In early 1976 I got my first job. It was in a publishing house. I was appointed as what is now called a commissioning editor. My remit was economics and management. One important part of the job was to find authors who could write textbooks for undergraduates. This involved visiting universities all over India. It was the best part of the job. In those days management was a fledgling discipline in India. So the managing editor told me to pay special attention to it. That meant one trip each year to Bombay, Ahmedabad and Calcutta where the management institutes were located. And thereby hangs a tale.
Once, in Ahmedabad, I decided to also visit the university, rather than just the IIM, in case I found an author who would write a textbook in economics. I was in for a shock. The faculty members told me that they would write only in Gujarati. That was clearly out of the question because ours was a British company, very pukka. When I narrated this to our local representative, he laughed and told me what’s probably an apocryphal story.
He said he had once gone to a printing press to get something printed. There he found two gentlemen busily scribbling something on notebooks, tearing off the filled pages, and handing them to a man who took them to the compositors. There was an air of urgency because the university was to reopen in four days after the summer break and the book had to be ready by then. One of the writers, our man in Ahmedabad said, was the professor who would prescribe his own book, thus guaranteeing sales. The printer was also the publisher, so peer reviewing etc were not needed. It was a tidy arrangement in which everyone except the students benefitted. But who knows, maybe they did too.
I bring up this old story because it seems to fit modern, western pharmaceutical companies quite well. They produce a whole variety of drugs which they then proceed to get prescribed by creating well-designed media campaigns that ‘persuade’ doctors. The method is exactly like the one used for textbooks — prescription based. Like the students in the above story, patients have to accept whatever nonsense they are handed out. In the case of the textbooks, it was usually a whispering campaign by the professor himself. It was quietly rumoured by the author that those who used his book would get high marks and those who didn’t would get low marks — and could even fail. In the case of the pharmaceutical companies, the message is “this drug will cure your patients. If you don’t prescribe it, the consequences can be very dire.”
The modern drug equivalents of the textbooks are medicines for diabetes, high BP and triglycerides. These two ailments afflict huge numbers of people but in differing degrees. So the market is massive and, if a company can popularise its drug, it can make very big profits. And this is what’s happening. You have doctors prescribing drugs at the drop of a hat. They scare the patient into submission.
This happened to me recently because the doctor who did my annual checks not only prescribed some new medication, he also referred me to another doctor who also did the same thing. I went from three tablets to six taken in confusing combinations throughout the day. I got so confused on Day 1 that I have not consumed the new medicines after one, probably wrong, dose. I have preferred to take a risk like the students who chose to read Paul Samuelson’s classic textbook on economics rather than local textbook writers, Pervezbhai or Rasheedaben or, if they were really unlucky, both!