Dr Javed Nayeem is a practising physician in Mysore and writes a regular column in `Star of Mysore`. Read how a cheap, widely prescribed and effective medicine for diabetes has been banned by our central govt without any notice to favour manufacturers of costly ones. Over a cup of Tea :Three Crore Indian Lives: Sold for a song By Dr.Javeed Nayeem, MD Yesterday morning 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 percent of the population, that is exactly what it translates to. Now, at least thirty percent 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 doctorâ€™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 twelve 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 Smithâ€™s novel of the same name that says, â€˜When the lion feeds, someone has to dieâ€™. 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 doctorsâ€™ prescriptions. Close upon the heels of this macabre victory the honourable â€˜Brutusesâ€™ 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 â€˜buyingâ€™ 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.