Over the last decade, I have been advocating for revamping drug regulatory laws in India. I have encountered much opposition in the process – some from the pharmaceutical industry and a lot more from public health activists working on access to medicine, many of whom look at quality and price as binaries in the context of our drug supply.
I hold no grudges against those with opposing viewpoints. Quite honestly, it makes the job more interesting. However, I do have a problem with the complete lack of disclosure by some public health activists engaging with the media on some of these issues.
Let me start with a We The People debate televised on NDTV on August 13 on the impact of the Jan Vishwas Act 2023 on public health.
The Jan Vishwas Bill was passed by Parliament earlier this month. I had earlier written on the issue for Newslaundry, explaining how the legislation made the manufacture of ‘not of standard quality’, or NSQ, drugs a compoundable offence. This means pharmaceutical manufacturers are now allowed to pay a fine of Rs 20,000 to avoid imprisonment of a minimum of one year and a maximum of two years under section 27(d) of the Drugs and Cosmetics Act, 1940.
My segment on NDTV was recorded in advance while the remaining participants appeared in real time. One of them was Mr S Srinivasan – the ticker on NDTV identified him as the co-convenor of the All India Drug Action Network, one of the more prominent collectives of public health activists in the country working on issues related to access to drugs and the pharmaceutical industry.
In his segment, Srinivasan, while acknowledging that the drug regulatory system in India has not kept pace with the growth of the pharmaceutical industry, defended the government’s move to make the offence of manufacturing NSQ drugs compoundable . He compared the offence to a non-serious traffic offence like a parking ticket as opposed to a serious traffic offence like “dashing against a cyclist”.
He said: “It is like this. If you’re driving a car and you get a parking ticket, then you’ll get a fine for say Rs 10 or Rs 15. But if that car goes and sort of dashes against a cyclist, you should get a bigger offence. But you can’t say a parking ticket and hitting the cyclist...should get the same punishment.”
What NDTV didn’t tell its viewers is that Srinivasan has run a pharmaceutical manufacturing unit called Low Cost Standard Therapeutics (Locost) for several years now. Here’s the kicker – Srinivasan and Locost have been convicted by a criminal court in Pune under section 27(d) of the Drugs and Cosmetics Act, which is the very provision made compoundable by the Jan Vishwas Act. A copy of the judgement can be accessed here.
It gets worse. Srinivasan and Locost were convicted for manufacturing a hypertension drug that contained only 45.8 percent of the active pharmaceutical ingredient. A drug with such little active ingredient can cause failure of treatment, leading to elevated blood pressure and, depending on the patient’s overall health, other complications. This is nothing like a traffic offence. (Note: They did not appeal against the decision.)
In short: Srinivasan runs a pharmaceutical manufacturing unit and was convicted under the very provision of law that was the subject of the discussion on NDTV. Should that have been disclosed to the audience?
I think it should, because it would have demonstrated to viewers that Srinivasan has a conflict of interest on the topic. I was asked by the NDTV producer to “provide us with your designation, which you want to mention with your name” prior to my recording. I presume Srinivasan was extended the same courtesy. I do not know if the blame for non-disclosure falls on NDTV or Srinivasan but I have noticed the same issue crop up with other media houses.
For example, The Hindu Business Line also quoted Srinivasan in its report on the Jan Vishwas Act, where he once again trivialised the health risks of NSQ drugs. While the report at least disclosed that he was affiliated with Locost, “a maker of inexpensive medicines”, there was no mention that Srinivasan was convicted under section 27(d) of the Drugs and Cosmetic Act.
The same reporter had reviewed my book – where I discussed Srinivasan’s conviction – for Business Line.
The problem does not end with Srinivasan. The same NDTV programme also featured Dr Anant Phadke, who was identified as a member of the Jan Swasthya Abhiyan, which describes itself as a “people’s movement working for health rights”. But Phadke, as per Locost’s disclosure, is also one of Locost’s trustees. Once again, NDTV made no mention of Phadke’s affiliation with a pharmaceutical manufacturing unit. This was a relevant disclosure because Locost, the legal entity, was also convicted in the case I referenced earlier. Trustees, depending on their level of involvement in operations, can also be convicted under section 27(d) – the provision under discussion on the show.
I do not know whether Phadke disclosed this information to NDTV but I do know that he never made any of these disclosures in his review of The Truth Pill, a book I co-authored, that he published in Economic and Political Weekly. In the review, Phadke did not disclose to readers that he’s named in the book in a section discussing the conflict of interest faced by activists like him and Srinivasan when it comes to drug quality issues because of the roles they play in Locost. The author description section in the EPW article does not disclose that he is a trustee of Locost or that Locost has been convicted for manufacturing NSQ drugs.
This is a vital disclosure because, in his review, Phadke took umbrage to the book’s criticism of lenient sentencing practices under section 27(d) of the Drugs and Cosmetic Act which, by the way, are not in line with precedents of the Supreme Court. It is a different story that EPW’s editorial board has not offered an apology or clarification or retraction despite being alerted to these issues.
On NDTV’s Hindi show Hum Log, for whom I had made a similar recording, the bias of the panelists was obvious. When the spokesperson for the Indian Drug Manufacturing Association said that the recent amendments were only for “sundry” violations, the audience could see for themselves that what he said was a bald-faced lie. Sadly, this level of bias is not always obvious when “activists” do not disclose their agenda.
It is healthy for voices with differing opinions to participate in public debate. The final outcome will be more measured and thoughtful. But it needs an honest disclosure of conflicts of interest when we advance certain agendas. We must strive to do better to enforce disclosure standards in the interest of transparency so that a reader can truly judge and evaluate our respective views and make an informed decision.
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