November 17, 2023

Category: Contemporary events of significance from India and the world

Many patients seek or solicit a second opinion in a medical shop — that of the seller. This is the reality of over-the-
counter sales in India, where a salesperson can decide which brand of generic medicine (pharmacological compound)
can be given to a patient. The prescribing doctor has no freedom to mention his favourite brand in which he has
invested his faith in terms of quality. On August 3, 2023, the National Medical Council (NMC) directed all doctors to
prescribe only generic names and not brand names which led to protests. Brand names are shunned because many
brands are costly. Generic names are much cheaper. In 1975, the Hathi Committee demanded that all brand names
should be weeded out gradually.

There is an alleged nexus between pharmaceutical companies and doctors who can be influenced to give in to
unethical marketing and promotional offers or kick-backs. But the Indian Medical Association and allied professional
organisations of specialists believe that improving access to affordable medicines is part of their ethical commitment
to patients. A doctor’s reputation on successful treatment depends on the reliability of the quantity and quality of the
active pharmaceutical ingredient in a tablet, syrup or injection available in a pharmacy. The prevalence rate of spurious
and “not standard quality” medicines (NSQs), stands at 4.5% and 3.4 %, respectively, as shown by two national drug
surveys in the last 10 years using thousands of samples from retail chemists across India.

The government must ensure the quality of medicines produced, procured, and supplied through its Universal Health
Coverage system as well as the private health-care network. For this, there has to be periodic lifting of samples for
testing. Batches of medicines that fail the quality test must be banned, with punitive action taken against
manufacturers. This will eliminate repeat defaulters from the supply chain. The mechanism and systems are in place
but are not implemented in earnest. Without such a reliable assurance from the government, it does not have the
moral right to enforce prescription only by generic name. Moreover, control over choosing the brand will pass on to
the chemist, or, even worse, the half-knowledgeable sales boy who, it is feared, will decide the brand primarily on the
basis of profits to be gained.

The availability rate of all essential medicines must be above 90%. In a study of the availability of 50 essential paediatric
medicines in Chhattisgarh, in 2010 — the first of its kind in India — my team calculated it to be only 17%. Non-essential
vitamin tonics and cough syrups line the shelves in a pharmacy but there is no trace of the low profit-margin essential
medicines. There must also be a ban on unscientific combinations of medicines — currently around 40% of the retail
market in India. To ensure affordable medicines for all under Universal Health Care, free medicines and free diagnostics
are acceptable policy, but implementation needs to be monitored.

The network of Janaushadhi kendras needs to be expanded. Approved norms of the profit margin for wholesale agents
must be limited to 15%. For retailers it must be 35% over the ex-factory or manufacturer’s selling prices (MSP)
excluding transportation cost and VAT. Without these comprehensive measures, accessibility to cheaper medicines in
India will be a mirage. Following the Indian Medical Association’s protest, the NMC has withdrawn the order on
‘generic prescribing’ since August 23, 2023. But this is only a case of one step forward but two steps back in moving to
the goal of universal access to affordable generic medicines for all without brand names.

[Extracted, with edits and revisions, from: "Branded, generic and the missing ingredient of quality", The Hindu]

Source: https://www.thehindu.com/opinion/op-ed/branded-generic-and-the-missing-ingredient-of-
quality/article67541096.ece
Key points:

• National Medical Council/Commission (NMC):

o According to a gazette announcement released by the Ministry of Health and Family Welfare, the National
Medical Commission (NMC) replaced the Medical Council of India (MCI) in September 2020.

o The MCI was founded in 1934 by the Indian Medical Council (IMC) Act of 1933, with the primary purpose of
creating consistent standards of higher credentials in medicine and recognising medical qualifications in India
and overseas.

o In 2018, the government dissolved the MCI and replaced it with a Board of Governors (BoG) chaired by a
member of NITI Aayog.

o After the gazette notification, the IMC Act of 1956 was repealed and was replaced by the National Medical
Commission Act, which took effect on August 8, 2019.

o The shift is intended to bring about reforms in the medical education system, particularly to replace the MCI,
which has been plagued by corruption and other issues.

o According to the NMC's new medical education framework, the shared final year Bachelor of Medicine and
Bachelor of Surgery (MBBS) examination will now be known as the National Exit Test (NEXT).

o In addition to the National Eligibility and Entrance Test (NEET), NEXT will be applied to institutes of national
importance such as all All-India Institutes of Medical Sciences (AIIMS) in order to ensure a uniform quality in
the country's medical education sector.

• Janaushadhi Kendras:
o These are the locations where high-quality generic medications are made available to the public. As part of the
Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP), the Bureau of Pharma PSUs in India (BPPI) promotes
Janaushadhi Kendras.

o The government has set a target of 10,500 Pradhan Mantri Bhartiya Janaushadhi Kendras (PMBJKs) by the end
of March 2025. The number of stores as of January 31, 2022 is 8,675.

o PMBJP's product basket includes 1451 pharmaceuticals and 240 surgical tools. In addition, new medications
and nutraceuticals goods such as protein powder, malt-based dietary supplements, protein bar, immunity bar,
sanitizer, masks, glucometer, oximeter, and so on have been introduced.
Category: International Affairs

U.S. President Joe Biden and Chinese President Xi Jinping agreed at their first summit in a year to restore military
communications between the two countries, even as Mr. Biden went off script by saying he still considered Mr. Xi a
“dictator”. The leaders shook hands and strolled around a garden at a historic California estate during four-hour talks
aimed at preventing growing tensions between the world's largest economies from spiralling into conflict. They also
agreed that China would crack down on the production of ingredients for fentanyl, responsible for a deadly epidemic
of opioid abuse in the United States. But Mr. Xi and Mr. Biden remained far apart on the wider flashpoint of Taiwan,
with the Chinese President telling his U.S. counterpart to stop arming the island, and that reunification was
“unstoppable”.

The two leaders had not met in person since they held talks in Bali in November 2022, and relations nosedived after
the United States shot down an alleged Chinese spy balloon in February this year. But Mr. Biden told a press conference
at the Filoli estate that his talks with Mr. Xi, whom he has known since 2011, were “some of the most constructive and
productive discussions we’ve had”. The United States would compete "vigorously" but "responsibly" with an
increasingly assertive China "so it doesn't veer into conflict or accidental conflict," Mr. Biden said. The separate move
to restore high-level U.S.-China military-to-military communications, which China severed after the then-U.S. House
Speaker Nancy Pelosi visited Taiwan in 2022, was "critically important" to avoid possible conflicts, Mr. Biden added.

The two sides also agreed to hold talks on Artificial Intelligence, and to deepen cooperation on climate change ahead
of the COP28 conference in Dubai next month. But a day of painstakingly choreographed diplomacy ended with a not-
so-diplomatic remark as Mr. Biden walked offstage after his press conference. Diplomats had spent months trying to
get the talks to happen, and then arranging the smallest details at the exclusive estate, which featured in the U.S.
television soap opera Dynasty in the 1980s. Mr. Xi said, "I believe that once the door to China-U.S. relations is opened,
it will not be closed again," he said. "China is ready to be a partner and friend of the United States."

The carefully cultivated symbolism of the day saw red carpet handshakes, delegations sitting on either side of a huge
table, culminating with Mr. Biden and Mr. Xi taking the air in the grounds. They also shared a working lunch of herbed
ricotta ravioli and tarragon chicken with gold rice pilaf. Xi and Biden waved at reporters during their garden walk, and
Biden had raised two thumbs up when asked how the talks went. The Chinese leader had earlier warned that “turning
their back on each other was not an option”, and said that “Planet Earth is big enough for the two countries to
succeed.” Mr. Biden and Mr. Xi also discussed the wars in Gaza and Ukraine, on which their countries have found
themselves backing opposing sides.

But Mr. Xi also had tough words for Biden after the talks, particularly on the subject of Taiwan. "The U.S. side should...
stop arming Taiwan, and support China's peaceful reunification," Mr. Xi told Mr. Biden, according to a readout from
China's Foreign Ministry. "China will realise reunification, and this is unstoppable," he added. Mr. Xi nevertheless
insisted in a later speech to business leaders that Beijing did not want confrontation with anyone. Russia, a partner of
China in what Washington sees as a growing authoritarian alliance, welcomed the meeting, with the Kremlin calling
the talks “important for everyone”.

[Extracted, with edits and revisions, from: "Biden, Xi restore military ties but remain apart on wider flashpoint of
Taiwan", The Hindu]

Source: https://www.thehindu.com/news/national/biden-xi-restore-military-ties-but-remain-apart-on-wider-
flashpoint-of-taiwan/article67541390.ece
Key points:

• The United States' Concerns About China:

o Human Rights Violations: The United States expressed alarm about human rights violations in Xinjiang (Uighur
Muslims), Tibet, and Hong Kong.

o Trade War: In 2017, the United States' trade imbalance with China was approximately USD 375 billion. As a
result, former US President Donald Trump placed tariffs on Chinese goods to the US.

o Free and Open Indo-Pacific: China's assertiveness in the South China Sea, where it claims the bulk of the sea
as its domain, has forced the US to emphasise the importance of free navigation and safe overflight to the
region's prosperity.

o Taiwan: The United States is still committed to the 'One China' policy. On the other hand, it "strongly
opposes unilateral efforts to change the status quo or undermine peace and stability across the Taiwan
Strait".

• China’s Concerns About the United States:

o Alliances and Groupings: China has expressed reservations about US-led alliances and coalitions. China
believed that these alliances caused "divisions" in the world.

o Competition for Dominating World Finances: China has established alternative financial institutions such as
the AIIB and the NDB to compete with the US-dominated IMF, World Bank, and WTO.

• US-India-China Relations:
o US Helping India address disputes with China: The US intends to assist India in addressing continental
concerns such as the border dispute with China through military, diplomatic, and intelligence channels.

o US Supports India's reservations against Belt Road Initiative: The United States demands open infrastructure-
debt practises in countries experiencing debt as a result of Chinese assistance under the Belt Road Initiative.

o Balancing China: The US supports a strong India, working with like-minded countries, to act as a
counterbalance to China in the critical Indo-Pacific area.

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