The Drug Industry in India - For Whom? · Community Health

The Drug Industry in India - For Whom?

Item

Title: The Drug Industry in India - For Whom?
extracted text: The Drug Industry in India

■ For Whom ?

N

I, JOSEPH

President, Federation of Medical

lapresentatives’ Associations of India

The Drug Industry in India - For Whom?

N. I. JOSEPH

President, Federation of Medical
Representatives' Associations of India.

The expansion of the colonial system around the world was
the significant contribution of the capitalist mode of production
during the nineteenth century. The expansion of colonialism was
severely hampered by disease. Tropical diseases, decimated the
ranks of mother country personnel and reduced the efficiency of
native population as imperialism’s work force. As a writer in a
popular journal observed in 1907 “disease still decimates native
populations and sends men home from the tropics prematurely old
and broken down. Until the white man has the key to the problem,
this blot must remain. To bring large tracts of the globe under
the white man’s rule has a grandiloquent ring; but unless we have
the means of improving the conditions of the inhabitants, it is
scarcely more than an empty boast.”1
The magnitude of this problem could be well understood
when it was told that hundreds of workmen being sent out from
their jobs, from the fields and the estates giving a charge sheet
that the dismissed employee was suffering from “germ of laziness”.
The only evidence that could be attributed to the ‘germ of lazi
ness’ and thereby get dismissed was ‘occasional sleep’ during the
working hours. To deal with this problem, to apply the medical
sciences to the needs of colonialism, schools of tropical medicine
were founded around the turn of the century. For example, Sir
Patrick Manson organised the London School of Tropical Medicine
in 1899 to help the Colonial Medical Service postponed the twilight
of the British Empire. These Schools of Tropical Medicines, along
with other medical institutes could identify “the sleep” or the

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“germ of laziness” as due to a particular typ c of anaemia caused
by hookworms. The eradication of hookworm disease was laun
ched in 1909 with all ferocity and the successful culmination of
anti hookworm drug by the Rockefeller Foundations could contain
this menace. In conditions of heavy infections, the resultingdisease of a particularly debilitating anaemia
results from
a combination of blood lost to the parasi tes and inadequate iron
replacement through the diet. Hookworm anaemia tends to be
especially severe among people with low protein and low mineral
diets. Thus hookworm disease, as distinguished by the mere inva
sion of the host of the parasite, is related to malnutrition which
especially affects workers on the bottom rungs of the social class
structure. Because the hookworm propagates itself in warm, moist
climates, it is particularly associated with mining, and the growing
of coffee, tea, sugar, cotton and bananas—the resources and cash
crops of concern. Because hookworm disease reduces the strength
and productivity of workers in these occupations, it had a direct
effect on profits.
My argument that the philanthropic contributions when
compared to the increased productivity is insignificant and it is the
urge for earning more and more profits in order to nail colonialism
the all round efforts were initiated to conquer the then menace.
Thus the hookworm campaign and other programmes even though
were valuable to the generally poor people, they contributed atleast
as much to integrate our economy to the forces of colonialism.
Now after 33 years of Independence if one analyses the
Health Care system in our country, one is reminded about the
editorial appeared in the Journal of Indian Medical Association
on 1st August, 1978. “In our country after Independence the
expectations of common man regarding Health Care became
understandably high. But in the perspective of ruling section of
our country this problem, which literally concerns people’s life and
death, did not receive the proper importance and priority.” This
proves that today our country is again wide opened to the forces
of neo-colonialism to subjugate the very root of our Health Policy
by implementing a Drug policy which is suited to cater to the
needs of their profits. Therefore the Multinational Corporations
because of their stranglehold over the drug industry have given
more priority to the production and marketing of non-essential
drugs rather than giving importance to the essential life saving
drugs and the production of those drugs which could be used to
prevent the onset of diseases commonly seen in a tropical country

like India. According to Prof. U. K. Sheth of G. S. Medical
College, Bombay, over Rs 525 million are spent on drugs of doubt
ful or unproved clinical value. Such large sums of money could be
more purposefully utilised to proven preventive measures such as
immunisation, oral dehydration, penicillin prophylaxis’for rheum
atic fever and the use of life saving drugs. India’s needs are not
so much for 'Power packed Vitamins’ and ‘pain killers’; but suffi
cient quantity of quality drugs to fight the menace of Malaria, TB
and Leprosy, which claims the largest number of victims. The
foreign drug units have yet to come out with appropriate drugs
in this field.
The result is our drug industry is more urban oriented; it
is more oriented to safeguard the interest of the privileged class in
our country ignoring the vast millions of the unprivileged rural
people and totally byepassing the preventive aspect of medicine;
giving more emphasis to the curative approach. This aspect has
been well highlighted by Dr. Mehler, Director-General of W.H.O.
and also by the Hathi Committee. Therefore we must have a
national policy on drugs which should be part and parcel of our
national health policy. It implies that no person should suffer
from or die of any illness for want of medicine and appliances,
irrespective of his social, economic, political and religious status,
geographical and other constraints.3

The recent study “Health for All: An Alternative Strategy”
by Dr. V. Ramalingaswamy, DirectorGeneral, Indian Council of
Medical Research emphasises the fact that the pattern of drug
production should be oriented to the disease pattern with an em
phasis on the production of basic and essential drugs (especially
those needed by the poor and underprivileged groups) which should
be produced in adequate quantities and sold at the cheapest pos
sible prices. The domination of the foreign section in drug produ
ction should be reduced further and further and price control
made more effective by reducing overheads and package cost and
adoption of generic names. The drug costs arc always a part of
the total cost of health services. If all essential drugs are made
available at reasonable prices, health care cost will fall further.
There should be strict quality control, adequate supply of drugs
to the rural sector.3
It is now clear from the above findings that the foreign
drug companies numbering 60 in our country control 80 per cent
of the drug production and they perpetuate a system of market-

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ing in such a way that neo colonialism is thrust on us by siphon
ing out a large proportion of our resources in the form of royalty,
transfer pricing mechanism and so on. The three well established
means adopted to perpetuate this mode of operation arc:
1) by maiketing the irrational drugs which are discontinued
in their countries of origin.

2) by marketing products through the media of advertisements
misleading the innocent and ignorant people of the developing
countries.

3) by selling drugs which are often discontinued from the
parent countries through the press and radio advertisements.
1.
Marketing of irrational drugs: We don’t wish to cite the var
ious documentary evidences which have already appeared in the
leading journals and dailies. But now we intend to place the
documents published by the various leading medical luminaries.
We refer to the Article published in Lancet, a leading medical
journal by Dr. John S. Yudkin. Dr. Yudkin observes “many drugs
are promoted for diseases for which they are not indicated and in
which their use may be hazardous and information on side effects
and contra indications are inadequate. In many developing coun
tries the money spent on such irrational drugs often can be used
more effectively to prevent diseases.” The instances of malprac
tices are really shocking. When Amidopyrine and dypyrone which
are restricted because of severe side effects with high mortality
rates in developed countries, such preparations are promoted in
developing countries ‘with a wide margin of safety’ or ‘that their
safety has been proven and confirmed in over 500 publications
throughout the world’.

Anabolic steroids are restricted because of stunting of
growth, irreversible virilisation in girls and liver tumours; they
arc used in developing countries for'malnutrition, weight loss and
kwashiorkar (protein deficiency) disease. Eg. Deccardurabolin,
Dinabol.

The use of high dose of oestrogen and progestron combina
tions as ‘hormonal pregnancy test’ is associated with an increased
incidence of congenital abnormality in Britain. It is only allowed
to use where pregnancy has been excluded, but strangely in devel
oping countries this is being marketed for the diagnosis of pregn

ancy.

5
When Chloramphenicol is restricted only for enteric fever
in U. K. and U.S.A, it is being promoted in developing countries
for a variety of diseases including throat infections.
Kenacort, a tyopical steroid, a dangerous drug is being
promoted in our country for insect bites and sunburns.
Tetracycline preparations are prohibited in U.K. and U.S.A.
for children below 12 years, the same being widely promoted for
children below 12 years in large quantities in our country.
Clioquinol has been withdrawn in several countries because
of‘Smon’ (a type of blindness). Producers claim that this risk is
dose related and that when it goes beyond a maximum dose of 7
grams and particularly confined in Japan, but in the monthly in
formation of medical specialities (MIMS) the recommended
maximum total dose of enterovioform are 14 grams and 29.4 grams
and as a prophylactic does not mention a stated maximum dose
at all. Dr. Yudkin concludes “a large proportion of the drug
budget of the developing countries is spent on expensive prepara
tions draining resources from Health Care in Rural areas.”4
Another shocking revelation is made by Charles Mede war
in his famous publication Insult or Injury published by Social
Audit against companies like Glaxo, Pfizer, Cynamid, I. C. I.
Reckitt and Colman etc.etc. One specific instance which will be of
interest is about the marketing of /Vncoloxin by Glaxo Allenburys
in India.
In Britain the official drug data sheet for Ancoloxin states
‘‘Whilst drug therapy is undesirable during the first semister of
pregnancy the administration of Ancoloxin may be warranted if
vomiting is severe (the reference here to vomitting is as opposed
to “nausea and vomiting”) but in developing countries like Africa
and in India in promoting Ancoloxin the manufacturers did
not hint at the need for special caution in pregnancy or the pos
sibility of terratogenesity. Glaxo has acknowledged that warnings
in India have not been sufficient and has stated that the offending
literature will be changed as soon as possible.6
Dr. Ronald H. Girdwood in his publication Clinical Phar
macology page 54 has given a signal warning in the use of
oral contraceptives Phenylbutazone, Chlorpramazine, Corticoste
roids, Halothane, Oxyphenbutazone Aspirin, Phenacetine etc.6
The Drug Controller of India, Shri S. S. Gothaskar had
constituted the Drugs Consultative Committee and as per the
Notification No. X-19013/2/90. D dated 23.8.1980 states that the

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Sub Committee examined 34 categories of fixed dose combinations
and felt that in the case of 23 categories of these formulations,
there was no therapeutic rationale for their marketing. Of these
23 categories, it was felt that 16 categories arc of harmful com
binations in respect of which action should be taken with immedi
ate effect to disallow their manufacture in the country.
Categories of fixed-dose combinations to be weeded out
immediately arc:-

1
2
3
4
5

Fixed dose combination of steroids
,,
,,
of Amidopyrine
,,
,,
of Chloramphenicol
,,
,,
of Ergot
,,
,,
of Vitamins with anti-inflammatory
agent and tranquillisers
6
Atropine in Analgesic Anti-pyrctics
1'
Analgin
8
Yohimbine and strychnine with
testosterone and vitamin
Iron with strychnine,
arsenic,
9
yohimbine
10
Phenacetin
11
Tetracycline, analgin with vita
min C
Ayurvedic drugs with Modern drugs
12
Chloramphenicol with streptomycin
13
Penicillin with streptomycin
14
More than one Anti-histaminics
15
Penicillin with sulphonamides
16
Anti-histaminic with tranquilliser
17
Vitamins and Analgesics
18
Tranquillisers, Anti-histaminics-and
19
Analgesics
Vitamins in Anti-TB drugs
20
It is alarming to observe that while code of discipline is
being enforced by the Governments in their parent countries, here
the MNCs and their allies are enforcing code of discipline on our
Government in order to get more and more concessions in their
favour.

One must feel ashamed to read is the genetic_engineering
research located in Bombay by a West German drug MNC called

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HOECHST. The research involves the recombinant DNA techni
que which enables transmission of new properties to Jiving organ
isms and creation of new organisms including unpredictable and
dangerous ones which could cause incurable diseases and enduring
disability. The choice of India for this research is obviously moti
vated by the absence of any strict rules of safety against genetic
research and not by Hoechst’s desire to transfer technology.
(London ECONOMIST, November 5,1977)
Mr. Justice, S. Rangarajan, chairman MRTP commission,
dealing with drugs and pharmaceuticals in UK observes: “The
Salisbury Committee had pointed out as early as in 1965-67 that
just over a third of 2,657 proprietory drugs available in the
national health service were undesirable because they were ‘ineffe
ctive, obsolete or in unsuitable combinations.’
There were quite a few drugs which were prohibited in
America still being prescribed in India. Product safety still seemed
to be a little understood concept.”7
Mr. Justice Rangarajan advocates consumer protection ‘not
only by awarding’ exemplary damages and fines, but also by
imprisonment of those who violate the law.
2. Marketing products through advertisements'. The Guardian (Feb.
4, 1979) had highlighted on advertising imperialism based on the
publication Insult or injury by Charles Medawar. The publication
has exposed various manipulations of misleading propaganda used
by leading firms like Glaxo, Cadburys, Beechams, Boots, Reckitt
and Colman. Cadbury’s Bournvita is sold in Britain as“a good night
drink, but promises third world consumers “energy, vitality, health
and strength”. The misuse of Reckitt & Colman patent Barley
water in Bangladesh has resulted in severe malnutrition and death.
Glaxo selling their Complan, Glaxose-D by misleading advertise
ments. While 200 grams of Complan costs Rs. 14/-, a kilogram of
Complan requires 5 tins thereby a consumer has to pay Rs. 70/whereas one kilogram of Complan is equivalent to one kilogram of
wheat plus a B complex tablet plus a vitamin C tablet,which all put
together shall cost only Rs. 4/-! Similarly one kilogram of sugar
now costs Rs.4/-,Glaxose-D which is nothing but sugar costs Rs. 30/
for one kilogram! Where does the money go? Crores of rupees thus
amassed are siphoned out to their foreign countries. One will have
a shock of his life when it is known that many of them prod
uce and market such items in our country freely without any
valid licence at all. This has been announced in the Floor of

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Parliament during this session in the case of Warner Hindustan,
The charges are already proved and the enquiries are going
against Sandoz, Cynamid, I. C. I. Ciba-Geigy, Pfizer etc. Pfizer is
accused of selling every year Protinex Granules worth about Rs.
3.5 crore without any valid licence.8
The story of bottle feeding and how it affects the health of
the children of developing countries has already been brought to
notice by eminent paediatric consultants like Dr. Doric Jcliff
and Dr. Benjamin Spak. Dr. Anand of Bombay has scientifically
proved that 75% of death among children in developing countries
is due to the indiscriminate use of baby foods through bottle feed
ing. W.H.O. has already given the slogan that “breast is the best”.
1 hese instances are cited to show how the foreign transnational
companies are strangulating our economy in collaboration with the
national monopoly houses and the feudal lords in our country
thereby siphoning out India’s valuable economic resources while
the employees and the common people arc struggling in our coun
try for just and minimum living conditions.
3. Selling of drugs through advertisements: If we tune the radio we
hear,‘Are you suffering from fever.take Chloroquine, as if all fevers
are due to Malaria. The gravity of this advertisement is serious
when it comes through the All India Radio and through our Inland
and Post-cards. Drugs containing various Analgesics are being sold
through the Press advertisement giving catchy caption. It is now
being revealed that most of these analgesic are already being with
drawn in their parent countries as they are found to be causing
severe kidney damage. The seriousness of the situation is such that
such drugs are sold to the laymen over the counters.
There is intensive promotion of food and drug products to
consumers in our country who do not need them, who cannot aff
ord them and who arc in no position to benefit from them. To sum
up one can say that the absence of a National Statutory Forum like
that of British Safety Committee of Medicines in U. K. or that of
F. D. A. in U. S. A. are fully made use of by the transnational
corporations in order to perpetuate their system of exploitation.
Further the absence of an Integrated Drug Control Machinery
with uniformity of action adds more fuel to the fire of exploitation.
The employees engaged in the Drugs and Pharmaceutical
industry who are primarily accountable to the Nation are being
allowed to be exploited as if the Law of the country is not
applicable to them. It is crystal clear that the security of the

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employees engaged in the drugs and pharmaceutical industry arc
very much tied up with the security of the Health of the people
of our country.
“Science”,states Bravermann, “is the last and after labour the
most important social property to be turned into an adjunct of
Capital.”9 But in our country every year we arc being told that
lakhs and lakhs of people are suffering from Leprosy, millions of
people are suffering from Tuberculosis, crores of people suffering
from malnutrition and 9 i% of our population are wanting for
pure drinking water. While these are the realities, the beneficiaries
of the present drug industry are the handful of Drug Cartals both
foreign and Indian monopolists. Neo-colonialism cannot be
defeated by people acting in isolation. It calls for the united and
determined efforts of all democratic minded forces of the country.
1
’

Monthly Review Sept 1977, page 21
Journal of the Indian Medical Association, Vol 71, No. 3, August 1, 1978, page 72

3

ICMR BULLETIN—November 1980-page 149

*
•'

Lancet, April 15, 1978
Insult or Injury by Charles Medawar Page I 18

0

Clinical Pharmacology by R. H. Girdwood, page 54

'
8

Economic Times—February 1981, page 7
Menace of Multinationals, People’s Publishing House, Page 78

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Labour and Monopoly Capital by Harry Bravermann

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