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India Today & Tommorow
   Dr. M K Choudhary, Director IIPM
Dr. Malay Chaudhuri
Founder - Director, IIPM & Author of the Best Seller 'The Great Indian Dream
[Sept 2006]

Doctors: divine messiahs or merchants of death?

The first and most important responsibility of a civilized society towards its citizens is that of giving them a good health system (followed by education, employment and judiciary, in order to make a good 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 opposite. On 29th August, 2006 there was a news item in Ananda Bazaar Patrika titled, 'How medicines for treatment of cancer patients (5,50,000 Morphine and 52,00,000 Morcontin tablets sent by the World Health Organization) to be distributed free, at all the hospitals in India were dumped in the stores of Chittaranjan Cancer Hospital beyond their expiry dates'. It left me completely shocked. These are costly medicinesdivine messiahs or merchants of death and Morphine is typically meant to relieve patients from intensive pain. It basically meant that 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.

WHO has of course demanded an explanation failing which, they will not send medicines anymore. But what is more important to the masses is, I am afraid, that the medical mafia did this to enhance profit of pharmaceutical establishment.

I can easily cite scores of such examples from reports on miserable conditions existing in hospitals all over India. Though examples of opposite nature are becoming rare day by day, it however 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/her to deposit any 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 over. For example, a By-Pass surgery for heart costs Rs. 25,000, inclusive of pre-and post-treatment after surgery.

The management of this hospital never presents any bill to the relatives of the patient, it he/she expires during treatment.

Elsewhere, by-pass surgery of heart may cost upwards of Rs. 1,00,000 to Rs. 3,50,000. Since surgery in a hospital and other services are not burdened with any transport and distribution costs, charges to be paid by patients should not exceed 100% of basic costs. But these charges are unfortunately 500 to 1000% more of basic costs, since patients can easily be blackmailed because of prevailing threat of death.

I am aware and proud of SHRAMJIBI HOSPITAL. Yet, service rendered by many private doctors and by private/public hospitals is of such miserable standard that, one has 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 USA/Europe are charged upto US$30,000 for one-year treatment. Cipla in India, for an equally effective medicine, charges only one dollar a day (for the same noble deed I do believe that Mr. Yaser Hamied, the Chairman of Cipla should be awarded the Bharat Ratna). It is so unbelievable and noble a cause that, Bill Clinton, Ex-President of USA has negotiated for an annual supply of drugs per patient at around $100 only. Taking another example, the production cost of a pack of 10 tablets of anti-allergic medicine cetirizine is under Rs. 1.50. Retail price with normal margins at retailer's and wholesaler's level 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 one-hundredth of the branded medicines supplied by the top pharmaceutical companies. However, doctors rarely prescribe a patient to buy a generic drug. In West Bengal for example, the Health Minister Mr. Surya Kanta Mishra has been repeatedly requesting doctors to prescribe generic medicines but to no avail. Drug industry spends on an average Rs. 1,10,000 per doctor per year in soliciting business and promoting branded medicine. It is no 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., for 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 prices which can be described only as 'brutal, ruthless, merciless and heartless'. This only can explain why hospitalization costs are beyond the reach of not only the common man, but also of the upper-middle class. Only the super-rich and the rich can dare to have treatment in Super-Specialty Private Hospitals.

Since foreigners from developed countries are coming in drove to get treatment in India, globalization has led to increase in cost of treatment in Indian hospitals. The average cost of hospitalization has increased by more than 5 times in a span of just 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 fight against reservation of treatment in modern hospitals for the creamy layers of Indians, whatever the caste.

The only way to get rid of the 'merchants of death' is to devise a National Health System geared to Indians of all castes and classes, inclusive of people at Starvation level (at around 40% of present official Poverty Level) Destitution Level (present official Poverty level) and Poverty Level as defined by IIPM Think Tank (which is 50% above present official Poverty Level).

Almost a life-time (60 years) of an average Indian has passed after achieving Independence. It is high time we do away with famine of food as well as of medicine. It is high time we build in each Block-level unit, at least one hospital, modeled on the lines of the SHRAMJIBI HOSPITAL, humanized and efficient. It is time for us to humanize our health system and make it efficient and provide for budgetary allocation for the same. We can do it and we must do it now.

One may think of adopting National Health System in Cuba, where health service is comparable to the same in U.K., though at around one tenth of the cost.

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