Medicalising Pakistan

Hi All


You can visit Pakistan Pharmacists Society website at www.pharmacists.pk or www.pharmacist.pk to read about this article and others about pharmacy profession in Pakistan.

Hi

A new discussion group `` Medicines_Pakistan`` has been created to discuss pharmaceutical issues in Pakistan, kindly visit http://health.groups.yahoo.com/group/Medicines_Pakistan/

To become a member of the group, send an e-mail to ``medicines_Pakistan@yahoogroups.com`` with your name and affiliation.

Dr. Zaheer-Ud-din Babar [Moderator of Medicines Pakistan]

Re: # 15
Interesting letter of Indonesian person
The prices of medicine


THIS refers to the letter by Raza Ali Dossa (Jan 4).To eliminate overcharging, the pharmaceutical companies should print the maximum retail price on each medicine. This is obligatory in India.

One wonders why a tube of Canesten, a skin ointment, costs the equivalent of five cents per gram in India but 25 cents per gram in Indonesia. Both versions are manufactured by the same multinational company.

Similarly, 500-milligram tablets of Glycophage cost five times more here than their equivalent, Glycomet, does in India. Daonil in five-milligram tablets costs 17 times than its Indian equivalent. Pioglar-15 costs 6.5 times more. Interestingly, the generic Metformin and Glibenclamide both cost about the same here as the branded variety in India. Why is there so much difference between the costs of generic and branded medicines? And why do Indonesian doctors not prescribe generic medicines?

Thanks to the printed prices on the medicines, Indian pharmacies sell medicines at the proper prices. On the other hand, the Indonesian customer is blissfully ignorant about what the price of the medicine should be. We desperately need to determine who is primarily responsible for the higher costs of medicines. Some NGOs should take up this issue. The government should also step in to curb the retail prices of medicines.

Indians will remain ever grateful to the late prime minister Indira Gandhi, who forced the pharmaceutical industry to print and charge fair prices. By and large, all pharmaceutical companies in India are still doing well.

I feel President Susilo Yudhoyono will win another bigger landslide victory in his quest for a second term if he earns the gratitude of millions of Indonesians who cannot afford medicines.

K.B. KALE
Jakarta, Indonesia

Re: # 15

Related letter by Indonesian person in Dawn
The prices of medicine


THIS refers to the letter by Raza Ali Dossa (Jan 4).To eliminate overcharging, the pharmaceutical companies should print the maximum retail price on each medicine. This is obligatory in India.

One wonders why a tube of Canesten, a skin ointment, costs the equivalent of five cents per gram in India but 25 cents per gram in Indonesia. Both versions are manufactured by the same multinational company.

Similarly, 500-milligram tablets of Glycophage cost five times more here than their equivalent, Glycomet, does in India. Daonil in five-milligram tablets costs 17 times than its Indian equivalent. Pioglar-15 costs 6.5 times more. Interestingly, the generic Metformin and Glibenclamide both cost about the same here as the branded variety in India. Why is there so much difference between the costs of generic and branded medicines? And why do Indonesian doctors not prescribe generic medicines?

Thanks to the printed prices on the medicines, Indian pharmacies sell medicines at the proper prices. On the other hand, the Indonesian customer is blissfully ignorant about what the price of the medicine should be. We desperately need to determine who is primarily responsible for the higher costs of medicines. Some NGOs should take up this issue. The government should also step in to curb the retail prices of medicines.

Indians will remain ever grateful to the late prime minister Indira Gandhi, who forced the pharmaceutical industry to print and charge fair prices. By and large, all pharmaceutical companies in India are still doing well.

I feel President Susilo Yudhoyono will win another bigger landslide victory in his quest for a second term if he earns the gratitude of millions of Indonesians who cannot afford medicines.

K.B. KALE
Jakarta, Indonesia

Dear Babar
It is a good article ``so many pharmacies`` doesn’t every Pakistani have access to medicine, still 50% population of the country is un able to access medicine and more then 60% are un able to access essential medicine. theses pharmacies are not interested to make available all essential medicine, they are mainly interested in high profits and make available only those drugs which provide them with high profits
I want to draw the attention of readers to other related issue, that is
``The inter brand prices variation`` I will coat an example of a medicine ``Ceftriaxone``
more then 100 companies are manufacturing Ceftriaxone in Pakistan but there huge difference of prices between different brands
Rocephin (Roch)
250mg IV MRP= Pak Rs. 141.40
500mg IV MRP= Pak Rs. 242.75
1000mg IV MRP= Pak Rs. 477.68
Same drug is sold by the M/S Zafa with the brand Name Zeftrox at the prices below
250mg IV MRP= Pak Rs. 54.00
500mg IV MRP= Pak Rs. 88.56
1000mg IV MRP= Pak Rs. 162.00
I have coated just one example; there are hundreds examples of the same type against every molecule
What I have concluded that Branding is game of corporate sector to maximize profits. patients are always ``the effected``
so for the betterment of health care system, sale of branded medicine should be prohibited and the base for the sale of medicine should be ``Generics``

By Mark Sappenfield | Staff writer of The Christian Science Monitor
NEW DELHI – During a lifetime spent treating AIDS patients from Asia to the deepest reaches of Africa, Chinkholal Thangsing has noticed something extraordinary. Whenever patients learn that he is from India, their response is almost universal.

``They say, `Thank you very much. You saved our lives,` `` he remarks.
In the Monitor
Wednesday, 01/10/07

Dr. Thangsing knows they are speaking not of him, but of his country. For decades, India`s drugmakers have been the pharmacy for the world`s destitute, finding ways to copy the best medicines at the lowest prices. By some estimates, India`s generic medicines treat half the AIDS patients in the developing world.

Yet this picture has begun to change since India decided to comply with global patent standards last year. Now as never before, Indian pharmaceutical companies are looking to expand business in rich countries, which, critics say, will come at the expense of the world`s poor. The intent is to follow the footsteps of India`s information-technology (IT) sector, which parlayed lower costs and improved innovation into India`s greatest modern success story.

The timing could be fortuitous. As the cost of healthcare rises worldwide, Indian pharmaceuticals have positioned themselves to take advantage. For instance, Indian drugmakers now have 75 plants approved to make drugs for the American market - the most of any nation except the United States itself. Also, like Indian IT a decade ago, pharmaceuticals are on the cusp of an outsourcing trend that could become a $3-billion-a-year industry by 2010.

``IT reached that threshold`` as a global brand, says Ramesh Adige, a spokesman for Indian drugmaker Ranbaxy. ``The pharmaceutical industry is right there.``

Leaving behind the poor?

The concern, however, is that as the industry reaches for newfound levels of prosperity, it will leave behind those poor who have long depended on it.

The industry is trying its best to straddle the old and the new. Last month, Ranbaxy and a second Indian pharmaceutical, Cipla, agreed to provide half-price HIV drugs to the foundation of former President Bill Clinton. The Clinton Foundation will distribute the medicines to 100,000 children in 62 countries.

The pact is further proof that India is still in many ways the premier drug-provider for the developing world. ``If you take the country as a whole, there is probably none like it,`` says Sujay Shetty, an industry analyst at PricewaterhouseCoopers. ``No other country has that kind of influence.``

Yet maintaining that influence might be difficult. Until last year, Indian pharmaceuticals were free to produce copies of patented drugs, so long as they made the drugs in a different way.

Given India`s low production costs and its scientists` skill at ``reverse-engineering,`` companies produced their own versions of patented drugs at a fraction of the price. Famously in 2000, Indian drugmaker Cipla unveiled new drugs for HIV patients that cut the annual price of treatment from $11,000 to $400. Today, 1 in 3 AIDS patients in Africa takes Cipla drugs.

India bows to patent pressure

The bounty of the third-world, however, was the bane of first-world pharmaceutical companies. They were outraged by India`s patent laws, which protected only the engineering process, not the product itself. In turn, they made India a pariah. At last bowing to this pressure, India fully joined the global patent standards last year.

To some, this risks undermining India`s responsibility to health in developing countries. ``These drugs will not be available at these prices,`` says Amar Lulla, a managing director of Cipla, suggesting they could be 30 to 50 times more expensive.

He acknowledges that his company loses some business opportunities under the new patent regime, but he demurs that ``it is no issue at all to survive.`` To him, the question is: ``How do you juxtapose the human right to health with intellectual property?``

From a purely economic standpoint, however, the change in the patent law has been clearer, and - in many respects - more positive. For one, foreign firms are no longer afraid to come here. In the past, they knew that their patents would not be respected, so they stayed away. Now, foreign pharmaceutical firms are entering the market to target India`s growing middle class, and they are considering outsourcing some research, which could cut costs as much as 60 percent, by some estimates.

At the same time, Indian companies are venturing abroad both to buy and to sell. Earlier this year, Dr. Reddy`s Laboratories bought German drugmaker Betapharm for $570 million, gaining better access to the European market. The hunger to compete abroad is also evident in the number of applications filed by Indian companies to sell their medicines abroad. Worldwide, 37 percent of the Drug Master Files submitted last year came from India, the largest share of any country.

``The Indian pharmaceutical industry is fast becoming an integral part of the global pharmaceutical market,`` writes Hitesh Gajaria, an industry analyst at KPMG consultants, in an e-mail. ``India`s inherent strengths, such as low development cost, skilled and efficient manpower, and easy availability of raw materials, give it a competitive cost advantage.``

At this point, India`s great strength is still generic drugs. But India`s leading companies are now taking the unprecedented step of investing hundreds of millions of dollars into research and design to invent entirely new drugs. ``We need to take that next step up,`` says Mr. Adige of Ranbaxy.

For his part, AIDS physician Thangsing is not convinced.

Sitting behind his desk at his New Delhi clinic, outfitted in a faded black sweatshirt, he does some quick math. Already, India has more people diagnosed with AIDS than any other country in the world, and the number is increasing. In five years, when forecasts suggest the needs will be dire, India`s new patent laws will be preventing its pharmaceuticals from making generics from the most up-to-date treatments.

He worries: ``That`s when the trouble will come.``

Re: # 9

Just because HIV symptomatic relief pills aren`t freely available over the counter, like in India, doesn`t mean no real pharmacies exist on this side. Someone should tell him.

Aisha Sarwari

Even this will be turned into Indo-Pak diatribe? LOL

so veeresh was right when he complained (some 3 years back) that he could not find any dawai dukan? i just thought he was confused because he could not see the cross sign used by chemist in india. in pakistan such a christian sign is prolly not used by chemist shops and that can be an explanation for veeresh`s experience.

I am glad that distribution of medicines is proliferating in Pakistan. Indian Pharmaceutical firms should take advantage of this and form partnerships or invest in Pakistan. 160 population with genetic stock similar to Indians is a viable market to exploit.

anyone remember vereesh - sadna`s soul mate and cross-border tourist ?........... well, he said that he could not find a single pharmacy in rawalpindi islamabad ....... it seems pakistan has come a long way in the last one year or so !

There are 9 pharmacies on Link Road, Model Town, while if I recall accurately there used to be 2 a year ago.

Aisha Sarwari

The alarming thing for a common person is high priced medicine:

The prices of drugs that are to cure chronic diseases as blood pressure, asthma, epilepsy are quite high and are unreachable for a low income holder. Prices of antibiotics are also far reachable for even a moderate salary holder. However the doctors prescribe for an entire cycle of drug to be taken for atleast 5-7 days but price of a unit of drug is more than 50Rs. atleast.

Nowadays there is an acute shortage of the drugs are local made in various parts of Sind and Punjab. The artificial shortage of them is created in market by the drug king companies just to take advantage by high pricing. Pakistan has a very high priced drug list that in its neighboring country is easily available at much cheaper rate. High Inflation rate and degradation of rupee in market for past 10 years are assumed the firing of cost of drugs. There is a very small segment in the society that can bear all the expenses of medication with ease of finances. The rest if get medical treatment have to think twice for expenses of food intake as well. This sorry situation is leading many well-educated people to derivate their choices to homeopathic medicines that are cheap and abundant in every nic and corner. One formula works for all cold symptoms and the slow effect is digested instead of having an expensive aleopathic brisk relief.

The making of new Drug Regulatory Authority is quite a bureaucratic attempt to make a new setup from prevailing aspect of 70Billion Industry to exceed its bounds furthermore. However the local drug producing companies are not interested in supplying the essential drugs despite of their shortage because of taxes monoply these companies are surviving. There should be proper review on prices of drugs giving a beneficial relief to the poors of state and the availability of drugs be made proper by not risking lives of masses.

``the only difference is that we have to stand at least a foot away from the wall, whereas you guys can get to within half an inch or so !``

now that is really mean and witty hamidm miaN....:) ......but what do the women say.......:)