How to Milk a Cow in India: Reclaiming Gau-Seva from Gau-Rakshaks

Material economies that involve cattle – dairy, beef or leather – have always involved service, labour, love and violence.

Material economies that involve cattle – dairy, beef or leather – have always involved service, labour, love and violence.

A villager milks a cow in Rajasthan. Credit: Wikimedia Commons

In 2011, I had a conversation with Raju Arya, which got me thinking about what it means to love a cow – or any livestock animal – and how that bond is formed. Raju da was a Dalit man who lived in a village not far from Nainital, which I was visiting for my fieldwork on people’s relationships with animals in Uttarakhand’s mountain villages.

As we pored over the day’s newspaper in his courtyard, I spotted a report about the police intercepting three gau-taskars (cow smugglers) with the aid of a few young men who had tipped them off and prevented a riot. Uttarakhand was an early adopter of legal cow-protection, having passed a law in 2007 that forbade the slaughter of cattle, the consumption or possession of beef and the transportation of cattle across state lines. Long before contemporary cow-protection came to occupy the national imagination, the news in Uttarakhand was rife with reports that Hindu youth were committing themselves to the task of protecting the gaumata at any cost.

Raju da, however, was unimpressed by the description of how these young men – who were members of a Sangh parivar organisation – had orchestrated the rescue.

“These laundas have too much empty time on their hands,” he grumbled. “I had an altercation with one of them once.”

“What happened?”

“We sold our Jersey to a man from the Bhabhar. And then suddenly this boy comes out of nowhere and starts shouting at us, saying that we are shameless because we sold Bindu to a taskar (smuggler).”

Raju da’s eyes flashed as he recalled being berated by an upper-caste man half his age. The proto-gau-rakshak had accused Raju da not just of breaking the law, but also of flouting his dharam, his religious and moral code. “He said that those who serve the cow don’t sell her body. But what does he know about seva?” Raju da asked. “We served Bindu well for seven years. My wife neglected her own health as she raised our cows. All day was spent in cutting oak, cutting grass, removing gobar. We cared for these animals like our own children, and woh bhi hame accha maante the (they liked us too).”

Raju da raises a difficult but important question: who decides what it means to serve and love a cow? The stakes of addressing this question cannot be overstated, at a time when accusations of inflicting harm upon cows – no matter how flimsy – can lead, at best, to flogging and arrest, or at worst, to murder. Recent commentaries on what some are calling gauntankwad (cow terrorism) have paid little attention to how gau-rakshaks are narrowing popular understandings of what acts of caring for, serving and loving cows should look like.

In public pronouncements, gau-rakshaks declare that one cannot both care for a cow and treat her as a material asset who can be sold for meat and leather once she has stopped giving milk. The historian Tanuja Kothiyal pointed out that contemporary gau-rakshaks have no stakes in the cattle-rearing economy, and produce an artificial separation between the sacred and economic. Gau-seva or cow-ethics are thus incompatible with cow-economics in the gau-rakshak’s worldview. For them, to protect and serve a cow is to reject the cow market.

The majoritarian violence at the heart of contemporary cow-protection increasingly relies upon a discourse of animal rights and nature conservation to legitimise itself in the public sphere. The recent celebration on social media of Yogi Adityanath’s vegetarianism and his proclaimed love of animals – ranging from tigers to dogs – is an apt example of the success (and dangers) of such projects of legitimisation. The recent case in Delhi in which a group of men claiming to be animal-rights activists beat up three Muslim youth for transporting buffaloes – the animal-rights organisation disowned any connection with them, saying they were “volunteers” – also reveals the complicated connections between Hindu nationalist cow-protection and global discourses of animal ethics. Reclaiming everyday acts of care and love for cows from the suffocating embrace of the Hindu Right is an urgent task if the ongoing violence in the name of gau-mata is to be challenged.

In my forthcoming book, I explain how the connections between labour, care and love for animals are at the heart of ongoing battles between gau-rakshaks and villagers in Uttarakhand. In the summer of 2016, I had a telephone conversation with Pratap Pant (pseudonym), who worked for the Uttarakhand branch of a national cow-protection organisation which is currently agitating for a national death penalty in criminal cases involving cattle slaughter. When I asked Pant why the organisation favoured such severe punishment, he responded that love for animals, especially the cow, was enshrined in Hinduism. “Our Vedas tell us that serving a cow is an act of the greatest merit,” he said passionately. “Gau-seva is an act of greater merit than serving your own parents. Serving the cow is serving the nation.”

The organisation’s target, Pant went on to tell me, was people who did not love and care for cows – “those who sell her to butchers, those who cut and kill her, those who trade in her flesh and meat”. As far as Pant was concerned, Muslims, Dalits, and even upper-castes who traded in the cow, were incapable of caring for or loving the cow because they viewed her as an object of material gain.

Such claims were resisted by villagers who were often at the receiving end of violence by gau-rakshaks. The people I spoke with insisted that the labour they performed in caring for animals, and the labour these animals did in turn by providing milk and gobar, created ties that were powerful precisely because they emerged in the crucible of value. Raju da and his wife Kamla bhabhi (pseudonym), for instance, said their decision to sell Bindu had not been easy, especially because she had nourished their family for so many years. Kamla mentioned repeatedly that she had devoted more time to her cows than her children, and that the cows were like her children because of the strength of her bonds with them. The deep affection they felt for Bindu was unmistakable. Caring for Bindu had clearly been a labour of love for this family.

Importantly, this love, which was rooted in a seva as devoted and careful as that of any gau-rakshak (if not more), could only emerge in the daily context of a material economy in which the cow was a key asset for poor rural families. For people like Raju da, Kamla bhabhi, and many others, love, service and economics were inextricably bound up with one another. People’s experiences from other parts of India bear out this connection. In the wake of Pehlu Khan’s murder in Rajasthan, Muslim dairy farmers from the region are protesting the claims of gau-rakshaks that Muslims can only relate to the cow as smugglers and butchers. On the contrary, as a journalist recently reported, these farmers serve the cow better than most gaushalas precisely because she is such an important part of their sustenance.

The separation between ethics and economics is at the heart of two narratives of purity offered by the Hindu right. The first is that cow milk is a pure, uncommodified substance – given unconditionally by cows – that forms the basis of Hindu kinship with gau-mata, who is represented as akin to the human mother nourishing her children without expecting anything in return. The second, related narrative, is that a pure Hindu nation, united by its service and reverence for the cow as a mother, is one that excludes Muslims and Dalits.

These public narratives conceal the real tension between the gau-rakshaks’ valorisation of the cow as kamadhenu (giver) – as well as the associated push by the government for a White Revolution through dairy development – and their rejection of the beef and leather economies that, in large part, derive from the dairy industry in India. Gau-rakshaks pay little attention to the ethical and environmental critiques of dairy development that are forming across the world, and insist that dairy is an ethical industry while beef and leather are not. Indeed, the irony is that gau-rakshaks idealise the figure of the dairy farmer who in practice breeds cows repeatedly, often through unnatural means (artificial insemination), in order to ensure a steady stream of milk to sell to dairies. Despite these contradictions, gau-rakshaks frame their violence as an act of ethical intervention on behalf of cows.

At a time when the narrow framing of gauseva legitimises majoritarian violence across the country, reclaiming the right to define animal ethics from gau-rakshaks is ever more urgent. Material economies that involve cattle – whether dairy, beef, or leather – have always been characterised by service, labor, love and violence. The false boundary gau-rakshaks construct between the material and the ethical is transgressed in the course of everyday relationships between people and the livestock animals they care for.

Radhika Govindrajan is an assistant professor of Anthropology at the University of Washington, Seattle. Her forthcoming book Animal Intimacies: Interspecies Relatedness in India’s Central Himalayas (2018) was awarded the Edward Cameron Dimock Prize in the Indian Humanities by the American Institute of Indian Studies.

As India’s New Bilateral Investment Strategy Sputters out, the Secrecy and Opaqueness Must Go

India’s opaque approach and practice to BITs undermines the right of ordinary citizens to be informed about these critical issues

India’s opaque approach and practice to bilateral investment treaties undermines the right of ordinary citizens to be informed about these critical issues.

India’s mass termination of BITs is problematic for many reasons. Credit: Reuters

In July 2016, the Narendra Modi government informed parliament that India planned on terminating the bilateral investment treaties (BITs) it had signed with 58 countries. Reportedly, India’s BITs with these 58 countries were allowed to expire on April 1, 2017. The reason behind the termination is that India wants to renegotiate its investment treaties based on India’s new model BIT.

As I’ve pointed out, this mass termination of BITs is problematic for three reasons.

First, till the time new BITs are signed, new foreign investment, either from these 58 countries to India or Indian investment to any of these 58 countries will not enjoy treaty protection under international law. This termination, in turn, will make foreign investment more vulnerable to regulatory abuse.

Second, most developed countries such as EU member states, Canada and the United States have reservations about India’s new model BIT for a number of reasons such as absence of a most favoured nation (MFN) provision, and the requirement to exhaust local remedies at least for a period of five years before an investor could commence international arbitration proceedings against the host state. Due to these differences, the possibility of having new BITs is bleak till one of the parties blink.

Third, some in India believe that BITs do not have a positive impact on foreign direct investment (FDI) inflows and thus play-down the termination of BITs by India. However, two empirical studies question this wisdom and show that BITs have had a positive impact on FDI inflows in India. The first study examines the impact of BITs on FDI inflows in 15 Asian developing countries including India from 1980-81 to 1999-2000 and concludes that India’s BITs with developed countries had a stronger and significant impact on FDI inflows. The second study considers the impact of BITs on FDI inflows in India from 2001-2012 and concludes that BITs signed by India contributed to rising FDI inflows in the said period by providing protection and commitment to foreign investors.

In addition to these three issues, the termination of BITs raises another important issue not adequately discussed – a lack of transparency in India’s approach to BITs. One can divide the problem of lack of transparency into three parts: first, the lack of transparency related to BIT termination; second, the lack of transparency associated with BIT claims brought against India; third, the lack of transparency in the handling of the Model BIT and related developments.

BIT termination

India’s recent mass termination of BITs is shrouded in secrecy. The ministry of finance, which is the nodal body dealing with BITs, does not provide any information on the termination of these 58 BITs. Does it include countries vis-à-vis whom India is a capital importer or a capital exporter or both? Also, the exact date of termination is not known. The government needs to answer why these BIT termination notices not been made public? Bizarrely, a list of BITs signed by India, given on the website of the finance ministry, has not been updated since December 2013.

BITs are international treaties that document a country’s obligations on the protection of foreign investment under international law. Thus, the public at large has a right to know the names of countries whom India owes these international law obligations and vice-versa.

Also, there is no information about whether the government plans to terminate BITs it has signed with 25 other countries. The only information that’s available about BITs with these 25 countries is that India has decided to sign joint interpretative statements regarding the interpretation of BITs with these 25 countries.

At the beginning of 2016, India decided on signing a joint explanatory note, and the ministry of external affairs was asked by the finance ministry to relay this information to these 25 countries. Interestingly, this information and the interpretative note are available on the website of the MEA not on the website of the finance ministry. Furthermore, no information is available whether any of these 25 countries have signed or shown interest in signing these joint interpretative statements.    

BIT claims

There is also a complete lack of transparency regarding the BIT claims that have been brought against India. One can gather from media reports that India is currently battling 20 odd BIT claims, in different international arbitration forums, for regulatory measures ranging from the imposition of retrospective taxes to cancellation of telecom and spectrum licenses. However, the website of the finance ministry does not contain any BIT notice served to India by any foreign investor. Consequently, no information is available on which are the companies that have brought these claims, why have these claims been brought, at what stages each of these claims are, what amount of damages have been claimed, etc.

There is also conspicuous silence about the two BIT awards that have been issued against India – White Industries v India and Devas Multimedia v India. Are there justifiable reasons not to make these awards public? If so, what are they? The government of the day needs to answer these questions.  

BIT disputes involve adjudication of sovereign action by an international tribunal and are not commercial arbitral disputes. For example, Vodafone, under the India-Netherlands BIT, has challenged the imposition of retrospective taxes that emanate from the retrospective amendment of the Income Tax Act by the Indian Parliament. If the arbitral tribunal finds the imposition of such retrospective tax a violation of India’s obligation under the BIT, it will amount to an indictment of exercise of the public power of the Indian state. Furthermore, if the investor succeeds in a BIT claim, as it has already happened in White Industries and the Devas Multimedia cases, then the government will have to pay damages to the foreign investor. These damages would have to be paid from the Indian tax-payer’s money, and thus the government is under an obligation to keep the Indian public informed by providing and updating information about these cases.  

Many Indian investors have also brought BIT claims against other countries, such as Flemingo Duty Free v Poland, demonstrating the significance of BITs for Indian investors. However, the finance ministry also does not provide any information about any of these BIT claims.  

Mishandling of model BIT

The Indian government has also not handled the notification of the Indian model BIT properly. It is important to bear in mind that India released a draft model BIT in early 2015 for comments. However, no information is available as to what processes were followed to adopt this draft model BIT? Was the draft model BIT merely an outcome of internal bureaucratic discussions within different ministries of the government or were public consultations held with stakeholders and domain experts? If yes, who were these domain experts?

After releasing the draft model BIT, India adopted a final version of the model BIT in December 2015-January 2016. However, the draft version continues to be available online without the word ‘draft’ being mentioned in the text anywhere. In most internet searches on ‘Indian Model BIT’ it is the draft version that continues to appear as the first result. This has created considerable confusion in the international community about the correct version of India’s Model BIT, and thus about India’s stand. The government should either remove the draft version or add the word ‘draft’ in the text.    

Another critical issue about which little information has been made available by the finance ministry is the report of the Law Commission of India (LCI) on the draft model BIT. The LCI in its 260th report, submitted to the-then law minister in August 2015, provided detailed comments on the ‘draft’ Indian Model BIT. However, there is no information available whether the finance ministry, while finalising the Indian model BIT, considered the recommendations made by the LCI in its 260th report. If yes, then to what extent, and if not, why? The press release issued on December 16, 2015 for the final model BIT, for example, does not mention anything about the LCI report.

This is a particularly valid question to ask because, as the text of the final model BIT shows, many recommendations made by the LCI, such as on the inclusion of a limited MFN clause and alternative drafting of the expropriation provision were not incorporated in the final model BIT.  

In sum, India’s opaque approach and practice to BITs undermines the right of ordinary citizens to be informed about these critical issues. This opaqueness is also baffling when juxtaposed with Prime Minister Modi’s ‘quest for transparency’ and the claim that transparency is a cornerstone of a pro-poor government.

These words need to translate into action and extend to India’s approach and practice on BITs.

Prabhash Ranjan is an assistant professor of law at the South Asian University and was part of the committee that drafted the 260th LCI report. He was also invited by the finance ministry to offer comments on the draft Indian model BIT. The views expressed here are personal.

Informal Labour, Another Wall Faced by Migrants in Latin America

A large proportion of the 4.3 million migrant workers in Latin America and the Caribbean survive by working in the informal economy or in irregular conditions.

A large proportion of the 4.3 million migrant workers in Latin America and the Caribbean survive by working in the informal economy or in irregular conditions.

File Photo: A general view shows a newly built section of the U.S.-Mexico border fence. Trump’s determination to build a wall to keep out migrants has people worried. Credit: Reuters/Jose Luis Gonzalez/File Photo

Lima: A large proportion of the 4.3 million migrant workers in Latin America and the Caribbean survive by working in the informal economy or in irregular conditions. An invisible wall that is necessary to bring down, together with discrimination and xenophobia.

“Looking for work is just one of the causes, but not the only one, or even a decisive one,” said Julio Fuentes, president of the Latin American and Caribbean Confederation of Public Sector Workers (CLATE). “I believe the determining factors driving migration are poverty, low wages, lack of access to health and education services and the unfair distribution of wealth in our countries.”

The study “Labour migration in Latin America and the Caribbean,” released in August 2016 by the International Labour Organisation (ILO), identifies 11 main migration corridors used by workers throughout this region, including nine intra-regional, South-South corridors that connect countries in the region, and two extra-regional South-North corridors connecting with the US and Spain.

According to the report, this network is constantly evolving due to changes in economic interdependence and labour markets, and has been expanding in volume, dynamism and complexity, growing from 3.2 million migrants in 2011 to 4.3 million at the start of 2016.

Denis Rojas, a Colombian sociologist with the Latin American Council of Social Sciences (CLACSO), mentioned from Buenos Aires other intra-regional migratory causes based on the experience of her compatriots in Argentina.

“It is necessary to bear in mind that the migration to Argentina seen in the past few decades is of different types: one well-identified group is that of generally middle-class professionals, who in view of the high costs and the constraints of access to postgraduate education in Colombia, decide to look for other options abroad, with Argentina being a country of interest due to its wide educational offer and accessible costs in comparison with Colombia,” she told IPS.

Moreover, “several years ago, the number of families sending their children to study in Argentina started increasing due to the high tuition costs in Colombian universities and extensive structural limitations to access education. It is similar to the case of Chile,” she said.

But although the main driver of this current of migration is access to education, Rojas doesn’t rule out labour causes.

“It responds fundamentally to Colombians’ need to enter the labour market. Due to the unemployment and a pervasive flexibilisation of labour standards, people believe that a higher level of education will give them a chance for a better income and better jobs,” she said.

Another group of migrants, she said, are those who were driven out of their homes by Colombia’s armed conflict. They range from poor peasant families and labourers to students and better-off activists.

“Insertion into the labour market depends in this case on the existing support networks,” she stressed.

The ILO points to several common labour-related aspects in these migration flows, which are important to note on International Workers’ Day, celebrated on May 1st.

Map of the 11 main migration corridors in Latin America and the Caribbean: nine South-South intra-regional and two North-South towards the US and Europe. Credit: ILO

It mentions the “feminisation” of labour migration, with women accounting for more than 50% of migrants; the high proportion of irregular and informal migrant workers and the low access to social protection; and the frequently deficient work conditions as well as the abuse, exploitation and discrimination faced by many migrant workers.

This is the case of a 35-year-old Peruvian migrant to Argentina, identified as Juliana, who was originally from the department of Arequipa in southern Peru.

To pay for her university studies, she worked five years as an unregistered domestic worker.

“At that time it was the only kind of work we could aspire to as foreigners with no contacts and often without the necessary papers. Back then, there was no immigration law as we have today, and it was very difficult to find something better. It took me three years to get my national identity document,” recalls Juliana, who is about to become a lawyer.

Pilar, a 34-year-old Colombian who has been in Brazil for eight years, mentioned a problem faced by many other migrants: they can only get jobs for which they are overqualified. Although she has a university degree, she had to work in a hostel without a contract or labour rights.

She chose Brazil because in her country higher education is expensive and “Brazil, with its free public education, is like a kind of paradise for many Colombians.”

“Many of the young Latin American migrants in Río de Janeiro end up being absorbed by the tourist market. I had no working permit the first few years and I would take whatever work cropped up. I would work over eight hours, with barely one day off a week, and they paid me less than minimum wage,” she said.

In Brazil as well as Argentina, Bolivians work in large clandestine textile sweatshops in near-slavery conditions, a reality that is repeated among migrants in different sectors and countries.
The ILO study points out that there are also migration corridors to other regions. Of a total 45 million migrants in the US, more than 21 million are Latin American. In Spain, nearly 1.3 million foreigners living in the country are South American.

“The exploitation of Latin American and Caribbean immigrant labour by the central powers is another side of our dependence; they not only plunder our natural resources, but we also provide them labour, which is overexploited. Generating poverty conditions in our region, or in others such as Africa, allows the central powers and their multinationals double benefits: natural resources and cheap labour,” CLATE’s  Fuentes told IPS.

He is worried about the tightening of US immigration policies and the threat of building a wall along the border with Mexico.

“No wall can keep out people seeking to leave behind the poverty to which they have been condemned,” Fuentes said.

“Latin Americans seeking a better life in the US undertake a terrifying journey, which costs the lives of many, and those who reach their destination take the worst jobs, with low wages and more precarious working conditions,” he said.

“They make an enormous contribution to the US economy, but never get to become citizens and are forced to always live as undocumented immigrants,” he said.

This year the annual International Labour Conference, which sets the ILO’s broad policies, will meet June 5-17 in Geneva, Switzerland, with a focus on migrant worker’s rights. CLATE will launch a campaign targeting public employees working in government agencies linked to immigration, to “put a human face on border posts”.

“As unions, we also have to represent those migrant workers whose irregular migratory situation is used by employers to get around labour legislation, subjecting migrants to more precarious conditions, and abusing the possibility of temporary employment,” said Fuentes.

“Those who don’t have a right to citizenship will always be victims of abuse. As trade unions, we must combat the idea that migrants compete with local workers. We have to accept that we are all part of the same class, which knows no borders,” he said.

 (IPS)

Quality, Not Price, is the Key Issue When Prescribing Generic Drugs in India

In the absence of a standard drug regulatory mechanism, Indian doctors rely on the reputation of companies who have demonstrated their commitment to quality over time.

In the absence of a standard drug regulatory mechanism, Indian doctors rely on the reputation of companies who have demonstrated their commitment to quality over time.

Prime minister Narendra Modi’s speech has triggered a debate on the merits of branded drugs over generics. Credit: Toni Blay/Flickr CC BY-NC-ND 2.0

The merits of branded drugs versus generic drugs has attracted heated debate among physicians, pharma professionals, media and healthcare activists after Prime Minister Narendra Modi’s speech in Surat, where he talked about bringing a law to ensure that doctors must prescribe only generic names of drugs so that patients can access cheaper versions of branded drugs.

Global standards on generics

It is necessary to understand the distinctions between branded drugs and generics, because the nuance is quite different in the Indian context. According to the USFDA, “A generic drug is approved only after it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity, and potency. All generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs. The generic drug manufacturer must prove its drug is the same as (bioequivalent) to the brand name drug. For example, after the patient takes the generic drug, the amount of drug in the bloodstream is measured. If the levels of the drug in the bloodstream are the same as the levels found when the brand name drug is used, the generic drug will work the same.”

From the above, it is clear that the only difference between a brand name drug and a generic is that brand name drugs are very expensive, while generics are far cheaper and are sold by just the pharmaceutical salt name. This is true for brand name drugs and generics in most developed countries. In the West, brand names are given to researched and patented first-in-market innovator drugs. After the expiry of patent period, other companies launch generics of the innovator drug with just the pharmaceutical salt name at a hugely discounted price. So, the only difference between a brand name drug and its generic version is the price.

The term ‘branded generic’ is an Indian creation, an oxymoron and jugaad for Indian pharma’s effort to distinguish its generics from the generics of other companies.

Branded generics – a question of quality and trust

The issue in India is not about expensive brand name drugs versus cheaper generics, as in the West, but one of quality drugs versus suspect quality drugs. Branded generics are also generics with a brand name, plus the quality assurance from well-known companies like Cipla, Sun or Dr Reddy’s. Doctors have come to trust these companies and their brands over time. Indian pharma’s field force numbering nearly one million medical representatives have done a good job of building this trust in their companies and brands. It is simply not possible for doctors to transfer this trust to generics, manufactured by unknown companies. And in most cases, the so called generics are also sold with a brand name – the only difference being that these brand names are not widely promoted or publicised. So, if a doctor prescribes a drug with just the pharmaceutical salt name, then in all probability, the chemist will dispense it with another branded generic or worse, with a generic drug of doubtful quality.

The entire issue of cheaper generics is based on the premise of measurable and enforceable assurance about quality through bioequivalence tests and other globally mandated parameters. In the absence of that, the generics-only diktat is a non-starter. In the absence of an international standard drug regulatory mechanism like the USFDA, Indian doctors have to rely on the reputation of companies like Cipla, Sun and hundreds of others who have demonstrated their commitment to quality over time and become trusted names in the eyes of doctors and patients.

Also, Indian branded generic companies have been innovative in terms of drug delivery systems to improve absorption, reduce side-effects, thereby increasing the efficacy of the drug. These novel drug delivery system (NDDS) drugs are available in all category of drugs from ordinary mouth dissolving pain-killers for quick results to complex diabetes drugs that are released into the blood in a steady stream to ensure better blood-sugar control with lesser chances of hyperglycemia – one of the dangerous complications of taking diabetes medicines. All generics are simply not equal when it comes to NDDS drugs. According to Puneet Dhamija, department of pharmacology, AIIMS Rishikesh, these drugs are more complex than those used in other fields of medicine. For example, diabetes drugs like Metformin-sustained release and gliclazide modified release (MR) have attributes, which are completely different from immediate release formulations.

Every specialty – from respiratory medicine where doctors treat asthma to neurology where doctors treat epilepsy – routinely use drugs with different NDDS for the additional benefits it offers their patients. Branded generics with NDDS are very useful in personalising the treatment for various types of patients. There are millions of asthma patients who depend on metered-dose inhalers of Cipla or GlaxosmithKline to manage their chronic condition. A poorly qualified and ill-trained chemist will not be able to make the distinction to dispense these highly differentiated inhalers through a generic prescription. Branded generics ensures that patients get the correct medicines. This aspect of NDDS in branded generics must be kept in mind while mandating generics-only prescriptions.

Institutional safeguards

Since the issue is about quality, the government must put in place reforms that will make it mandatory for drug manufacturers in India to adhere to globally accepted standards. Only recently, the government has put out a statement to the effect, “The union health ministry is in the final stages to release a draft guideline towards enhancement of good manufacturing practices (GMP) to align India-specific standards with global regulations for better product quality of pharmaceutical products. Meanwhile, the drug controller general of India has also submitted a proposal to the Union health ministry to mandate upgradation of Schedule M drug manufacturing units to WHO-GMP level under the purview of drug rules towards good manufacturing practices adopted globally.”

This process of issuing guidelines and enforcing them could take years and decades, going by past experience. The government must sit down with all stakeholders to discuss the issue and roll-out a time bound plan to make generic prescriptions mandatory over the next three to five years. This will give the necessary time needed by all stakeholders from industry to doctors, retailers and patients to get used to the new system. For example, the government can roll-out a generics-only plan for one group of drugs like analgesics (pain-killers) and see how it works and learn from it and progressively roll-out for all other group of drugs. I mentioned analgesics, because it is prescribed by all groups of doctors from general practitioners to super specialists.

The solution to the problem of branded versus generic lies in strengthening the existing drug regulatory and quality control structure. The strategy can be two pronged with an increase in the capacity of existing testing laboratories and opening up of new laboratories in government colleges. Pharmacology departments of existing medical colleges can play a big role in this direction, according to Dhamija and co-authors in their article, ‘Only generics: Is India ready?’

India can also learn a lot from similar generics roll-out experiences in Europe and Latin America.

Serving the interest of patients

A time bound plan to make generic prescriptions mandatory will also prepare Indian pharma’s vast supply chain of 800,000 wholesalers and retailers to get used to the new initiative progressively. India’s 800,000 retailers have thrived because it is a profitable high-margin business. Whether branded-generics or unbranded generics, they stock and sell drugs only if they are profitable. These 800,000 retailers have repeatedly demonstrated their intolerance for any interference in their business by going on strikes and holding patients to ransom till their demands are met. Their collective power through the All India Organisation of Chemists and Druggists (AIOCD) ensures that India’s mighty pharmaceutical industry quietly gives in to their demands. In fact, the Competition Commission of India has in 2013, slapped a fine on AIOCD and directed it to cease from unfair trade practices that restrict supply of medicines.

Long before the Medical Council of India (MCI) decree to write generics, these 800,000 retailers have been selling unbranded generics at margins as high as 1000%. Expecting these 800,000 retailers to suddenly transform and become charitable dispensers of low cost generics like Jan Aushadhi, shows a complete lack of understanding how the system works.

As things stand, pharmacists at retailer counters are ill-equipped to dispense generics accurately. The government must explore ways of educating and certifying retailer-pharmacists as community pharmacists in partnership with pharmacology and community medicine departments of medical colleges. In the West, community pharmacists are the most accessible health professionals to the public. They dispense medicines and counsel patients and answer queries at the time of dispensing drugs. Community pharmacists are the necessary link between the physician and the patient to address the concerns of patients related to medicines.

Finally, patients in whose interest the generics-only reform is being rolled out will be in a better position to understand the nuances of generic medicines and exploit the benefits, if they are educated over a period of time instead of a sudden switch from their regular medications of branded generics, which they have been talking for many years.

The MCI order on generics

Without a well thought-out plan, which is made operational over a period of time, the generics-only diktat has caused nothing more than pandemonium. The prime minister’s intention of curbing the pharma-doctor nexus has been brought to naught by MCI’s ambiguous framing of its order and the Indian Medical Association’s (IMA) clever manipulation of words. The IMA has interpreted the MCI order on generics as voluntary, and issued a detailed guideline that essentially says, “Nobody can stop doctors from choosing a company or brand for quality assurance.”

Indian pharma can breathe easy for some time although the ominous, generics-only Damocles sword is bound to keep the industry on tenterhooks and give pharma business leaders sleepless nights for some more time. Only a time-bound health policy covering all aspects of healthcare can address these issues in a holistic manner.

Anup Soans is editor of MedicinMan.net and formerly the executive director of Indian Journal of Clinical Practice.