare the R&D claim - with 50% of new drugs coming from universities and biotech firms. The icing on the cake, the article also claims that these firms spend more 19 times more on Marketing than R&D  : Big Pharma

Now do some basic number calculation. India's per capita income in monthly terms is Rs. 5729 - or Rs, 28000 approx per family of 5. Now add onto this the income distribution chart to arrive at a truly scary figure in terms of life in India. How many people in India - let alone people, how many families in India earn 5729 per month? The bottom 40% have a share of less than 30% of income - and even that is a stretch! It is a known fact that millions of Indians have to struggle just to make ends meet; just to have 2 square meals. One on side, you have Billions of Dollars of profits from Drug Sales, and on another - you have this:

I was on saline, and my attending Doctor was monitoring. We got into a conversation, which veered around to costs of Medicine. He shared a heart-rending case with me. A patient - a poor labourer - was diagnosed with Dengue Fever, and was in a severe condition. This doctor told the entire family the expenses involved; and what best he could do : waive off his fees, and at best get a discount from the Pharmaceutical store. The family went away without treatment. Days later, after consulting several doctors, they approached him again. I was speechless, and thanked God, my Company and my Family for their support. But who, apart from God, was with that patient of Dengue Fever? He could not afford the cost of the treatment!

This is an extreme case. Lets look at another, this time hypothetical case. My total bills for this disease is likely to go upto 25000/- all told. For nearly the bottom 70% of India's population, this is either one, or several months - or even an annual salary. I took a private room; subtract that - and you are still staring at 18000/- on drugs and related expenses. Again, several months to several years income. Billions of profit on side - and this on another. How many would have afforded this treatment we Middle Class Indians take for granted?

More to the point, in the entire brouhaha over IPRs, not one single Western Source, Medicines Sans Frontieres aside, has even looked at this side of the picture, a picture that is repeated across of a minimum of 105 of the nations of the Earth - perhaps nearer 150 nations, covering a humanity in excess of several Billion! By disallowing Generics, and granting long exclusive licences, you are not only stifling innovation (by ensuring superior, more cost-effective methods are not found), you are creating guaranteed gargantuan profits, you are creating a monopoly (where is the risk, pray tell? Research Risk? The profit numbers fully and finally debunk that, as do the sources of new drugs) and to top it all, you are denying cheap affordable medicines to the needy not only in your own country, but fighting to ensure the same in each and every country in the world. 

I wish some of these hotshot MNC people would look into the tear-filled eye of the child who holds out a 100-Rs note to the pharmacist, and asks "how many will come in this?". The Pharmacist replies, son you need more money for the full course. The son replies - give me what you will in this money. This is also a real story, played in front of my eyes. I wish these MNC guys are made to meet the people whose relatives died because the drugs were too expensive. But they wont; they will be too busy in their meetings. I feel double sad because I too, am  a corporate guy - maybe at a lower level - but still a corporate guy...

Somewhere, somehow, someone will have to take the Pharmaceutical Trade into a phase of deep introspection... what I have seen these past 10 days has truly shaken me to the core of my being...

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