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28 April 2016 Editorial


 28 APRIL 2016 

More medicine for less

The Centre is reported to be in favour of moving a bill requiring doctors to prescribe generic medicines in place of costly, branded ones. This progressive step, which will reform the way essential medicines are distributed to patients, was recommended by the Planning Commission’s High Level Expert Group on Universal Health Coverage five years ago. Among its suggestions is a system of bulk procurement of important drugs from quality generics manufacturers through Central and State-level supply logistics corporations and their distribution through Jan Aushadhi outlets. Given the large size of India’s pharmaceuticals market, and the vested interests in favour of the status quo on price and distribution, it has taken inordinately long to move to low-cost generic medicines on a large scale. There is also a lack of awareness on the availability of affordable alternatives to expensive brands. A recent assessment of India’s expenditure on health published by The Lancet showed that out-of-pocket spending comprises 58 per cent of the total; two-thirds of this is on drugs. What makes the situation difficult even for relatively better-off patients who can afford commercial health insurance is that risk cover is generally confined to part payment of hospitalisation bills, but not prescription medicines. The poor are impoverished further by drug costs. It is vital, therefore, that governments act on multiple fronts — making listed essential medicines available free or nearly free to all in hospitals through higher public spending, widening access to generics through Jan Aushadhi outlets, and closely monitoring professional practice to eliminate prescription of irrational, non-essential drugs that have no curative effect. 

Famed as it is for leading in the production of generic medicines and catering to the needs of other developing countries, Indian pharmaceutical manufacturing has also faced censure over quality. The episode of Ranbaxy pleading guilty to felony charges in the U.S. three years ago for adulteration of its products and failure to meet standard manufacturing practices highlights the need for close regulatory oversight. Only with a guarantee of efficacy can the plan for mandatory prescription of generics succeed. To achieve this, the government should proactively help all manufacturers — public and private — to meet the internationally recognised Good Manufacturing Practice standards. Scaling up the number of Jan Aushadhi outlets quickly to a few thousand poses a challenge; moreover, the performance so far has been uninspiring. Barring a few States like Tamil Nadu, Rajasthan and Kerala that have a creditable record of public provision through hospitals, the target for opening generic drug pharmacies, first announced in 2008, has never been met. Co-opting private pharmacists is one way ahead. Again, one of the persistent problems with low-cost access systems is non-availability of specific drugs. A transparent supply chain managed by state-run procurement agencies can help overcome such bottlenecks.

The United States of Trumperica

The march of Donald Trump towards securing the Republican presidential nomination has assumed an air of inevitability. The billionaire property mogul and Grand Old Party frontrunner scored a major victory in Tuesday’s primary elections in five northeastern States. His delegate count now soars at 949, compared to 544 for Senator Ted Cruz from Texas, and 153 for Ohio Governor John Kasich. The response of the panicked GOP mainstream has been feeble. The idea of holding a “contested convention” to thwart Mr. Trump and the plan for Mr. Cruz and Mr. Kasich to collude in the remaining primary races do not appear to be retarding Mr. Trump’s momentum. He is inching ever closer to securing the minimum number of 1,237 delegates required for the nomination. There is a good chance that if Democrat and former Secretary of State Hillary Clinton wins her party’s nomination, she may emerge as an insurmountable obstacle in Mr. Trump’s path to the White House. Yet her own campaign is not without risks — for example, the troubling questions surrounding the 2012 Benghazi attack and her use of a private email server while serving as Secretary. Thus it has come to a point where Democrats, the American people, and the rest of the world watching the spectacle of the election may have to ponder a question that most wouldn’t have dreamt of asking a year ago: What would the United States and the world look like under the reign of President Donald Trump?

Consider his policies that would have the strongest ripple effect globally. On trade, Mr. Trump promises to negotiate better agreements by punishing companies that seek to offshore their operations with a 35 per cent tariff on goods they want to sell to the U.S. This flies in the face of the laissez-faire, free-trade model that Republicans generally support. It also risks price wars and spiralling trade disputes that would make their way to the WTO. Relatively low-cost economies such as India may be hit badly. Second, Mr. Trump’s policies may produce instability vis-à-vis countries that are important to the Indian economy. His sabre-rattling towards China, including his promise to label it a “currency manipulator” and to force it to end “illegal export subsidies” could lead to volatility in the global markets that would exceed the turmoil witnessed at the Shanghai Stock Exchange in 2015. Similarly, his intention to tear up the nuclear treaty with Iran, bomb Syria and shake up ties with Saudi Arabia could send oil prices soaring. On domestic politics, Mr. Trump has sounded hateful about Muslims, Mexicans, women, the differently-abled and the media. Combine this with a vow to roll back health-care reforms, loosen gun control and reinstate torture, a Trump presidency poses the risk of heightening socioeconomic inequality and fuelling bigotry. Internationally, no nation would be more isolated than the United States of Trumperica.

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