E-drug: Reply from Dr Attaran to Dr Srinivas
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[Below are not only a message of Dr Srinivas to Dr Attaran, but also
the original message of Dr Attaran to Dr Srinivas. The latter should
have been copied to E-drug, but I did not receive it. I find this a
disturbing development, and hope that reactions such as Dr Attaran's
do not cause E-druggers to hold back their comments! HH]
Dear Dr Attaran (and e-druggers),
At the outset I have to remind you and everyone on this network that
my comments had been made in my personal capacity as a doctor
and not in my official capacity (I am not a high ranking official and my
views may be taken as that of an interested participant).
I had thought that this network was a forum for an exchange of ideas
which would enrich everyone concerned and reactions as strong as
yours, which in a way see contrary points of view not in a constructive
manner, but in an adversorial manner, inhibit further discussion.
My submission was merely that not only in developing countries but in
all countries including the most developed, there is a certain influence
on prescribing habits of providers, by a lot of factors. To say that this
does not exist at all would be to ignore what is happening the ground.
However, the point of my submission was never to give the
impression that patents were the root cause of all evil, but merely to
state that in certain situations prevailing on the ground, the
introduction of patented drugs would contribute to increasing costs of
drugs. These situations could also be hypothetical at the present
time, as such a situation may lie in the future.
I have benefitted greatly from the discussions held on various
subjects on e-drug in the past, and it was precisely this kind of
reaction, that hold back people like me from contributing to
discussions even when I feel strongly about something, and feel that I
can make a contribution based on experience. To participate, one has
to give his/her affiliation and if one holds an official position, then
inevitably views expressed, are taken to be official in some sort of
way, even if there is an express rider that these are made in personal
and private capacity. I do not handle drug related issues in my
ministry nor do I represent any sort of official viewpoint. Even in a
developing country, a Government official is entitled to read up and
hold independent views as an individual, irrespective of his/her job.
However, I do realize that even in forums like this there will be an
element talking down to lesser mortals and this would be reflected in
these rather strong reactions to mild comments. I hope this will end all
discussions in the matter.
I shall hold my comments in future.
Dr Srinivas Tata
Ministry of Health and Family Welfare
Delhi, India
(In personal capacity)
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From: amir_attaran@harvard.edu
To: tatabuchi@hotmail.com, e-drug@healthnet.org
Subject: reply to Dr. Srinivas from Dr. Attaran
Date: Thu, 27 Mar 2003 09:26:28 -0500Dear Dr. Srinivas (and all e-druggers),
I've just been forwarded your note from e-drug (copied below) which
I've read with tremendous surprise.There is one remarkable point in your argument which one ought to
find difficult to utter at best, and downright unspeakable at worst,
made all the more so when it is said by you, being a high official in
India's Ministry of Health. Specifically, you write that in the
developing world, doctors often prescribe new and patented
medicines "even in the presence of other cheaper and effective
substitutes", because the doctors are "influenced and...unethically
pushed" by marketing practices which wrongfully cause the new
medicine to be perceived as better than the old one. For example,
Lexchin and Henry cite esomeprazole and omeprazole as an
example where the newer medicine is only marginally better than
the old, but which enjoys an irrational leg up in prescribing. They
and you conclude that patents are to blame for this evil.
Can we please establish one point? The core of your argument is
that Indian doctors are (pardon the expression) gullible, uninformed,
essentially irrational prescribers, who can't be trusted to understand
the scientific evidence comparing one medicine's efficacy against
another. You didn't quite call these poor doctors dupes, but you
might as well have, because you give no credence to the proposition
that Indian doctors actually might be intelligent enough to base their
prescribing decisions on epidemiological and clinical findings instead
of slick marketing. The doctors, you contend, will always follow the
marketing like lambs. They cannot resist.
If it really is true that the average Indian doctor is too poorly
educated to discern science from advertising, and cannot in his or
her professional capacity respond differently to these, I agree with
you that there is a dreadful problem---but I daresay that problem has
little do with patents. Further attention by your ministry to the
advertising standards for medicines and the quality of medical
education would then sound urgently needed. I maintain that the
patent system remains necessary to generate new pharmaceutical
inventions, some of which are of breathtaking merit (i.e. enough
merit that generic firms scramble to copy them, and patients
clamour for them) while others, like esomeprazole, I agree with you
aren't of much use at all. Rather than faulting the patent system,
which delivers the good with the bad, why don't you and the Indian
Ministry of Health instead please concentrate on helping and training
doctors to know the difference?
Amicably,
Dr. Amir Attaran
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