- Cure lies elsewhere (Indian Express, The Hindu)
- TB Timeline (The Hindu)
- Should we do away with Capital Punishment? (The Hindu)
- Explained: Peer to Peer lending
1. Cure lies elsewhere (Indian Express, The Hindu)
Synoptic line: It throws light on the regulation on medical practitioners to recommend only generic drugs. (GS paper II and III)
- The Medical Council of India has asked all the registered Medical Practitioners to ensure that they prescribe drugs with generic names only.
- The Council also warns disciplinary action against those found violating these regulations and has also directed all concerned to give wide publicity to the regulations.
The move by MCI
- The move is meant to prevent doctors from prescribe brand-name drugs that are usually significantly costlier. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug.
- The Circular quotes the 2016 amendment of Indian medical council professional conduct ethics regulations 2002, which says 1.5 Use of Generic names of drugs: “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”.
- Earlier, the Prime Minister had announced that the government intended to move a law to ensure that doctors prescribe medicines by their generic names only.
Nomenclature of drugs
- Nearly all drugs have three types of names:
- The International Union of Pure and Applied Chemistry (IUPAC),
- The non-proprietary or generic, most commonly the International Non-proprietary Name (INN) administered by the World Health Organisation (WHO),
- The brand name.
- Once patents have expired, companies other than the original manufacturer can produce and sell the drug. This usually results in significant reduction in costs. These off-patent drugs are called generics internationally.
- However, the term ‘generic’ has a different meaning in India’s pharma trade. Medicines marketed exclusively with INN names are called generics or generic medicine.
Challenges with the decision
- There are certain concerns with the decision as it simply shifts the focus of promotional activities to the pharmacists. It is well known that different companies offer different trade margins. There is the moral hazard that pharmacists will dispense the brand which offers them the biggest margin. The current diktat by the MCI therefore may not reduce prices for the consumer.
- There is a chronic shortage of drug inspectors who look after quality control at manufacturing and dispensing sites of medicines. In 2010, 55 per cent posts of drug inspectors in Maharashtra were lying vacant. In the absence of stringent controls over dispensing chemists in the country, the move will create havoc. Besides substituting prescribed drugs, chemists could be selling more expensive generic drugs to patients, thereby defeating the very purpose of the law.
- Quality is the other major issue with generic drugs. In the last couple of years, the US Food and Drug Administration (USFDA) has initiated action against many Indian pharmaceutical companies for alleged violation of good manufacturing practices and other irregularities at the drug manufacturing facilities. This happened mainly with generic drugs, which were manufactured in India and exported to the US. With such poor-quality controls in manufacturing, the intent of the legislation will be compromised.
- There are a perplexing number of fixed-dose combinations (FDCs), the vast majority of which have no therapeutic justification. These FDCs account for about 45% of the market (about ₹45,000 crore). The British National Formulary lists very few FDCs whereas in India there are thousands. Thus, an urgent work needs to be done to curtail the usage of FDC(s).
- It is extremely important to reduce the burden of health-related costs on common people, but instead of jumping the gun on generic medicines, alternative methods to reduce costs and improving quality of drugs should be given priority.
- A logical step would have been to institute better quality control in the manufacture of generic drugs first, test their bioequivalence with standard branded medicines, build doctor and patient confidence on the product and then, push for a change in prescription behaviour of physicians.
- National Medicine Pricing Policy would be a simple but very effective way in controlling drug prices, without taking away the choice of prescription from doctors. This could be easily done through the government’s National Pharmaceutical Pricing Authority.
- Moreover, increasing drug manufacturing units and investing heavily in drug research and development will effectively make India “drug self-sufficient” with a wider and cost-effective “drug reach.
Question: Providing accessibility and affordability of medicines is the most important task for the health administration. Apart from price controls, what novel methods can be adopted to assure quality medicines?
TB Timeline (The Hindu)
Synole meptic line: It throws light on impending crisis of TB in India and certain suitabasures to overcome it. (GS paper II and III)
- Government kept aside a target of two months to eliminate TB. However, recent report by a medical journal The Lancet, presents a grim picture of impending TB crisis in India.
Draft plan to eliminate TB
- Government has prepared a National strategic plan (NSP) formulated by the Central Tuberculosis Division to eliminate tuberculosis (TB) by 2025 aims to fight the bacteria by better detection, treatment, prevention, and strengthening policies.
- The draft National Strategic Plan (NSP) for TB Elimination (2017-2025) proposes incentives for private doctors who treat TB patients, and financial benefits and free medicines to those visiting them, under its “aggressive” strategy to eliminate the disease.
- One of the prevention strategies in the NSP states that 95% population with latent TB should be started on preventive treatment, if found eligible for it. It also aims at taking treatment success rate of TB patients in private sector from the current 13% to 90% in 2025.
- The draft also has provisions for TB patients who seek treatment from the private sector. “To address financial and nutritional hardship that a patient and the family undergo due to TB, and to reduce catastrophic costs to patients, a cash incentive of Rs 2,000 will be provided for every TB patient through Direct Beneficiary Transfer.
Extent of TB in India
- The Revised National TB Control Programme (RNTCP) notified 17.5 lakh TB patients in 2016, from both the public and private sectors, and 33,820 drug-resistant TB patients were additionally notified.
- In 2015, TB is estimated to have killed 1.8 million people, and six countries India, Indonesia, China, Nigeria, Pakistan and South Africa accounted for 60 per cent of the total number of cases of TB worldwide.
- India also has more than a million “missing” cases every year, which are not notified, with most remaining either undiagnosed or unaccountably and inadequately diagnosed, and treated in the private sector.
Recent findings and the present scenario in India
- The Lancet indicates that India’s TB crisis is set to escalate by 2040 when one in 10 cases could be drug-resistant — both multidrug-resistant TB (or MDR-TB, resistant to more than one of the first-line drugs) and extensively drug-resistant TB (or XDR-TB, also resistant to fluoroquinolones and at least one of the second-line injectable drugs).
- What is even more alarming is the projection that the increased number of drug-resistant cases will come from direct transmission from infected people to others rather than by strains acquiring resistance to TB drugs during treatment due to inadequate treatment or discontinuation of treatment midway.
- The increased availability of drugs to fight drug-sensitive TB has led to the emergence of MDR-TB strains. With an increasing number of MDR-TB cases, there has been a shift in the way people get infected with drug-resistant TB from strains acquiring drug resistance during treatment to direct transmission of MDR-TB strains from an infected person.
- Contact screening of family members and preventive treatment of all children below the age of five who have not developed the disease are already a part of the Revised National Tuberculosis Control Programme, but rarely done. Hence, Health administration should be more vigilant on this front.
- Another important strategy that has to be adopted is making drug-susceptibility testing universal and mandatory. Developing more accurate, cheaper and effective diagnostic tests and improved treatment regimens that are less expensive and of shorter duration will also go a long way in winning the war against the disease.
Question– In order to meet SDG targets, India should respond swiftly on heath fronts such as TB. Discuss.
Should we do away with Capital Punishment? (The Hindu)
Synoptic line: It throws light on the issue of persist question that whether Capital punishment should be there or not. (GS paper II)
- With the recent announcement by Supreme court of India for the capital punishment to accused of infamous 2012 Delhi gang rape case, has again sparked the debate that whether in democratic society like India, there is need of capital punishment or not?
- The society is in uproar today as crime is constantly on the rise. Law enforcement structures are struggling to meet the expectations of the civil society. There is a breakdown of the arguments given for death penalty.
Capital punishment in India
- The Capital punishment is a legal penalty in India. According to the Article 21 of The Constitution of India, “no person shall be deprived of his life or personal liberty except according to procedure established by law.” Capital punishments have always been a point of contention in the Judiciary, not only in India but also in most developed countries.
- In colonial India, death was prescribed as one of the punishments in the Indian Penal Code 1860, which listed a number of capital crimes. It remained in effect after independence in 1947. The first hanging in Independent India was that of Nathuram Godse and Narayan Apte in the Mahatma Gandhi assassination case in 1949.
- In the Bachan Singh vs. State of Punjab (1980) case, the Constitution Bench judgment of Supreme Court of India in Bachan Singh made it very clear that Capital punishment in India can be given only in rarest of rare cases, affirming the principle of “life imprisonment” as the rule and death penalty as the exception.
- According to the left view, crime purely is not as actions of “inherently bad” people, i.e. attribute responsibility exclusively to the individual, rather socialization is a great factor. We are all products of our circumstances. This is not to suggest the absolute lack of individual agency in the things we do but rather to argue that the reasons why we do the things we do is influenced by a lot more than just individual will.
- Crimes are as much about social failure as they are about individual responsibility. According to them, the burden of the death penalty has a disparate impact on the most marginalised and poorest sections of society.
- Our criminal justice system is in severe crisis given the rampant use of torture in investigations, a broken legal aid system and alienating trial processes. It is incapable of administering the death penalty in a fair manner and that is evidenced by the fact that over 30% of death sentences handed out by trial courts result in acquittals (not commutations) in the appellate process.
- According to their view, the perpetrator has also individual responsibility, but before giving capital punishment we must also recognize the failure of society and state.
- For the rightist view, “The crimes we are now witnessing cannot be addressed by simple punishments. We need drastic action”.
- There is a peculiar problem where law enforcement agencies are not working for ordinary citizens, according to the estimate roughly over 1,50,000 personal security officers are guarding the VIPs so how do expect them to protect the common man.
- In a society when it is impossible to reform criminals, the recurrence of heinous crimes against the vulnerable sections, all such acts call for a serious deterrence. Unless you take drastic action, especially in the case of rape, murder and terror attacks, the situation will not improve.
- It may be possible to abolish death penalties in extremely advanced countries where people are normally law abiding and the state is strong enough and has enough resources to even attempt to correct the behaviour patterns of deadly criminals. But India is not anywhere near that stage. We need the death penalty for our own reasons at this stage in our development as a civilised society.
- According to their view, our judicial system moves at snail’s pace, there are multiple layers of appeal from the trial court to the apex court. These layers act as a safety valve against miscarriage of justice and so the criminal justice system is unable to offer protection of law.
- In ancient times, the sole purpose of punishment was retribution. However, in more modern societies the objectives of punishment include deterrence, retribution, incapacitation, rehabilitation and reparation. There are two main arguments for capital punishment- first, that it acts as a deterrent and second, it gives due justice to the aggrieved.
According to a quote by Montaigne- “We do not aim to correct the man we hang; rather we correct and warn others by him.”
- However, the crusaders against death penalty have often argued that there is no empirical data to confirm that capital punishments act as a deterrent, but studies have shown that even though it may not have an immediate effect; there is a long-term decrease in heinous crime.
- According to their view, when the crime is diabolical in nature as it shocks the collective conscience of society, any mitigation cannot survive and the crime has to be tested on the anvil of the ‘rarest of the rare’.
- In the land of the Mahatma, it might seem as an affront to our ideals as a nation, but to give the accused privileges of perks for good behaviour while sentenced for life is not justice.
- In a rapidly antipathic society, our legal structures need to send a strong message to enforce the idea that punishment will be “consequential” and commensurate to the crime.
- The world is moving away from using the death penalty. Amnesty International reports that more than two-thirds of the world does not use the death penalty any more.
- In a country which symbolizes as “Largest democracy” of world, it should think this issue very precisely, there are no easy answers to this, as there are many stakeholders involved and all have a right to a fair and just existence in society. So the question remains open, whose perspective should society take into account, the convict or those of the victim and their surviving kin?
Question– India being a liberal democracy, a reformative punishment should be norm in India. Critically analyse.
Peer to Peer lending (GS paper III)
- Peer-to-peer lending (P2P) is a method of debt financing that enables individuals to borrow and lend money – without the use of an official financial institution as an intermediary. Peer-to-peer lending removes the middleman from the process, but it also involves more time, effort and risk than the general brick-and-mortar lending scenarios.
- The advantage to the lenders is that the loans generate income in the form of interest, which can often exceed the amount interest that can be earned by traditional means (such as from saving accounts and CDs). P2P loans give borrowers access to financing that they may not have otherwise gotten approval for by standard financial intermediaries.
- Also known as crowdlending, many peer-to-peer loans are unsecured personal loans, though some of the largest amounts are lent to businesses. Secured loans are sometimes offered by using luxury assets such as jewellery, watches, vintage cars, fine art, buildings, aircraft and other business assets as collateral.
Regulations with regard to P2P lending in India
- The Reserve Bank of India (RBI) had initiated steps to regulate the nascent and hitherto unregulated peer-to-peer (P2P) lending business. RBI has proposed registering P2P lending platforms as non-banking financial companies (NBFCs).
- Online P2P lending companies work as marketplaces that bring individual borrowers and lenders together for loan transactions without the intervention of traditional financial institutions such as banks and NBFCs.
- RBI said it would be “prudent” to regulate the business because of the impact it can have on traditional banking channels and NBFCs and its “potential to disrupt the financial sector and throw up surprises.
- P2P companies must act only as intermediaries and their role must be limited to bringing the borrower and lender together. This basically means that P2P lenders cannot take on the functions of a bank and seek and keep deposits.
- Funds must move directly from the lender’s account to the borrower’s account to prevent risk of money laundering.
- P2P platforms can’t assure returns to lenders.
- The companies must have a minimum capital of Rs.2 crore.
- P2P platforms may be required to have a “brick-and-mortar” presence in India.
- Platforms will need to submit regular reports on their financial position, loans arranged each quarter, complaints and so on to RBI.
- The guidelines should strike a balance between overregulation and leaving too many loopholes. If guidelines are too strict and harsh, it will bring down the P2P market. If P2P isn’t well regulated and things get ugly, the government will come back with heavy restrictions. But, in any case, the guidelines will bring awareness about the sector and more individual lenders will come on board.
- However, regulating P2P is not a cakewalk but an arduous task. The old mantra of ‘one size fits all’ will not work here. Fundamentally, it demands adjustments to regulatory thought and will. The RBI needs to accept that existing structures were simply not built for such models of direct finance. They were designed for a totally different world. Moreover, in a sense, P2P lending depicts the perfect regulatory arbitrage exam hypothetical, often baffling the top legal minds.
Question– What can be the possible advantages for P2P lending with respect to credit availability in India?