NAME GAME

Doctors body fights for freedom on prescriptions, tells government to focus on price

The government is considering rules to make doctors write only generic names of drugs in prescriptions.

India’s largest professional medical body, the Indian Medical Association, has opposed the government’s suggestion that doctors should write generic names of drugs while prescribing medicines. Prime Minister Narendra Modi announced on April 17 that the government was considering such a rule, following which the Medical Council of India issued a circular reiterating its September 2016 notification, which already states that a doctor is expected to “prescribe drugs with generic names”.

But the Indian Medical Association is finding this hard to swallow. “Not writing a brand name is like asking people to vote but without mentioning the names, BJP or Congress,” said Dr KK Aggarwal, president of the association, which has close to 2.75 lakh members.

Generic drugs are those for which the patent has expired and may be branded or unbranded. Unbranded generics are referred to and sold under their International Non-proprietary names – the names that doctors are now expected to use when writing prescriptions. The government’s purported aim for the move is to ensure that patients are being given affordable medicines. Original branded medicines sold by large pharmaceutical companies are more expensive because they are marketed more extensively. Generic drugs are may be manufactured by smaller companies at lower costs and may have lower prices. Generic drugs have the same formulations as original drugs, as well as the same effect and can be as safe as branded drugs.

More than 90% of the medicine market in India is made up of branded generics. Members of the medical community and health activists have said that the government must move to reduce the profit margins on branded generics instead of trying to regulate doctors’ prescriptions.

Said uro-gynaecologist Dr Aparna Hegde: “Profits resulting from prescriptions most often benefit the pharmacist and/or the hospital and not the doctor because often it is former who decide which drug is given to the patient based on their available stock irrespective of the brand prescribed by the doctor. This practice of substitution [where a pharmacist may decide which drug to give] can be dangerous if maximising profits underlies the choice of the drugs stocked.”

Hegde is concerned about the quality generic drugs, especially non-branded generic drugs, given India’s poor drug regulatory systems.

Dr S Utture, elected member of Maharashtra Medical Council, said that the need to prescribe branded generic drugs arises because doctors have little faith in the non-branded generics. “The problem is that we have a very weak Food and Drug Authority,” he said. “If the FDA ensures that the non-branded drugs have the same bio availability [the amount of drug absorbed in the blood stream] as branded generics, there would be no problem.”

In a recent article on Scroll.in, S Srinivasan who runs Low Cost Standard Therapeutics, which manufactures essential medicines for rural and urban poor, wrote that the quality of a medicine does not necessarily depend on whether it is an expensive branded medicine or a less-expensive generic one. But much of the price of a branded medicine may be to cover the marketing costs to the manufacturer that might include special attention to doctors like gifts and paid holidays.

But instead of regulating doctors’ prescription habits, the Indian Medical Association wants the government to disallow differential pricing of the same drug under different brand names. “The judgment to prescribe a drug and the format lies with the registered medical practitioner,” said Aggarwal, calling this right to make such a judgment sacrosanct.

The Medical Council of India certainly does not think so. The council had tried to get doctors to write generic names in prescriptions last September when it amended its regulations.

Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs.

The above Clause – 1.5 is substituted in terms of Notification published in the Gazette of India on 08.10.2016 as under.

“Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”

— September 2016 amendment to the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002

“The amendment clearly says ‘should’ prescribe medicines with generic names and not ‘shall’, which clearly means that it is a doctors’ discretion,” countered Aggarwal.

He insisted that the association’s members may prescribe the medicines using their generic names but will continue to “put the brand name in the brackets”.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Behind the garb of wealth and success, white collar criminals are hiding in plain sight

Understanding the forces that motivate leaders to become fraudsters.

Most con artists are very easy to like; the ones that belong to the corporate society, even more so. The Jordan Belforts of the world are confident, sharp and can smooth-talk their way into convincing people to bend at their will. For years, Harshad Mehta, a practiced con-artist, employed all-of-the-above to earn the sobriquet “big bull” on Dalaal Street. In 1992, the stockbroker used the pump and dump technique, explained later, to falsely inflate the Sensex from 1,194 points to 4,467. It was only after the scam that journalist Sucheta Dalal, acting on a tip-off, broke the story exposing how he fraudulently dipped into the banking system to finance a boom that manipulated the stock market.

Play

In her book ‘The confidence game’, Maria Konnikova observes that con artists are expert storytellers - “When a story is plausible, we often assume it’s true.” Harshad Mehta’s story was an endearing rags-to-riches tale in which an insurance agent turned stockbroker flourished based on his skill and knowledge of the market. For years, he gave hope to marketmen that they too could one day live in a 15,000 sq.ft. posh apartment with a swimming pool in upmarket Worli.

One such marketman was Ketan Parekh who took over Dalaal Street after the arrest of Harshad Mehta. Ketan Parekh kept a low profile and broke character only to celebrate milestones such as reaching Rs. 100 crore in net worth, for which he threw a lavish bash with a star-studded guest-list to show off his wealth and connections. Ketan Parekh, a trainee in Harshad Mehta’s company, used the same infamous pump-and-dump scheme to make his riches. In that, he first used false bank documents to buy high stakes in shares that would inflate the stock prices of certain companies. The rise in stock prices lured in other institutional investors, further increasing the price of the stock. Once the price was high, Ketan dumped these stocks making huge profits and causing the stock market to take a tumble since it was propped up on misleading share prices. Ketan Parekh was later implicated in the 2001 securities scam and is serving a 14-years SEBI ban. The tactics employed by Harshad Mehta and Ketan Parekh were similar, in that they found a loophole in the system and took advantage of it to accumulate an obscene amount of wealth.

Play

Call it greed, addiction or smarts, the 1992 and 2001 Securities Scams, for the first time, revealed the magnitude of white collar crimes in India. To fill the gaps exposed through these scams, the Securities Laws Act 1995 widened SEBI’s jurisdiction and allowed it to regulate depositories, FIIs, venture capital funds and credit-rating agencies. SEBI further received greater autonomy to penalise capital market violations with a fine of Rs 10 lakhs.

Despite an empowered regulatory body, the next white-collar crime struck India’s capital market with a massive blow. In a confession letter, Ramalinga Raju, ex-chairman of Satyam Computers convicted of criminal conspiracy and financial fraud, disclosed that Satyam’s balance sheets were cooked up to show an excess of revenues amounting to Rs. 7,000 crore. This accounting fraud allowed the chairman to keep the share prices of the company high. The deception, once revealed to unsuspecting board members and shareholders, made the company’s stock prices crash, with the investors losing as much as Rs. 14,000 crores. The crash of India’s fourth largest software services company is often likened to the bankruptcy of Enron - both companies achieved dizzying heights but collapsed to the ground taking their shareholders with them. Ramalinga Raju wrote in his letter “it was like riding a tiger, not knowing how to get off without being eaten”, implying that even after the realisation of consequences of the crime, it was impossible for him to rectify it.

It is theorised that white-collar crimes like these are highly rationalised. The motivation for the crime can be linked to the strain theory developed by Robert K Merton who stated that society puts pressure on individuals to achieve socially accepted goals (the importance of money, social status etc.). Not having the means to achieve those goals leads individuals to commit crimes.

Take the case of the executive who spent nine years in McKinsey as managing director and thereafter on the corporate and non-profit boards of Goldman Sachs, Procter & Gamble, American Airlines, and Harvard Business School. Rajat Gupta was a figure of success. Furthermore, his commitment to philanthropy added an additional layer of credibility to his image. He created the American India Foundation which brought in millions of dollars in philanthropic contributions from NRIs to development programs across the country. Rajat Gupta’s descent started during the investigation on Raj Rajaratnam, a Sri-Lankan hedge fund manager accused of insider trading. Convicted for leaking confidential information about Warren Buffet’s sizeable investment plans for Goldman Sachs to Raj Rajaratnam, Rajat Gupta was found guilty of conspiracy and three counts of securities fraud. Safe to say, Mr. Gupta’s philanthropic work did not sway the jury.

Play

The people discussed above have one thing in common - each one of them was well respected and celebrated for their industry prowess and social standing, but got sucked down a path of non-violent crime. The question remains - Why are individuals at successful positions willing to risk it all? The book Why They Do It: Inside the mind of the White-Collar Criminal based on a research by Eugene Soltes reveals a startling insight. Soltes spoke to fifty white collar criminals to understand their motivations behind the crimes. Like most of us, Soltes expected the workings of a calculated and greedy mind behind the crimes, something that could separate them from regular people. However, the results were surprisingly unnerving. According to the research, most of the executives who committed crimes made decisions the way we all do–on the basis of their intuitions and gut feelings. They often didn’t realise the consequences of their action and got caught in the flow of making more money.

Play

The arena of white collar crimes is full of commanding players with large and complex personalities. Billions, starring Damien Lewis and Paul Giamatti, captures the undercurrents of Wall Street and delivers a high-octane ‘ruthless attorney vs wealthy kingpin’ drama. The show looks at the fine line between success and fraud in the stock market. Bobby Axelrod, the hedge fund kingpin, skilfully walks on this fine line like a tightrope walker, making it difficult for Chuck Rhoades, a US attorney, to build a case against him.

If financial drama is your thing, then block your weekend for Billions. You can catch it on Hotstar Premium, a platform that offers a wide collection of popular and Emmy-winning shows such as Game of Thrones, Modern Family and This Is Us, in addition to live sports coverage, and movies. To subscribe, click here.

This article was produced by the Scroll marketing team on behalf of Hotstar and not by the Scroll editorial team.