Monday, September 17, 2012

News of the day

Middle income group to pay Rs 20,000 for case in Supreme Court

New Delhi: In some good news, middle income group people can get their cases argued in the Supreme Court for a nominal fee of not more than Rs 20,000. 

To fulfil the requirement the annual gross salary should not exceed Rs 7.5 lakh or and the monthly income Rs 60,000. 

The scheme is available under the Supreme Court Middle Income Group Legal Aid Society, which is headed by a sitting judge of the Supreme Court with the Attorney General of India as its ex-official vice president. 
Disclosing this at a news conference here on Monday, office bearers of the society and senior counsel Ranjit Kumar and Raju Ramachandran, said middle class people who can't afford the expensive litigation in the Supreme Court can avail the services of the society for a nominal amount. The society comprises 30 prominent senior advocates, besides 100-odd advocates on record. 

Counsel Ravindra Bana and president of the Supreme Court Advocates on Record Association Sushil Kumar Jain were also present at the press meet. 
As per the Supreme Court rules it is only through advocates on record cases can be filed before it. 

According to Ranjit Kumar, any person desirous of availing the services of an advocate empanelled under the scheme will have to approach the secretary of the society by filing an application. The society's office is located at 109, Lawyers Chambers, Post Office Wing, located within the Supreme Court complex. 

Under the scheme even a senior advocate if engaged by a client can charge a maximum of Rs 9,000 for three days of hearing or for the entire case. The amount would start from as low as Rs 3,000 depending upon the stage of the petition at which it is argued. 

The counsel said that though the scheme was in vogue since 1995, the general public was not aware of it. Hence, efforts are being made to create awareness among the general public on the beneficial scheme. 

Free medicines for all at public health facilities soon
: Monday, September 17, 2012,21:04

New Delhi: With finalisation of 12th Plan outlay, Health Ministry is aiming to roll out its ambitious project for provision of free medicines to all at public health facilities across the country from November 1.

 Despite a scaled-down outlay of 1.95 per cent of GDP during the 12th Plan, Health Ministry officials say none of its planned schemes will be sacrificed and it is keen to launch the free medicines project soon."We should be able to work out all our schemes within the budget earmarked for the 12th Plan. No scheme will be sacrificed," a top Health Ministry official told PTI.
 He said, "We are keen to launch the free medicine scheme within the next two months. The effort is to launch it from November 1 and the model of Rajasthan Medical Services Corporation and that of Tamil Nadu, which has been a pioneer in this, are being studied."Once the scheme is launched, the government will provide free generic medicines to all patients coming to public health facilities - from primary and community health centres to district hospitals and medical colleges.
 The Health Ministry intends to earmark an amount of Rs 2,000 crore annually under the proposed National Health Mission (NHM) for supplementing the states` resources under the scheme, which will see its scaling up to Rs 6,000 crore for augmenting the supply chain management of medicines.
While the Centre will supplement the states` efforts, the Health Ministry is mandating that besides creating a list of generic medicines, states should prepare standard treatment guidelines and evolve a system of procurement.

The Ministry has favoured that medicines be procured centrally and their stocks be maintained which will help in drastic reduction in the cost of such medicines. Officials said by doing so, like in Rajasthan, there can be reduction in cost of medicines by up to 70 per cent.

For the success of the project, the Centre is also pressing for prescription of generic medicines and ensuring that their quality is maintained through proper testing of drugs, besides developing a grievance redressal mechanism.

Adequate supply of essential medicines at health centres has been an area of concern, with even the performance audit of National Rural Health Mission pointing to glaring deficiencies in the drug supply chain at health centres across India.

So much so so that the CAG found expired drugs being supplied to patients at some places, defeating the very purpose of the scheme.

 During a performance audit of NRHM in 2008, the CAG had found essential medicines in short supply at a number of test -checked health centres.The CAG also found that the NRHM provision of two month medicine stock at a health centre was not being adhered to in most places.
As many as 13 states including Assam, Delhi, Haryana, J&K, Punjab and Jharkhand had not cared to prepare the common formulary of essential drugs that should be available at a health centre, the CAG report said.

The free medicines scheme being evolved now will finally take the ministry towards universal health care for all. The scheme aims to help reassert the faith of the common man in public health facilities, which the Ministry intends to strengthen across the country during the 12th Plan.


In India, gift-giving drives drugmakers' marketing
  • September 17, 

Sales representatives for Abbott Laboratories Inc's Indian subsidiaries know what it takes get a doctor to prescribe the drugs they market: a coffee maker, perhaps, or some cookware, or maybe a vacuum cleaner.
These are among the many gifts for doctors listed in an Abbott sales-strategy guide for the second quarter of 2011. As laid out explicitly in the guide, doctors who pledge to prescribe Abbott's branded drugs, or who've already prescribed certain amounts, can expect some of these items in return.
Consider the guide's entry for Nupod, an Abbott antibiotic generically known as cefpodoxime. It lists a medical textbook, a mosquito repellant and a coffee maker as incentives for doctors.
It also provides a script of the social niceties for clinching the quid pro quo: "Dr presenting you advanced coffee maker from Philips which will make coffee within three minutes. Dr in the box we have made advancement easy for you by giving the ideal usage guidelines of the coffee maker. Dr I look forward for advancement in action i.e. our Nupod brand. Dr can get just 3 Rx per day for Nupod."
Especially in India's poorer areas, says one Abbott rep, "if you give them a small gift, they are happy."
A larger problem
The Abbott guide - reps say the company produces them regularly - is evidence of a larger problem in India. Dozens of doctors, drug reps and other healthcare insiders said domestic and multinational drug makers routinely shower Indian doctors with gifts, posh junkets abroad, and cash payments disguised as consultancy or other types of fees.
"Indian CRM," or customer-relationship management, is what industry insiders call this system of inducements. None of the doctors or reps who described their participation in this trade would speak on the record. Under Indian law, doctors are prohibited from accepting cash, gifts or travel from drug companies. Still, enforcement is rare, and drug makers may lavish gifts on doctors with impunity, though their home countries may punish the practice.
In a country where doctors often make less than $10,000 a year, it can be an effective strategy.
"Somebody is doing something for you," says a Delhi-based cardiologist. "Obviously you will want to return the favor." He says he prescribes more drugs from companies that provide gifts and send him on paid vacations to Thailand, Hong Kong and elsewhere. One of those companies, he says, is the India-based Ranbaxy unit of Japan's Daiichi Sankyo Co.
"We do not sponsor vacations for doctors," a Ranbaxy spokesperson said. "We are viewed as a scientifically and academically orientated company and our promotional activities are built around academics and science."
Chicago-based Abbott said that it complies with local laws and regulations in India. It added that company policy forbids employees to "offer or give a sponsorship, gift, meal or entertainment in exchange for an explicit or implicit agreement that Abbott Products will be used, purchased, ordered, recommended or prescribed or that Abbott or any Abbott products will receive any favorable treatment."
So many choices
The Indian market is particularly vulnerable to corruption because of the intense competition here. Until 2005, India flouted drug patents, refusing to rein in domestic copycats of Big Pharma's blockbusters. Brands proliferated. Today, an Indian doctor can choose from among 224 registered brands of the cholesterol-lowering drug atorvastatin, sold by Pfizer Inc as Lipitor in the U.S. and elsewhere.
Foreign companies that want a piece of this crowded market "have to adapt, or they are not going to survive," says an executive with Biocon, a leading Indian biotech company. The executive says Biocon routinely gives doctors iPads, iPods, mobile phones, "you name it."
A Biocon spokesperson said the executive's statements are "incorrect and absolutely untrue" and added that the company operates "in strict compliance" with the law.
Public health experts and some Indian doctors say that as a result of drug companies' tactics, drugs are dangerously overprescribed and expensive brands are prescribed instead of cheap ones. That can be devastating for patients -- physically and financially -- in a country where health care is mostly private and unsubsidized and 400 million people live on less than $1.25 a day.
At the Amrita Clinic, a private practice in Pune, Maharashtra State, physician Vinay Kulkarni says he refuses to accept gifts from reps, in part because he believes drug makers overcharge for their products to recoup marketing expenses. "Ultimately," he says, "everything is being paid by the patient."
As Big Pharma has pushed into emerging markets like India in recent years, companies have been running into trouble with their home-market overseers. Many of the world's top drug makers have warned in recent regulatory filings of potential costs related to charges of corruption in foreign markets.
Tea sets in China
Last year, Johnson & Johnson agreed to pay $70 million to settle U.S. charges that it paid bribes and kickbacks to win business in Greece, Iraq, Poland and Romania. Pfizer Inc recently agreed to pay $60.2 million to settle a U.S. government probe of the drug maker's use of illegal payments to win business overseas, including gifts such as cellphones and tea sets to doctors in China who prescribed the company's products.
Abbott became the No. 1 pharmaceuticals company in India in 2010, when it paid $3.7 billion for the branded generics business of Mumbai-based Piramal Healthcare. Its thousands-strong Indian sales force has helped buoy the parent, as sales in emerging markets rose 23 percent to $2.59 billion in the second quarter of 2011 -- more than twice Abbott's global growth rate.
Reps from Abbott True Care, Abbott Healthcare and Abbott Primary Care - all formerly part of Piramal and now subsidiaries of Abbott -- say sales plans are revealed to them at "cyclical sales meetings" every three or four months. These meetings, they say, sometimes include studying printed strategy guides like the one for second-quarter 2011 that Reuters reviewed.
That guide offers no clarity on why particular gifts are paired with particular drugs. None of the items that come with Nupod, the antibiotic, go to doctors who prescribe Pantagon IT. That drug - a combination of itopride, for bloating and indigestion, and the antacid pantoprazole - comes with a stapler, a set of six glasses and a jar from Luminarc, and a Forbes Trendy Nano vacuum cleaner.
"THE PANTA REWARDS INPUTS MUST ONLY BE PRESENTED AT THE DRS HOME," the guide tells reps. When delivering the glassware, reps are instructed to say, "Thus Dr requesting your continuous prescription support for Pantagon IT."
Prescriptions for Paraxin, a drug for typhoid fever, are rewarded with a hand sanitizer and an antique pen. Prescriptions for Lysupra, a multivitamin supplement, could earn a beaded car-seat cover "for the relaxation when you are traveling."
Depending on the drug, a doctor might find himself the owner of a Kiwi shoeshine kit, an Ambi Pur car air freshener, a Birla steam iron, or a Pure Relaxation CD series. And if that's not enough, participation in a "Doctor Talent Contest" judged by Bollywood actor Boman Irani might seal the deal.
Scanners and steam irons
Abbott reps say that so far this year, they have doled out, among other things, scanners, steam irons, shoes, stethoscopes and gift vouchers worth more than $100 to doctors - both private and government-employed.
Amitava Guha, a member of the national working committee of the Federation of Medical and Sales Representatives' Associations of India, worked as a rep for decades, including for Piramal from 1997 to 2008, when he retired. "Everybody is doing it," he says. "I was doing it when I was in service.... They said that it is your job to go and give to the doctors."
He says he resisted giving anything but the smallest gifts, like pens. Today, he says, he receives frequent complaints from reps across the country about the practice. It taints their professional image, he says. Also, it's hard work toting around all those gifts. "They have been given huge extra bags to carry," he says. "One on the shoulders and two others in the hands."
The managing director of a large diabetes clinic in Calcutta says he sees as many as 25 reps a day. "Whatever you like, they can provide you," this doctor says.
His interview with Reuters was interrupted when a man squeezed into his office and placed a big yellow box on the table. "Sir, this is an exquisite casserole set," the visitor said, slipping the doctor a note bearing the brand name Rostar, a cholesterol-lowering medicine from Mumbai-based Unichem Laboratories Ltd.
Unichem did not respond to requests for comment.
Guha, the union federation official, says that reps have begun reporting a shift in emphasis away from the types of gifts listed in Abbott's guide toward free "foreign tours" and outright cash payments, often made under the guise of public health initiatives or research.
Every year, Abbott, collaborating with doctors and other groups, conducts hundreds of "health camps" across India to raise awareness about conditions such as diabetes, high cholesterol, anemia, breast cancer, sleep problems and thyroid disease.
Abbott says these programs "generally incorporate diagnosis, prevention and education. � The focus of these camps is around disease and not products."
In the name of science
Reps say public health isn't always the point. "This is a business transaction," says one. This rep says that at a diabetes camp he worked on, patients were given random blood-sugar tests - not a valid means of diagnosing diabetes - and based on the result, were prescribed Abbott oral diabetes medications by the participating doctor.
Similarly, reps and doctors say companies try to boost sales through so-called non-interventional post-marketing studies, commonly used around the world to monitor the safety and efficacy of drugs after they have been approved for sale.
Doctors and reps say that often, companies use these studies as cover for paying doctors to prescribe the drugs under study. According to one Abbott rep, the company doesn't pay doctors if sales at nearby pharmacies don't increase.
A doctor who has done post-marketing studies in India says the companies rarely monitor the studies or check the data. "We all understand that post-marketing studies are not really true studies," says the doctor, a diabetes specialist at a Calcutta hospital. They're "just a way to offer an honorarium. So we also don't take them seriously."

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