MNC Pharma Companies & the Indian Market

“Is this going to have a big effect on our business model? No, because we did not develop this product for the Indian market, let’s be honest. We developed this product for Western patients who can afford this product, quite honestly. It is an expensive product, being an oncology product.” ~ Marijn Dekkers, Bayer Chief Executive Officer

The global pharma industry’s reputation is getting worse, and is only slightly better than health insurers. Statements, like the one above, do not help.

This statement, made by none less than the CEO of a major MNC pharmaceutical player, while being incredibly insensitive, is also alarmingly honest.

At ~$12bn and double digit growth the Indian pharma market seems incredibly attractive. However, according to industry estimates, only about 1-2% of this market is accounted for by patented products, which is what most MNC players are interested in.

Pricing is the key issue

A large part of the patented drug market is contributed by the DPP-IV inhibitors, anti-diabetes drugs, and they continue to grow rapidly. One of the key reason for the quick uptake and growth of this class of molecules is their pricing. Priced at around Rs 50 per day, they are priced at around 60-70% of their price in Europe. While it seems high at a first glance, they still appear affordable for a large number of middle class consumer in terms of daily cost. However, industry insiders mention that the price impacts long term compliance and most patients drop-off therapy in a few months, in the largely self pay Indian market.

Contrast this with the price of Sprycel (dasatinib) promoted by Bristol-Myers Squibb. The drug is being considered for a compulsory license by the government. The drug is priced at Rs 1.65 Lacs a month, less than a third of its price in the US – well within the PPP price. At this price and despite the generous access program that the company has, a very small part of the Indian population, including the author, would be able to afford the drug.

India is facing a double whammy of not having reduced its load of acute illnesses while still facing growth of chronic diseases including CVDs and cancers. It is this disease burden which when combined with the pricing that scares a lot of policy makers.

Lack of transparency doesn’t help

A large part of the dissatisfaction of the MNC players is driven by the unilateral actions of the government and any clarity of thinking on the part of the government. The compulsory license of dasatinib is a case-in-point. Compulsory licenses are generally granted under Section 92 of the 1970 Patents Act for “public health crises, relating to Acquired Immuno Deficiency Syndrome, Human Immuno Deficiency Virus, tuberculosis, malaria or other epidemics“. First, I do not believe that CML  is a public emergency or their is an epidemic of CML. Second, Sprycel is not the drug of choice for first line treatment of CML. Gleevec (another litigated upon drug) is the standard of care and is widely available at affordable prices. Hence, a compulsory license for the drug does not make much sense.

On this regard, it would be wise of the government to lay out its method of evaluating drugs for compulsory license and the framework being used.

Final thoughts

Gilead recently announced its plan to license its Hep-C wonder drug, Solvaldi (Sofosbuvir), (priced at $1000 per pill) to Indian generic manufacturers for ensuring affordable access to the drug. The unilateral and proactive move by the company is sure to be cited by many as perhaps one of the way to go.

As George Merck once said, “We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.

Disclaimer: I have worked at BMS India earlier, and currently work for Novartis. The views are my own and do not reflect those of my employers.

Indian Pharma – A case of regulatory failure?

Disclaimer: I work for Novartis, an MNC pharmaceutical player. However, the view expressed in the post are my own, and do not reflect those of my employer.

Indian pharmaceutical companies cannot be judged by American standards. – GN Singh, Drug Controller General of India [source]

If you are looking for one reason for the mess that the Indian pharma industry is in, you do not need to look further than the statement above. This is a statement made by the head of the body responsible for ensuring the quality of drugs manufactured and sold in the country.

As any physician will tell you, one of the prime reasons for them prescribing higher priced brand of generic medicines is that the quality of those brands can be trusted. Call them fake, spurious, or poor quality drugs, it is one of the worst kept secrets of the Indian pharma industry. While the US FDA imposes stringent norms on the quality of drugs sold in US, such enforcement of standards is missing in India. The DGCI is severely understaffed and enforcement of manufacturing norms questionable. Manufacturers often get away using approvals from state FDAs which are even more limited than the DGCI in terms of resources for checking the quality of drugs.

For example, there are 200 brands available for  Metformin 500 mg (a common drug for diabetes) and the price of a strip of 10 tablets varies between Rs. 8 to Rs. 80 per tablet, with an average price of Rs. 17. In fact, brands by reputed manufacturers like USV, Abbott, and Glenmark are available for around the average price of Rs 17. Brands by Emcure and Torrent are available at Rs 12. In fact, most manufacturers have multiple brands at different price points. For example, Cipla has a brand at Rs. 7 and another at Rs. 18. Same drug, same composition. [Source: HealthKart Plus]

While theoretically you should be able to switch medicine brands, as long as they have the same composition and formulation, without change in efficacy, it is not true in practice in India. I have personally heard from a number of physicians that the quality of drugs, especially those supplied to the government, is highly questionable and that they often suggest their patients to procure the drugs from open market as those supplied for free at the hospital may not be efficacious. If the DGCI and state FDAs ensures quality, the price variances would come down and the premium charged by major trusted manufacturers decrease making medicines more affordable.

While a lot of people blame big pharma players and MNCs of having hidden interest in raising quality issues, do we not agree that the problem is not just access to medicines, but access to quality medicines.

Dilli ki sardi & Biking

A random discussion on Delhi winters with some colleagues reminded of the joys of riding on a winter evening in Delhi. The cold, slightly damp, wind across your face. The fog. The warmth of the engine. And the fog that doesn’t let you see too far in the distance, and because you are riding slowly you are actually enjoying the view. Missing my bike and those rides with Tk so much!

These lines by Robert Pirsig in Zen and the Art of Motorcycle Maintenance are just so apt.

You see things vacationing on a motorcycle in a way that is completely different from any other. In a car you’re always in a compartment, and because you’re used to it you don’t realize that through that car window everything you see is just more TV. You’re a passive observer and it is all moving by you boringly in a frame.

On a cycle the frame is gone. You’re completely in contact with it all. You’re in the scene, not just watching it anymore, and the sense of presence is overwhelming. That concrete whizzing by five inches below your foot is the real thing, the same stuff you walk on, it’s right there, so blurred you can’t focus on it, yet you can put your foot down and touch it anytime, and the whole thing, the whole experience, is never removed from immediate consciousness.

The Google Reader Rant!

Dear Google. You feel threatened by Facebook, I get it. You launch Google+, which I appreciate for its features, but don’t really use. I get it.

Other than Gmail, Search, YouTube, and Maps, the only other Google product that I use regularly is Reader. I am sure I spend more time it on than any other webapp. And I was a happy user. Content that Google did not really pay attention to it. Content that Google did not meddle around much with it, and let it be what it was meant to be – useful.

However, I am not happy anymore. You’ve taken my favorite app, and rendered it useless in the name of redesign and social strategy. I don’t get it.

You have removed the sharing features, without allowing the user any option. May I ask why?? To push people to Google+?? From a service that some (passionate) users swear by, to a service that not many use, at least regularly?? I will try and understand. Some ass could have suggested this. However, you could have handled this better. Here is what I think you should have done.

  1. Create a feature that would allow people to (in a single click) create Google Circle containing the users they were following on Reader.
  2. Allow, again in a single click, users to (by means of RSS or whatever suits your whims and fancies) follow the Reader shares of people in their Reader circle.
  3. Allow for simpler sharing – clicking share should have shared the post (by default) with your Reader circle.
  4. For further conversation and comments, taken users to the Google+ page for the particular post.

The benefits of this method. Satisfied users. More traffic driven to Google+. No??

The second point. Redesign. Should Reader look like GMail?? Not necessarily!! But then again, I am no design guru, But I am an understanding user. Maybe consistency is what you were aiming for. Unfortunately, what you ended up with is decreased usability. You see, the key feature of Reader is …. wait for it …. the ability to read. And the redesign has killed that.

The current usable are for content is less than sixty percent. While the total screen area (on my laptop) is approximately 1280×670 pixels, the area for actual content is 1010×490 pixels (rough approximates – screenshots below). That is, the content is on less than 60% of the screen space. Let me repeat that for you. Less than 60%

Total Screen Area for Google Reader

Total Screen Area for Google Reader

Area available for content in Google Reader

Area available for content in Google Reader

While, I believe that this problem will be solved soon by some hacker (God bless his noble soul) using JavaScript, I am not so sure what are you going to do about sharing. I hope someone comes back to senses at Google, rolls back the madness, and talks to Kevin Fox - he has done it before, and I believe he can do it again.

Please give me back my precious!

On Story Telling

Got this gem from Natasha Badhwar, who is a gifted story teller herself, on Twitter (follow her now). The quotes below are from Steve McCurry‘s (of the iconic Afghan Girl photo fame) wonderful blog.

The story was the bushman’s most sacred possession. These people knew what we do not; that without a story you have not got a nation, or culture, or civilization. Without a story of your own, you haven’t got a life of your own. — Laurens Van der Post

People did not wait until there was writing before they told stories and sang songs. — Albert Bates Lord

To be a person is to have a story to tell. — Isak Dinesen

Reminded me of a chapter from the wonderful book, “Soccer in Sun and Shadow” by Eduardo Galeano.

Have you ever entered an empty stadium? Try it. Stand in the middle of the field and listen. There is nothing less empty than an empty stadium. There is nothing less mute than stands bereft of people.

At Wembley, shouts from the ’66 World Cup which England won still resound, and if you listen very closely you can hear groans from 1953 when England fell to the Hungarians. Montevideo’s Centenario Stadium sighs with nostalgia for the glory days of Uruguayan football. Maracana is still crying over Brazil’s 1950 World Cup defeat.

At Bombonera in Buenos Aires, drums boom from half a century ago. From the depths of Azteca Stadium, you can hear the ceremonial chants of the ancient Mexican ball game. The concrete terraces of the Nou Camp in Barcelona speak Catalan, and the stands of San Mames in Bilbao talk in Euskera.

In Milan, the ghost of Giuseppe Meazza scores goals that shake the stadium bearing his name. The final of the ’74 World Cup, won by Germany, is played day after day and night after night at Munich’s Olympic Stadium.

The stadium of King Fahd in Saudi Arabia has marble and gold boxes and carpeted stands, but it has no memory or much of anything to say.