X Monograph: Where is Medicine Heading? ...(Concluded)

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Concluding Remarks

1.  Cost of medicines escalate unreasonably because of increased R and D spending over ‘Me Too’ drugs, catering to the wants of the medical man which have multiplied beyond imagination, expenses over conferences, litigation, hype by the marketing departments, and keeping all those in power sufficiently satisfied to help push a drug from the laboratory shelf to the pharmacy one.

2.  The cost of organizing conferences is no longer ever possible on delegate fees. The bottom-line is: Crores for a Conference, Millions for a Mid-Term. The problem is that the sponsor keeps a discreet but careful tab on docs. All in all, costs of medicines escalate, which means medical care becomes a luxury. The whole brunt of this movement is borne by the patient.

4.Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased R and D spending, and litigation costs are the main reasons.

5.   In the future, the messy lawsuits situation will no longer be restricted to industry. It will involve academia and practicing doctors as well. Indian pharma industry captains, who are busy raking in the profits, will also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. 

6. Both short and long-term measures will have to be put into place. Short-term measures involve reduced pharma spending over junkets and trinkets, hype over ‘me too’ drugs, manipulation of drug trials, avoiding getting pliant researchers into drug trials, manipulating Journal Editors to publish positive findings about their drug trials and launches; and for Indian Pharma, to conduct their own clinical drug trial of the latest blockbuster so projected in the West.

7. The long-term measures are related to the way biomedical advance is to be charted. To decide whether medicine is to be a corporate enterprise or a patient welfare centered profession.

8. Medicine as a corporate enterprise means ethical practices are to be followed, but those of a business, not of a profession. The basic difference between the two being that for the former it is profits with patient welfare, and for the latter it is patient welfare with profits. There are many advantages in this approach. However, there were four main hitches here. One is the massive cost escalation. Second hitch is neglect of disease conditions that afflict the socially disadvantaged. Third is how to curb the questionable business practices of the less scrupulous. Fourth hitch is how to tackle forces of the market place. Greater accountability, more transparency, and heightened efficiency are what the sick consumer can then ask for, and get.

8. Medicine as a Patient Welfare Centered Profession means patient welfare has to become paramount, regardless of profits. The profit margins have to be wholesome but not awesome. There has to be a clear distinction between the business of medicine, which industry follows, and the profession of medicine, which the medical practitioner/researcher should. The patient is the boss, his welfare is the mantra, and the doctor and other paraphernalia are the means to ensure it. In this profits are needed to forward the onward march of the boss’ welfare, but it could never be at the cost of his welfare. This should be, and would always remain, the guiding force. 

10.  A third approach involves an eclectic resolution of the two. Patient welfare is necessary, but not a sufficient enough criterion. We think a healthy proportion is patient welfare with profits, in that order. Such amount of patient welfare as also ensured profit, and such amount of profit as also ensured patient welfare. Because, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. Hence medicine becomes a patient welfare centered professional enterprise. By an enterprise we mean here an activity wherein the profits that accrue from its practice can be considered legitimate if it does not forsake patient welfare at any stage of its planning and action.

11. However, if an essentially blind profit decides to chart the course and determine the destination, it would spell disaster. Similarly an essentially lame patient welfare would also falter. Similarly, a blind patient welfare and a lame profit would also mean chaos.

12. The resolution has to be the combination of an essentially lame patient welfare riding an essentially blind profit motive, so both can complete the journey.



1. Angell M., (2004), The Truth About The Drug Companies: How They Deceive Us, And What To Do About It, New York: Random House.

2. Datamonitor Newswire (2005), Pfizer sued over marketing of Lipitor, Pharmaceutical Business Review Online, 30 Sept 2005.

 3. EFPIA, (2005), European Federation of Pharmaceutical Industries and Associations, FAQs, available at: http://www.efpia.org/tools/faq.htm (Accessed on 27 October, 2005).

4. Harris G., (2004a), Guilty plea seen for drug maker, New York Times, July 16, 2004, A1.

5. Harris G., (2004b), As doctor writes prescription, drug company writes a check, New York Times, June 27, A1.

6. Horton R. (2004a), Business as usual, The Lancet, Vol. 364, p1209-1210.

7. Horton R. (2004b), Vioxx, the implosion of Merck, and aftershocks at the FDA, The Lancet, Vol. 364, Issue 9450, p1995-1996.

8. Peterson M., (2003), AstraZeneca pleads guilty in cancer medicine scheme, New York Times, June 21, 2003, pC1.

9. Premji A. (2004), Business Times, The Times of India, 30 Sept. 2004, p15. (Quoted on masthead).

10. Singh A.R., Singh S.A., (2005), Psychiatry, Medical Practice and the Pharmaceutical Industry: And Ever the Trio shall Meet-II: Public Welfare Agenda or Corporate Research Agenda? Mens Sana Monographs, III:2-4, July-October 2005, p41-78. Quote on p70.

11. TNN and Agencies (2005), Ranbaxy records Rs. 11 crore loss in Q3, Business Times, The Times if India, Mumbai, Saturday, Oct 22, 2005, p 17.

12. United States v. TAP Pharmaceuticals, (2001), Sentencing memorandum of the United States, Criminal Action No. 01-CR-10354-WGY, Dec.14, 2001.



Questions that this monograph raises


1. How can the problem of price deflation, increased R and D spending and litigation costs of pharmaceuticals be solved?

2. How can conference costs be kept within such control that sponsors cannot exercise undue control over conference activities and participants?

3. Lawsuits against industry are on the increase. Lawsuits against doctors will rise as well. Any solutions come to mind?

4. Can medicine be acceptable as a commercial enterprise?

5. Will we be able to keep medicine patient welfare oriented? What measures would be necessary to ensure this?

6. Does it make sense to combine patient welfare with profit? What to do when the latter tries to dictate to the former?

7. If patient welfare is lame and profit is blind, the two handicapped are likely to deny their handicaps and blame the other for mishaps. What can be done to ensure that this is minimized?

8. What should Indian pharma do to establish its presence as a genuine world player, and not just a conduit for profit making in the name of new molecules launched in the west? How can genuine R and D efforts be enhanced in India?

9. Can doctors/researchers decide research agenda and minimize untoward industry influence over research, and how?

10. If we think of medicine as a patient welfare oriented professional enterprise, does it not amount to granting legitimacy to nefarious business influences through the back door?

11. Where do you think medicine is heading:

i) will become a business;

ii) will remain a profession;

iii) will combine the best of both

iv) professional standards will control business interests;

v) business interests will control professional standards;

vi) will combine the worst of both.

12. As a medical man, do you regret taking up medicine as a career? Will you encourage an ethical minded bright young person to take it up?

Mens Sana Monographs, III,4-5, Nov. 2005-Feb. 2006 51


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