This might be one of the scariest books you’d ever read. It might sound so scary that you might not want to read it all. And what a mistake that would be. Because unless you know the reality of India’s pharmacological past and present, there is absolutely no chance that we can secure our future.
Because all of us rest easy in the idea that the medicines we are given are true to what they claim to be and that they will make us better. We may not believe that pharmaceutical companies are always honest but we depend upon our state agencies to make regular checks and ensure that we are kept safe.
Well, two pages into The Truth Pill and you know immediately how unsafe we are and how unsafe we have been for ages.
As you read through the history of drug regulation in India, you realise a terrible irony as well. That there was a bigger clamour for drug regulation and safety protocols in colonial India. This is P. Neogi, professor of chemistry from Presidency College, Calcutta, quoted in the Chopra Committee of 1930-31, “I am of the opinion that secret remedies should be banned. The approximate composition of each patent medicine must be disclosed to the public.”
You would imagine that this would be common sense and a stringently followed law.
Yet over and over again in Independent India, as this book reveals, the law although seemingly in favour of honesty and disclosure has treated evident malfeasance by manufacturing companies with sympathy and given them a long rope. This is in spite of serious damage and even death to the consumer.
One case mentioned in the book is hair-raising, especially for anyone with diabetes. A complaint was filed by the Tamil Nadu Drug Control Administration against the Chennai-based Alfred Berg & Co for claiming to sell Glipizide, for Type 2 diabetes but actually substituted it for Glibenclamide, also a diabetes drug but with a slower metabolization than Glipizide. This is potentially dangerous for diabetics who assume they’re taking Glipizide for obvious reasons. The most relevant factor is that Glibenclamide is about 8 times cheaper than Glipizide.
As the writers discovered, to their shock, a case filed in 2014 had not come up for trial even by March 2022. This in a matter of life and death.
Thus does India’s system let us down in more ways than one.
As The Truth Pill explores, with fact, examples and observation, we get caught up not just in officialdom and procedures but political interference and matters of national pride. For instance, ayurvedic medications are a matter of national pride. But safety of those medications is not a matter of national pride, and nor are the consequences of cheating and lies a matter of national shame. And yet, as The Truth Pill delves into history, we have long known of the dangers of unchecked and untested indigenous and traditional medications. The writers call it a losing battle. Two chapters are dedicated to the dangers of such medications. Although the writers are hopeful at the stance taken by doctors, we know that our political class plays to the gallery when it comes to the practice of traditional medicine.
Apart from cheating, adulteration, fraudulent claims, unregulated medicines, we have the additional problem of our own chaotic systems. Justice Krishna Iyer noted in a judgment in 1978, “There is no doubt that if a scientific system of over-seeing wholesale distribution and a viable scheme of protected distribution is to be devised, licences for large and well-equipped conveyances and storage depots is desirable.”
Anyone would think this was obvious, but between 1978 and today, we have not managed to sort this out, for a number of reasons.
The authors, Dinesh Thakur and Prashant Reddy T, both of whom have established track records in monitoring and following India’s drug and pharmaceutical industries, have not left us high and dry in this potentially lethal mess. They provide a number of suggestions and remedies at a number of levels, which can solve at least some of the problems we face.
For their troubles, they have faced threats and flak.
But what Thakur and Reddy have done here is a form of public service. To carefully lay out the problems we face when it comes to drug regulation and what can done. The Truth Pill is a serious study, but it is an easy, fluid read that leaves you sadder and wiser. And with any luck, having been scared out of our minds, angry enough to demand that something be done.
The Truth Pill: The Myth of Drug Regulation in India
By Dinesh S Thakur and Prashant Reddy T
Simon & Schuster
pp. 477, Rs.899
