Sourabh Ghosh was a student when he was diagnosed with cancer. This was 13 years ago, before Swiss drugmaker Novartis launched Glivec, its blockbuster leukemia therapy in India. Ghosh was put on available medicines, which ngos occassionally helped pay for, but times were hard, the bills hefty. Ghosh then moved to Switzerland for higher studies. There, Novartis’s drug donation programme got him Glivec free of cost for the first time. He then went to the US, where insurance covered the drug.
It is when Ghosh returned to India in 2008 that his problems with accessing Glivec, a medicine known to work wonders but which must be taken every day throughout life, began. In India Glivec costs Rs 1.25 lakh a month. This puts the drug firmly beyond the reach of even well employed patients like Ghosh, an assistant professor at IIT Delhi. So much so that Novartis (and all companies marketing “high-value” specialised drugs) rarely sell through regular retail channels. To keep commissions off sticker price, networks of agents sell expensive, branded drugs. “I was told that since my employer can afford to pay for Glivec, I could not qualify for Novartis’s free drug programme,” says Ghosh.
Today, 16,380 people get Glivec from Novartis as part of a project it started in 2002 and gets the non-profit Max Foundation to administer. The project was revamped in 2009, setting up a financial evaluation and “co-pay” system to screen beneficiaries. “No patient pays for more than 80 days of Glivec a year. Most get it completely free,” says its head, Viji Venkatesh. The foundation does not set or know the financial criteria for eligibility—Venkatesh says IndiaBulls oversees that aspect.
Novartis’s India head Ranjit Shahani defends the programme and pricing strategy saying, “We have distributed Glivec worth more than $1.7 billion to patients free of charge since 2002.” Practically everyone—95 per cent of consumers—gets it absolutely free. He did not say how the patients are selected or what the financial criteria are.
Against this backdrop, Novartis has struggled for 15 years to secure an Indian patent for Glivec. “If it had been approved, those diagnosed with two rare but dangerous forms of cancer would find a key treatment slip beyond reach,” says Y.K. Sapru, who heads the Cancer Patients Aid Association, a non-profit that assists cancer patients and opposed Novartis’s patent bid in court. Finally, the Supreme Court itself ruled on April 1 that India’s patent law is indeed compatible with international norms; that the refusal did not exceed flexibility allowed under the rules; and that product patents are entirely acceptable—it’s just that Glivec couldn’t make a strong enough case.
“The court’s decision discourages innovative drug discovery essential to advancing medical science for patients in need of new treatments,” says Shahani. “We will be cautious in our investments in India, especially with respect to innovative medicines.”
While Novartis chafes, health activists and ngos say the verdict has put paid to “evergreening” of drugs in India. “Patented medicines, after some tinkering, are re-patented by pharma companies keeping generic versions out indefinitely. This judgement makes it clear that is against the rules,” says D.G. Shah, a pharma analyst who runs Vision Consulting Group.
Pharma executives acknowledge behind the scene that the judgement will force new strategies for India across diseases, not just cancer. “Some companies like gsk are beginning to explore tiered pricing across a broader class of medicines, expressly in least developed and low-income countries, more cautiously elsewhere,” says Dr Brook K. Baker, Health Global Access Project, Northeastern University School of Law.
Drug monopolies have been challenged by Indian generic firms, which wouldn’t have happened without government support. Roche’s patent for a liver drug was withdrawn last year. Generics major Glenmark and Merck are in a patent war over diabetes drugs. Bayer’s challenge to Natco’s Nexavar (for liver cancers) was dismissed recently. A bigger global battle will occur this summer as the EU, US and others talk about intellectual property. What matters for India is that an Abdul or Sourabh should equally qualify for every life-saving drug.
Commerce cannot triumph over healthcare—which should be a basic right for everyone in this country (The Crab and the Patient, Apr 15). Even if companies spend a lot on research, poor patients should not be made to pay the high prices. The benefits of small margins and high state subsidies should benefit them. Rich people can donate for them. Patent law must keep this point in view. The SC was right in its ruling on Novartis.
Thank you to all those who have taken the trouble to read the article and share their thoughts. Out of the arguments made here, there are two that perhaps need answering. So here they go.
1. The first part of the article compares outcomes (relative percentages of population of the religions concerned) irrespective of the process that led to those outcomes - whether immigration, relatively faster population growth or conversions. This was for two reasons. One, to put the figure of 2.3 per cent in "numerical perspective", as the article itself explained. The second reason was that outcomes are ultimately what the crux of debate is about. The rest of the article in any case dealt with process - or conversions in this case, from both a contemporary and historical perspective.
2. Some commenters have tried to cast doubts on the reliability of Census 2001. Those who do this should bear in mind that Census 2001 was conducted by a BJP government. Considering the extreme importance that BJP gives to this issue, it would be reasonable to expect that IF it had perceived a problem with the methodology that was distorting the numbers, it would have fixed it. As the article mentioned, BJP or BJP-supported governments have been in power for 10 of the last 40 years, or about a quarter of the time, and the only reasonable conclusion one can arrive at is that any misreporting of numbers, real or perceived, would be marginal and hence, not of importance.
To all other arguments made, my answer is the following: Please read the article again, with particular focus on the quotations of Vivekananda and Monier Williams, and the history of the missionary efforts in Bengal and their outcome.
If the Indian government genuinely cares for the health of the poor, it should EDUCATE more DOCTORS and male NURSES. And bring doctor population ratios to 1 :400 ( at least ), by opening district hospitals to training.
It should rather be some famine struck, poor African country, that strikes gold-mine, by manufacturing cheap drugs. that too by robbing an MNC off its patent rights.
"Nearly 75% of global drugs sales by dollar volume in 2011 was in Europe, North America, and Japan. Indian sales are less that 2% of global sales."
that shows how few new drugs come to Indian markets.
The actual health problem in india is lack of hygine and drainage than cancer. The govt if it has money put money in drainage and toilet training
Rupees 4.5 crores - that is how much it can cost for a 3 year post graduate degree in medicine.
Hope the government uses some of the ill-gotten money to finance some medical training seats.
//The SC ruling on Novartis’s cancer drug Glivec makes things just a bit easier for poor patients//
......for now while fucking things up in a big way long term!
The interesting thought, and humbling too, is that the symbol of the crab, is what is the astrological symbol of the birth date of Sri Rama, or of the moment, when he was born.
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