The diabetes mega scam MSM won’t talk about

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K. JAVEED NAYEEM writes: Last week, a relative called me up when I was in the middle of my practice to ask me if I knew that the anti-diabetic drug I had been treating his wife with had been banned by the Indian government, according to a newspaper report he was reading.

Surprised that I had no wind of this development from the two morning dailies I had just finished reading, I switched to the online edition of his newspaper to discover that what he had informed me was indeed true.

***

Our country with a conservatively estimated population of over a hundred crore now has a population of about ten crore diabetics.

If you are stunned by this figure I am not surprised as it certainly appears very huge. But with the incidence of diabetes, conservatively estimated again, to be between seven and nine per cent of the population, that is exactly what it translates to.

Now, at least 30 per cent of these ten crore diabetics are being treated or would have been treated sometime sooner or later in their lives with a drug called Pioglitazone which is one of the very potent anti-diabetic drugs available almost all over the world in any doctor’s armamentarium.

This is the drug that was being used as the last resort when all else failed to control the disease, before recommending Insulin injections which most patients understandably dread, both because of the pain and the cost.

This was a drug that had some very unique beneficial properties, the most important one being its ability to reduce the development of insulin resistance in the body. It was therefore a very good add-on drug that would also help in reducing the dose of insulin required to bring the blood sugar levels down.

This drug was also capable of reducing the levels of Triglyceride, one of the bad Cholesterols in the blood that can increase the risk of heart attacks. But like almost every other drug this drug too was said to be potentially capable of sometimes causing some serious side effects which notably were almost unheard of in Indian patients.

I have been treating almost a third of my diabetic patients with it over the past 12 years of its existence in India and I have never come across even a single patient who developed any of the serious side effects.

And, I have never come across any of my fellow doctors, including exclusive diabetologists who have encountered them in their practices.

Most importantly, it was also a drug that was indigenously manufactured and therefore cheaply available across the length and breadth of the country and this perhaps was what sounded its death knell in our poor nation.

***

Just a few years ago there appeared on the medical horizon a new class of drugs called the Gliptins, developed and manufactured overseas, by seething rich pharma giants under strong and strict patents.

They were touted as the miracle molecules that could revolutionise the treatment of diabetes by obviating the need to use insulin and were hastily thrust, at an astronomical cost, into almost all the third-world countries, including India which could ill afford them.

Imagine even a well-to-do diabetic patient having to take tablets costing around forty to forty five rupees every day, life-long.

How many Indians can afford this kind of treatment for themselves when there are many other things to do for the rest of their family members with their hard-earned money?

Most importantly, despite aggressive marketing these newer drugs simply failed to even make a tiny dent in the management of diabetes because they simply failed to live up to what was expected of them by way of their efficacy.

So all those who stood to lose heavily after breeding and backing the wrong horses had to quickly do something to rein in their losses.

***

There is a sentence in Wilbur Smith’s novel of the same name that says, ‘When the lion feeds, someone has to die’. And so the first victim that had to die to keep the powerful Gliptin lion alive was Rosiglitazone, a sibling of Pioglitazone.

It was accused of first degree murder, quickly tried, convicted and summarily executed although more than a hundred other more lethal drugs still rule the roost here, flying across sales counters, without doctors’ prescriptions.

Close upon the heels of this macabre victory the honourable ‘Brutuses’ turned their daggers on the present victim citing its banishment from France and Germany, although it is still very much in use in almost the whole world, including the United States, Canada, Japan and the rest of Europe.

In fact it is still the tenth largest selling drug in the United States.

Now in our country, with Pioglitazone gone, the Gliptins, which have failed to do anything impressive, will be the only option for diabetics who desperately try to avoid embarking on Insulin. And, this is where all those who peddle them will stand to gain their billions from their clever act.

***

So investing just a few millions in ‘buying’ the help of someone in our health ministry only amounts to offering the crumbs that fall off their plates onto the dining table.

Perhaps the makers and marketers of the different kinds of Insulins too are abettors of this heinous crime as patients who do not benefit from Gliptins now have no other option than to start them.

Today, it is a matter of pride that Indian doctors are among the most respected and trusted all over the world. With their academic excellence and clinical skills they have made a tremendous impact on the healthcare front and are much sought after both by patients and research foundations.

We have some of the best professional societies for conducting research on almost all the major diseases well within our country.

Yet, without seeking the opinion of any of these bodies and without as much as a debate or discussion among the many excellent academic fora that we have in our country for the study of Diabetes and with just a stroke of the bureaucratic pen, someone, somewhere, sitting in the ivory towers of administration in New Delhi and who does not know the A, B or C of pharmacology or medical practice has signed the death warrant that is bound to spell doom for at least three crore Indian lives.

It is an act that will amount to being the biggest genocide in history if only we have the far-sighted vision to foresee it. And if we do not have this vision, it will be a tragedy that will most likely go unnoticed because it is not going to happen at once like the Bhopal gas disaster to make a noticeable impact, unfolding silently like a Biblical pestilence only over the next few decades.

Diabetic patients who cannot afford the Gliptins, the prices of which have shown no signs of coming down and which cannot do much good even if made affordable, simply cannot keep their disease under control.

All those who cannot afford Insulin injections or accept the pain and inconvenience of embarking on them will stand to lose.

Elderly patients who stay alone and who do not have the dexterity to inject themselves and who could have kept the disease under control for many more years with oral tablets of Pioglitazone will be the most helpless losers.

And, to top it all, uncontrolled diabetes is a disease with unimaginable morbidity and the highest mortality, all of which is easily avoidable with proper management.

Despite the grim scenario that is set to unfold, all is not lost yet and I still see hope for all the hopeless if a few professional bodies seek a legal remedy from the Supreme Court against this ban which certainly smells of a mega-scam and demand a rethink, taking all pros and cons into consideration.

We can at least retain the drug with a stipulation that it should be used very judiciously only in those patients who are not at risk of its side effects.

But with the Gliptin and Insulin lobby being very strong, perhaps tomorrow itself you may find the media abuzz with write-ups and blogs calling my kind of writing ill-informed and amateurish.

Well paid ghost writers can certainly write a more effective charge-sheet than what an unpaid doctor like me can do and I may naturally be no match for them. But the truth needs to be told in the interests of all those who stand to lose.

The millions of patients who will lose their lives due to their reluctance to buy the expensive medicines that will help them live just a wee bit longer, while their loved ones die of hunger.

Or, the loved ones who will live on, after losing much, much before their time, the ones who nourished and nurtured them.

(K. Javeed Nayeem is a practising physician who writes a weekly column in Star of Mysore, where this piece originally appeared)

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15 Responses to “The diabetes mega scam MSM won’t talk about”

  1. Vivek Vijayan Says:

    Where are we as a nation heading?

  2. nagib hussain Says:

    excellent analysis sir. we have to raise our voice against this stupid act of the govt.

  3. Dr. Ravi Says:

    Maybe this a a hasty decision.The decinding authorities must have
    thoroughly checked the pros and cosn and also analised the chemical properties and the case studies done by several medical experts.

  4. Shetty Says:

    Greed has no limits!

    http://articles.economictimes.indiatimes.com/2013-06-24/news/40166709_1_ranbaxy-laboratories-ltd-mohali-plant-52-week-low

    http://indiatoday.intoday.in/story/supreme-court-dismisses-pil-for-ban-on-ranbaxy-drugs-in-india/1/285190.html

    http://profit.ndtv.com/news/corporates/article-why-do-great-indian-companies-like-infosys-self-destruct-323442

  5. Melanie Says:

    But how does one go about pushing for a backtrack, with the corporate media and the Mandarins in government already having done the damage? Who knows whether palms were greased in the corridors of power, to ensure the ban? Can a PIL be filed by the good doctor, since he has solid evidence to back his arguments?

  6. harkol Says:

    There are other diabetic drugs that are bloody expensive being prescribed to ‘wealthy’ patients. Victoza, a liraglutide injection, can cost upwards of Rs.10,000/month! This has known side effect in some of causing cancer, and is only to be prescribed if the known benefits outweigh risk of cancer. But, it is being prescribed as first line by many doctors especially for folks who are over weight – as it has a side effect of weight loss!

    The govt. won’t ban this drug – too profitable.

  7. narayana, narayana! Says:

    Dr Nayeem has hit the nail on the head. The pharma companies have thrived on pushing new drugs hard, hiding their bad effects, and after recovering their investment many times over, then making them seem obsolete or unsafe by pushing another new drug barely different but priced exorbitantly. To support the company’s promotion, the US government steps in to persuade the Indian government to honour IPR of drug companies, and then arm-twist it to make the changes they want. Of course, our babus are no idle watchers of the game being played and are more than willing accomplices to carry out the company’s command at a price!! Who suffers? Who cares!
    There is another sinister game being played with the connivance of doctors. Year after year, the threshold of diabetes keeps changing so that more people are labelled diabetics and more are put under medication they don’t really need. Diabetes detection camps, free advice, diet advice, drugs, followed by scare of complications of diabetes if one neglects medication…
    I do not think the average South Indian diet has changed so much over two or three generations to swell the percentage of diabetics in a population.
    Medicine has become a big scam and the so called lifestyle diseases an even bigger scam, diabetes and heart diseases in particular.

  8. Arun Says:

    I was shocked too hearing the ban. Just today had to change prescriptions of scores of patients omitting Pioglitazone.
    My post here
    http://arunnm.wordpress.com/2013/07/01/ban-on-anti-diabetes-medicine-pioglitazone-irrational/

  9. Doddi Buddi Says:

    Excellent analysis. Dr. Nayeem should be interviewed on TV and he should expose these malpractices by pharma giants!

  10. Gaampa Says:

    Doc

    I am your patient. You have helped me.

    Astounded and shocked to see this.

    Pray Subramaniam swamy or someone e takes it up in the courts.

  11. chidu22 Says:

    The debate surrounding pioglitazone and its association with bladder cancer is still unsettled. True to its character the gov has banned the drug without any proper consultation. The tirade against gliptins by Dr Nayeem in the context was uncalled for. Also, I am dubious about Dr Nayeem’s superfluous writing to make a simple point.

  12. Doddi Buddi Says:

    Chidu22,
    Please remember Dr Nayeem has numbers on his side treating his patients with the “now banned” drug! That should dispel all doubts about his understanding on this issue. What is flummoxing us is your sentence …”Also, I am dubious about Dr Nayeem’s superfluous writing to make a simple point.” You seem to have at once put together a sentence of such beauty my head reels and I am reaching for some strong coffee!

  13. chidu22 Says:

    @Doddi Buddi,
    Couple of things, not for once I doubted the knowledge, and experience behind it, of Dr Nayeem, the good Muslim he is in his own words. Secondly, I am at loss to understand as to what is so bewildering about my comment that you had to run for coffee. On the contrary you are the one who comes up with such beauties time and again that, your comments are the partly the reason for me to follow churumuri.

  14. Doddi Buddi Says:

    Chidu22
    Imitation is the sincerest form of flattery! You need to read your original post with some coffee and see for yourself. May be ask your friends. Thanks.

  15. Manava Says:

    Best to get the opinions of a few diabetologists or endocrinologists who specialise in this area.

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