By Dr. K. Javeed Nayeem, MD

The recent announcement by an international drug testing laboratory that many anti-cancer drugs of Indian origin have failed to clear quality tests by alarmingly wide margins, should come as an eye-opener to our authorities vested with the very crucial responsibility of the enforcement of drug quality control standards.

The report says that many of the tested drugs, which qualified to be called life-savers, contained either far too less or far too much active ingredients, than what they should have, thus jeopardising the lives of patients treated with them. Needless to say, while the former situation can fail to effect a cure and kill the patients, for want of sufficient drug, the latter can kill them with a drug overdose.

This is particularly true in the case of anti-cancer drugs because most of them are highly toxic, with very little margin between their effective doses and lethal doses. A little less and they just fail to work and a little more and they can turn out to be deadly poisonous! And so, doctors using them on their patients have a very great responsibility in calculating the exact dose of each drug, depending on the type and severity of disease and the body weight of each patient they treat.

While doing this delicate, tight rope walk, they do it with the trust and faith that the medicine they use is perfect, both in its quality and content. And, if these two very vital parameters do not meet the very high standards that are expected of them, it can mean the difference between life and death itself!

Sadly, this is not for the first time that an accusing finger is being pointed at the quality of our locally produced medicines. Not very long ago, the very distressing deaths of children in some African countries were attributed to the presence of toxic substances like ethylene glycol in cough syrups of Indian origin. Although these reports were at first brushed off by our authorities as unconfirmed rumours, they had to soon swallow the bitter pill of truth, when lab tests confirmed that the quality of suspect drugs was confirmed to be the culprit.

More recently, nearer home in Ballari, the substandard quality of the IV fluids supplied to some of our government hospitals resulted in the deaths of not less than six women who had gone there to deliver their babies. What were meant to be visits to the hospital to bring home bundles of joy, turned out to be a tragedy for the families that had to bring home the dead bodies of the now orphaned children’s mothers. When medicines, which are meant to cure ailing patients, can themselves begin to kill them, it is indeed a distressing and shameful situation, which needs to be addressed with some strict and unforgiving remedial measures.

Although India is today proudly at the forefront, when it comes to the quality of medical care and the manufacture of drugs, many lacunae still exist that need to be addressed before we can sit back and say that our systems are faultless. While we have some of the best players in the field of drug manufacture, who are doing a great job of meeting our needs and even protecting the image of our country in the export market, with the high quality of their products, a great many black sheep do exist.

The main cause of some of our drugs not meeting the quality standards expected out of them is because as things stand now, any Tom, Dick and Harry, with my apologies to all people with these three names, can set up a drug manufacturing facility in our country, thanks to our lack of strict vigilance.

I do not say that our set quality control standards are below par, but our morals certainly are. Thanks to all-pervasive corruption that exists all around us, in every single government department, the officers vested with the responsibility of implementing regulations can be bribed into giving any kind of clearance, in any sector and sadly even for the manufacture of drugs. And, with the costs of these bribes and kickbacks, compounded with their own unrestrained greed, the manufacturers decide to give quality standards a wide go-by, resulting in their substandard drugs flooding the market.

And, while our government may not find this an easy pill to swallow and may insist that there are only white sheep grazing in the field, practicing doctors like me know from their experience in their field, that everything is not so hunky dory. Many patients under my treatment come back to me after their first few visits and ask me whether they can buy the so-called generic versions of the drugs prescribed by me, which come at a considerably lesser cost.

Earlier, I used to spend some time in counselling them about the seemingly logical relationship between costs and quality, but soon I discovered that this was an exercise in futility. So, I have now started telling them that they are free to make their choices and try out for themselves what works best for them and their ailments.

But with our government pushing its Janaushadi Scheme as the best medicine for our aam janta’s health, there is just no room on the road to prosperity, for any doctor to stand alongside and dispense what they think is good for them. It is a different matter that all our netas and babus, who make our laws and rules, and who pop only branded pills, prescribed at the best private hospitals, think that as long as the people they rule, think that they are getting the kindest governance, they are themselves on the right road to their own prosperity!

There is nothing more attractive than a free lunch, which is why all the freebies launched at your cost and mine, are so successful in winning elections!

Coming back to where I left myself standing on the roadside, I would like to tell you that though not all, a good many of the patients who experiment with a good many of the so-called low-cost, high-quality medicines, soon come back with the complaint that they are not working for them as expected. That is when I tell them that this relationship between what you pay for and what you get, which holds good in matters of what they eat, wear, drink or drive, holds good, even for all the pills they pop, for all their ills!

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