"No Free Lunch now has 30 members," says Dr Gopal Dabade, convener of Karnataka’s All India Drug Action Network, which campaigns for better controls on drug promotion and for unbiased information for prescribers and consumers. He’s speaking about the Indian chapter of an international movement of doctors seeking to break the stranglehold that pharmaceutical companies have on the healthcare sector. It’s a project he initiated just five months ago with Dr Narendra Gupta, founder of Prayas, an NGO that works to procure basic services for the adivasis of Chittorgarh.
Dr Gopal Dabade
The idea was born at the 2014 Indian Bioethics Conference in Bengaluru where the duo heard members of the German group MEZIS (Mein Essen Zahl Ich Selbst, German for "I pay for my own lunch") talk about corruption in healthcare. For Dharwad-based Dr Dabade however, the project is the natural extension of a long career of campaigning to improve public healthcare. He was just 28 when he arrived in Nellie (Assam) in the aftermath of the 1983 pogrom. There with the National Youth Project, the young ENT surgeon found that the sufferers needed more than medicines. “Mainly, they wanted people to talk to. It was through listening to their stories and living amid the tragedy that I came in touch with ground reality.”
Around the same time, Dr Dabade, had been following with interest the activities of Swedish paediatric neurologist Olle Hansson. "He fought against CIBA GEIGY, manufacturer of the drug Clioquinols that paralysed hundreds of people in Japan." These influences would fuel his own humanitarianism and, upon returning from Nellie, Dabade got involved with Medico Friend Circle, a platform for pro-poor health practitioners and activists, a group he is still a part of. “We meet once or twice a year to discuss health policies and share experiences.” Through these sessions, the doctors hope to galvanise action on everything from unchecked costs of treatments to the prejudice against women in healthcare.
Naturally, Dr Dabade has a strong view on the raging debate about India’s patent law and the argument that drug companies deserve compensation for the huge amounts they spend on research. “Most of the innovating happens at public-funded institutions and universities. The teams here discover a molecule and then the drug companies sell it. There are countless studies that show that drug companies really spend more on advertising and promotion. When they spend on research, it’s mainly to gauge how to sell a drug better,” says the doctor, who made several presentations in Germany in April emphasising not just this point but also the wanton pricing of drugs.
Offering the example of Chronic Myeloid Leukaemia (CML or Blood Cancer), "which is completely curable with the salt Imatinib," Dr Dabade shares, “A month’s treatment using one brand would cost the patient Rs 1,24,000, using another Rs 11,400 and still another Rs 5,720 per month, or as the Tamil Nadu government has achieved through their excellent public health scheme Rs 560 per month.”
The money-making nature of the pharmaceutical industry encourages a 'me-too' strain rather than innovation, says Dabade. "French Medical Journal, La Revue Prescrire announces an annual award (called La Pilule d’Or or The Golden Pill), for the most important breakthrough. It could not find a single worthy innovation in 2010, 2011 or 2012. Why? Because pharmaceutical companies only want to make drugs that they know they can sell for maximum profit."
Encouraging doctors to peddle their products is part of the game. "Some companies stock their drugs exclusively with certain doctors. So, if you need this medicine, you must go to the pharmacy of the doctor. Aside from sponsoring holidays and Continuing Medical Education (CME) workshops, drug companies also give direct cash incentives — commissions — and they keep a track of every doctor’s prescriptions through pharmacies. Pharmacies also get kickbacks and huge commissions."
Dr Dabade is, however, hopeful that their efforts will bring even those on the payroll of Big Pharma over to the NFL side eventually. “Some time ago, about half a dozen of us doctors started a generic drug store in Dharwad. Today, a dozen other doctors there have lent us their outright support. I know this project is not going to be easy, but once we start the conversation, if nothing else, it will give other doctors pause to think. Ultimately, it’s for the people to decide what sort of doctors they want to stock their faith in.”