Regulations must to boost generic drug prescriptions

Whenever you have some time, I would suggest that you walk into your neighbourhood chemist (choose a time when he is less busy) and ask him to give you alternatives for any of the medicines that you normally buy. You will be surprised at the price difference between various brands!

You may also discover, during this exercise, that the brand prescribed by your doctor is the most expensive and there are several other brands that cost much less. If you check the prices of drugs sold by their generic name, you will be even more astonished at the wide price variation. And if you are buying medicines on a regular basis, you will realise that you can well cut your monthly medicine bill substantially by choosing less expensive options.

This exercise will also make you understand the significance of Prime Minister Narendra Modi’s promise of bringing in a regulatory framework to ensure that doctors prescribe drugs by their generic name. Because such prescription opens up a lot of possibilities for you in terms of exercising your right to informed choice and your right to quality medicines at reasonable prices. On the other hand, when your doctor prescribes a brand, you would not know its generic or common name and end up buying whatever the doctor recommended. And that brand may well be the most expensive of brands, prescribed not because it is the best, but because of the expensive gifts lavished on the doctor by the pharmaceutical company.

Yes, medical prescriptions by generic names will also end the unholy nexus between medical professionals and pharmaceutical companies and bring down the prices of branded drugs too. Today, pharmaceutical companies have huge budgets for promoting their products through doctors and since this expenditure becomes part of the costing of the drug, we, as consumers, are paying for it too.

Use of generic names in medical prescriptions will also bring down prescription errors considerably. In the absence of the generic name, badly scrawled prescriptions and similar sounding brand names have resulted in chemists dispensing the wrong medication, at times leading to the death of the patient. Prescribing the drug by its generic name will avert such disasters. Similarly, consumers have often complained that certain brands are region-specific and when they are travelling, it becomes very difficult to find the medication prescribed by their doctor. Generic name will prevent such problems

However, having said that, I must underscore the need for better quality control vis-à-vis generic drugs. Many doctors working in state-run hospitals express concern over the poor quality of some of the generic drugs and the even poorer enforcement of quality norms vis-à-vis these drugs. This has to change, so that there is no difference in quality between the generic and the branded drug.

The health ministry or the consumer affairs ministry should also come out with a mobile app through which, by scanning the name of the drug, a consumer can get all the options available to her or him, in not just English, but also in the local language. This would facilitate the consumer’s right to informed choice and ensure that pharmaceutical companies do not start wooing pharmacists to push their products. It is equally important to educate consumers on their rights, so that they insist on doctors writing the generic name in the prescription.

In fact the amendment to the Indian Medical Council (Professional Conduct, Etiquette and ethics) Regulations, 2002, notified last year, says: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.” Now that the prime minister has spoken on the issue, one hopes that such prescription becomes a reality soon, facilitating informed consumer choice.

This image — of Yasin running with the girl in his arms — was captured by another young photojournalist and has gone viral, striking a chord with hundreds of Kashmiris. Many are comparing Yasin with Syrian photographer Abd Alkader Habak, who was captured in a now-iconic photograph picking up a young boy and running to safety after a bomb hit a convoy of buses.

For millions, the photo — clicked earlier this week — brought home the horrors of war but also rekindled hope of humanity. Many on social media say Yasin has done the same for them in a region where human bonds have been eroded by decades of insurgency.

“I told the girl’s friends that I have two daughters and this girl is just like one of them. If you are the father of two girls or if you are a father of any child, you cannot just see anyone’s child helplessly suffering like that,” says Yasin.

The 43-year-old has covered Kashmir since 2002 and received at least 15 international and national awards for his work. He says he picked up the girl when he realised no one was around to help her. “Looking back, I feel happy that I helped her. Pictures will keep coming,” he says. The story has a happy ending: The girl got to the hospital in time, was treated and is now stable.

Yasin says in a conflict zone, photographers are often faced with such a dilemma: Of whether to take pictures or keep the camera aside for some time and help the wounded. He brushes aside praise for thinking about the girl first, and not his photography.

“I am not the first one to have done this. I can tell you there are so many guys on the field in Kashmir who would have done the same ,’ Yasin adds.

The image was captured by young Srinagar-based photojournalist Faisal Khan. “Dar Yasin handed the camera to someone else, lifted he girl and began running. My first instinct was to assist him, but then I realised I should capture this moment in a picture,” Khan tells HT.

“We got a cab to stop, put Khusboo and some of her friends in it and they were taken to SMHS hospital,” Khan says. Who caused the injury is still unclear: Police say the stone that hit Khusboo came from miscreants and students, locals say otherwise.

“The Chogyal is a forgotten past. He is nothing but a sort of a vague symbol of unity among the handful of royalists within the former ruling class and hardcore Lepcha and Bhutia minorities,” said a minister in the Pawan Chamling-led government in the state.

Namgyal, who ascended to the throne that his father Palden Thondup Namgyal had forfeited, has stayed away from controversies. Rarely seen in public, his mystique has grown instead. Now 64, he has spent the last 35 years meditating, sometimes in the caves of Bhutan and Nepal.

He visits what was the family palace in Gangtok at times. But he never ventures out, slipping out as quietly as he had arrived. “The Chogyal visits Sikkim quietly and leaves the same way,” a close relative said.

The former royal family is overzealously guarded about him. “We want the people to understand that the Namgyal family has lost the kingdom and people should respect our privacy,” one of them told HT.

Old-timers, however, say the Namgyal was a reluctant monk. “Once he realised there was no way of getting back his throne, he could only fall back on religion to seek solace,” pointed out a local. But monkhood was far from his mind on February 19, 1982, the day he was crowned at the Tsuklakhang Palace atop a hill overlooking Gangtok even as his father’s funeral pyres were being lit at the Luksyama royal crematorium.

Inside the palace drawing room, Namgyal sat on the throne as a motley crowd of people – commoners, relatives and even 10 MLAs of the then 32-member state assembly – trooped in one by one to present him the tradi- tional ‘Khada’ (silk scarf) and wish good luck.

India never recognized the coronation, though those present said Namgyal was the 13th Chogyal of Sikkim. “Prominent lamas from more than 44 monasteries chanted prayers while school students shouted ‘long live the Chogyal’, waving the banned Sikkim national flag,” recollected a former chief minister who happened to be present.

But the excitement died out soon and Namgyal receded to the background. “He can’t even be contacted on mobile as he takes no calls. It is he who contacts people when he needs some work done,” pointed out a cousin.

The family owns cardamom plantations and real estates and hotels across the globe, but Namgyal, it is said, is more at peace leading an austere life. He has not even pursued the compensation claim of Rs 110 crore that his father had sought from the Indian government for taking away his kingdom. “Forget the throne, even the compensation is not in the realm of possibility,” pointed out one of his cousins, citing the fact that Palden Namgyal had refused to sign the instrument of accession. Taking refuge in religion has therefore been the best option for the monarch who ended up as a monk.

The back-to-back decline is a first in three decades, the World Bank report said. “I lost two jobs in past two years in Saudi and then I headed home and waiting for dues to be settled,” said Satheesh Kurup from Kerala.

In 2016, 165,356 people found jobs in Saudi Arabia, almost half of the 306,642 people who got employment in 2015.

“With oil prices hitting below 40 USD per barrel this was bound to happen. But we doing our best to ensure anyone who lost his or her job is assisted”, the diplomat posted in a Gulf country said. He requested to not be identified for this story since he was not authorised to speak on the matter.

In addition to the problems in the Gulf, the rising anti-globalisation sentiment in the West is seen dealing a one-two punch to foreign job prospects.

Companies in US have been seen paring back plans to hire Indians through the H1-B visa scheme after the election of Donald Trump who rode on, among others, a promise to protect the employment opportunities for Americans. On Tuesday, Trump signed an executive order to overhaul the H-1B program. One of the bills calls for a minimum wage of $130,000 against the current $60,000 for those being brought in on the visa category.

The higher ceiling will close the wage benefit the H1-B programme gave to US firms when they hired Indian workers, who typically draw significantly lower salaries than American workers at comparable levels.

According to industry body ASSOCHAM, nearly 86% of H-1B visas issued for workers in the technology sector goes to Indians and this figure could be scaled down to about 60% or less.

“Currently there are four Bills in the US Congress about curbs on H-1B visas. We are engaged (in a dialogue) with the US at very high level regarding this... We are making all efforts (through diplomatic channels) to ensure these Bills are not passed,” external affairs minister Sushma Swaraj said in the Rajya Sabha in March.

Australia too tightened its visa rules for foreign workers, abolishing a scheme primarily used by Indians.

While India is engaging officials in most countries that have tightened work visa rules, prospect seems bleak. “The government should always look at ways to promote legal immigration. If one destination is hit, there will be others, and they need to be explored and found out and proper legal mechanism for immigration should be arrived at with the host country”, said S Irudayarajan of Central for Development Studies in Thiruvananthapuram and a former consultant for the government on immigration.