Fixed Doze Combination Drug Ban in India: An Unbiased Analysis!

In a surprise move on 10th March 2016, the central government of India has banned about 340 combinations of orally consumed drugs produced and marketed by modern pharma companies in India for various ailments such as cough, allergy, fever, cold, influenza, etc.(See this report) Many of these so called medicines have been in common use for quite some years and have been used by the common folks as over the counter (OTC) medicines without the prescriptions by any medical doctor.

The following gives the list of the banned  combinations- also called fixed dose combination (FDC) drugs - of medicines that are banned in accordance with the powers entrusted with the government under section 26A of the Drugs and Cosmetics Act 1940 and the Drug Rules 1945 of India:

 

  

  

I do not know whether this sudden action by the government is the right initiative or not. Apparently, the government has done this to safeguard the citizens health. However, all industry experts and users may not agree to this (Click here to read this!). I too am of the same opinion, as governmental decisions are mostly seen as governed by political or extraneous considerations and not always based on well informed and logical reasoning! (Also read my earlier blog on 'the politics and strategy of bans') 

The India government combination drug ban is estimated to cause the immediate disappearance of nearly 1500 popular prescription and over the counter English medicines from the medical shops across the length and breadth of India which is likely to cause much difficulties for the patients, doctors, the drug retail shops and the pharmaceutical companies. The problem would have been less severe, had the government did this in a planned manner with due diligence and planning!

The following are some of the very common medicine brands that would disappear:

Anti diabetic drugs : Tribet, Gemer P, Gluconorm, Triexer
Cough syrups : Phensedyl, Tossex, Ascoril, Zedex
Fever, cold, pain relief: Sumo, Vicks Action 500, Zerodol-P

There are hundreds of others for other kinds of ailments!

The governmental action is reportedly on the basis of several research studies which suggest possible adverse effects of using such fixed combinations of more than one drug. However, all these research findings are debatable issues as there are other research studies which support alternative views.

The authorities have been telling the pharma companies and the medical community not to use brand names while prescribing medicines. Instead, they were advised to use the original chemical name (generic name). However, the pharma companies and the medical doctors have just ignored these guidelines for quite some time now.

The pharma companies have been making huge profits from the medicine business. Most of the medicine suppliers are not original manufacturers of the basic drug. Many of them import or buy the basic medicine in bulk fro original drug producers from India or abroad and convert it into very small tablets, capsules, injectables, oral syrups, etc containing few milligrams of the original drug and market those in various kinds of fancy trade names. 

The sales representatives of these pharma companies, called the medical representatives, go to the hospitals and the medical doctors and educate them about the method of use of these so that the doctors remember these names to prescribe them to the needy patients. There exists an unholy nexus in this business and this is known to all concerned. The companies have devised their own systems wherein the prescribing doctors and the medical shops get good rewards when a particular brand of medicine gives good sales returns to the company.

There is nothing very surprising in this. Doctors, hospital managements, the medical shop owners and the pharma company people are all humans and they are all in this business for making some profits or earning a livelihood. 

But the markets operate in a competitive environment. The government allows so many drug makers to start business and operate. They simply cannot exist, unless they make profits. So they too are compelled to device marketing techniques of various kinds.

Fixed combination drugs are essentially a kind of marketing technique. In this method, more than one drug combination allow the pharma company to market a drug combination product under a brand name different from that of its competitors and reap better benefits and returns commensurate with its own marketing efforts.

While the law of the land has been in existence for decades, the drug enforcement authorities have never been publicly against any pharma company as the pharma companies know pretty well how to take care of the statutory authorities. It has been a win-win situation for every one. Even the poor patients too benefited to some extent as many had the choice of buying the medicines over the counter without actually being in the crowded lines in front of the hospitals and the medical doctors for small ailments like cough and cold that is so common. Their experience with the drugs have been better than many of the doctors!

And India is no USA, Canada or the European Union. In the latter, the prime responsibility of the citizens' health vests with the government and the government and the medical systems reportedly work pretty well unlike in India.

So India has been different so far and we call it as the Indian way of working. Even the foreign companies understood how to work in India. They work differently in India as compared to their own mother nations. So they make and market drug combinations that they do not make and sell in their own countries.

When we consider all these, the sudden ban of the combination drugs looks a bit absurd and perhaps even motivated with agendas other than citizens' health. What will happen when all these common remedies vanish from the medical shops? What will the common man do? Rush to the already overcrowded hospitals for seeking alternatives? Will our doctors be competent to prescribe non-combination alternative medicines to manage an ailment in such a short notice? We should consider the fact that they have been in the practice of remembering mostly trade names of common combination drugs!

Will this cause a sudden shortage of all kinds of life saving drugs and medicines when the pharma companies retaliate with their own methods?

Muhammad-bin-tugluq thought of many good things to give better administration to his people of his time. But all those good ideas became miseries for the people and this ruler has never been admired for his good ideas and deeds!

Is the present government doing such a thing by the many bans that it has initiated in the name of good governance?

Only time will tell!  

The Politics and Strategy of Bans!

Many leading personalities in my country are very good strategists, who understand the great potential of artificial scarcity has in accumulating wealth in a selective manner.

They understand the first principle of economics very well which states: 'Demand is inversely proportional to supplies'. Simply put, it means that the demand for any goods (or even services) is more when its supply is less. In other words, if something is in excess, it would be difficult to realize good money from it because its demand (and price) would be less.

Would You Like to Ban the Plants from Growing?

So, if supply is abundand, there would be some problem for the suppliers to make good money or wealth for them. So if supply is abundant either more demand has to be created or else the supply is artificially cut from the consumers for creating an apparently high demand. 

If tea production is less, some straight forward producers adopt the technique of marketting which involve in enhancing the tea consumption in consumers by various advertising techniques. But this method is time consuming and expensive.

But you can perhaps make more money by less production through artificial scarcity created by the modern marketing technology called the ' ban technique' which is widely used in developing nations such as my own India.

Ban technique is relatively simple. It uses democratic power of administration and the psychology of humans.

First about the psychology of humans. Human beings, both men, women and children are naturally bound to do some challenges before they acquire their desired possession of food, partner, toy, recreation, freedom and the like. If food is abundant, they do not feel like eating! If it is not available, they feel so hungry that they can do anything for it!

If a man or woman is free to move around, then they do not feel the importance of freedom. But if they were imprisoned, they are prepared to spend any amount to buy their freedom!

So the ban technique is essentially involved in preventing people from getting what they need.

So, if a high demand for tea is to be created, you can use the ban technique instead of other less effective marketing methods. What is done in this is to make the people who are involved in government or administration to promulgate a law or ordinance which bans the possession and consumption of tea by people. If any one is found to violate the law, various kinds of punishments are stipulated. 

If the people are found not taking the law seriously, the law enforcing authorities need to catch a few harmless violaters and punish them in accordance with the provisions of the law to make others scared of the new law.

When this is done, tea would become a banned item and people start feeling the desire for this item which is now scarce and illegal. Some fellows might even become so entrapped in their desire for drinking tea that they would now be willing to spend a fortune for it. The tea which used to sell for Rs.250/- a kg would now begin to sell for Rs.25000/- a kg! The producer would now make a killing by less production. The only thing that he has to do now is to share a good part of his huge profits to the ban enforcers!

Ofcourse, the ban equations need not be so clear and obvious. For bans to become effective, they need to be implemented cunningly and deceptively! The good thing here is that the ban supporters are normally very clever people with very good intelligence than the average common man. They know exactly what they are supposedly doing or have to do.

So some enlightened leaders of the people may advice the less developed folks about the reasons why they took the trouble to ban the sale of alcoholic liquors in a particular state or a region or country. Alcohol brews are very easy to produce. It could be produced in the homes of the ordinary people just as they make their normal foods. If it were so, these alcoholic drinks would not have been a charming thing for the people to spend money for getting it and consuming it. They would never have liked its obviously nauseating taste! They would not have liked the half poisoned state of their mind and bodies after consuming it!

But then the clever leaders have been doing the ban technique on it for centuries in various nations and regions of the world that people have developed the motive force of attraction to it because of its ban and undesirability forced upon them.

Same is the case with all kinds of bans. The more you ban, the more the motive force of desirability developing in the people affected by the ban.

You deny some thing to your child and your child will develop the curiosity and eagerness to go after it. The more you try to punish, them for their violating your ban rule, the more they get the impulse to violate. When you try to stop a natural flow, pressure builds up. That is the natural law. The build up of pressure can go to such heights that it could even burst to full destruction of the thing that prevented the natural flow!

The americans a few generations ago had been experimenting with the ban technique on various things. Many of them in the current generation are realizing the follies of their previous generations. The current move to liberalize marihuana (ganja) could be viewed as an example to this kind of drastic changes in thoughts.

If you want your child not to go after some food or drink or drug or other kind of  perceived sins, the wise way is not any forceful ban technique. Do not create the ban presssure on the child to instigate him or her to violate your diktat. The best and ideal way is not to project any negative clamour on any thing resulting it to gain some degree of sin value!

Just as it is applicable to the child, it is applicable to groups of people as well.

Clever fellows who are proponents of the ban technique are trying to enhance the so called sin value to otherwise normal things such as alcohol, beef, pork, porn, meat, drugs, coffee, tea, carbonated drinks, packed foods, plastics, books, ideas, and the like. By doing so, they are enhancing the marketability of such things in an indirect fashion making those otherwise non-desirable things as most desirable to many fellows who are possessed with a bit more adventure type characteristic deep in their minds.

Do not be under the impression that the ban proponents do their ban propaganda for your good. All propagandas are for gaining some benefits. Bans are promulgated by governments and governments of modern times act only when propagandists do their work with full force. And for creating that full force propaganda, money is required. That money comes from the beneficiaries who spin money from the bans.

But humans are not same in mind. Their minds have so many things in varying degrees. While some say yes, some others are bound to say no! All propaganda naturally generate counter propaganda! For every action there is an equal and opposite reaction!

But then what should be done by us? Should we go with the ban proponents or the ban antagonists? 

My dear friend! Remember this universal law: Anything in excess is destructive poison. You have the freedom of choice. But your freedom should not harm my freedom or their freedom. While you live in this world, you should respect others who too are living in this world. How much and how best you proceed is well recorded in your mind itself. That is called human maturity and wisdom. 

But unfortunately, some humans do not have enough receptive power to tune to their own wisdom. Else they do not have the patience to do it. Some of them even forget that they are short lived humans and keep thinking that they are even greater than God!

What a pity!