Two articles in Scientific American and New Scientist question the efficacy of medicine. A new book (Medical Nihilism) reviewed by SA claims that: “Most treatments do not work very well, and many do more harm than good. Therefore we should “have little confidence in medical interventions” and resort to them much more sparingly.” while NS cites a study: “An analysis of 216 medicines launched in Germany since 2011, most of which would have been made available throughout Europe, has found that only a quarter brought significant benefits over existing treatments, according to the available evidence. The rest had only minor or no benefits, or the impact of the medicine was unknown.”
SA likes “medical nihilism” because it stings. It delivers a much-needed slap across the face of health-care providers and consumers, a slap we need to rouse us from our acceptance of the abysmal status quo. If more of us accepted medicine’s limits and acted accordingly, our health would surely improve and our costs plummet.”
I agree but what can consumers do to turn this around? India may have found the answer. In India you can get cancer surgery for $700 and a heart bypass for $2,000. How do they do that?
Dr. Shetty is the founder and chairman of Narayana Health, a chain of 23 hospitals across India that may be the cheapest full-service health-care provider in the world but has outcomes for patients that meet or exceed international benchmarks. They control expenses by re-using medical tubing, for instance. The tubing gets washed and sterilized as opposed to being thrown away after one-time use in Western hospitals.
Under a new Indian health reform initiative Dr. Devi Shetty speculates that “In 10 years, India will become the first country in the world to dissociate health from affluence. India will prove that the wealth of the nation has nothing to do with the quality of health care its citizens can enjoy.”
India also introduced price controls for pharmaceuticals in 2013. The controls produced mixed results, as stated in a study of India’s price controls: “the legislation led to decreased sales of price-controlled and closely related products, preventing trade that would have otherwise occurred. The sales of small, local generics manufacturers were most impacted by the legislation, seeing a 14.5 percent decrease in market share and a 5.3 percent decrease in sales. These products tend to be inexpensive, but we use novel data to show that they are also of lower average quality. We provide evidence that the legislation impacted consumer types differentially. The benefits of the legislation were largest for quality-sensitive consumers, while the downsides largely affected poor and rural consumers, two groups already suffering from low access to medicines.”
Over the years India’s price controls proved to be too restrictive, causing profit loss and the ensuing decline in R&D funding and foreign direct investment. New legislation announced in January 2019 removed price restrictions on new and innovative drugs developed by foreign pharmaceutical companies for the first five years.
At the same time the Department of Pharmaceuticals introduced another policy measure: for formulations that are not manufactured in India, the minimum local content was capped at 10% in 2018-19. Preference for public procurement programs in the pharmaceutical sector was to be given to domestically-produced drugs with minimum of 75% local content in the ongoing fiscal, which will go up to 90% by 2023-25. The move is likely to benefit the micro, small and medium enterprises in the drug sector.
It looks like India may have most of the answers for affordable healthcare for all. Is it an experiment worth watching and maybe duplicating in the future.