ANIL PILGADKAR

India,

Consumer health advocate Anil Pilgaonkar is working to ensure that Indian consumers have access to practical, unbiased, medically sound information about the drugs they are asked to take that will allow them to assess the need, proper use, possible risks or side effects, and fair costs of the myriad formulations available.

This profile below was prepared when Anil Pilgadkar was elected to the Ashoka Fellowship in 1992.

INTRODUCTION

Consumer health advocate Anil Pilgaonkar is working to ensure that Indian consumers have access to practical, unbiased, medically sound information about the drugs they are asked to take that will allow them to assess the need, proper use, possible risks or side effects, and fair costs of the myriad formulations available.




THE NEW IDEA

Anil wants to make patients active partners in protecting their own health by offering them the practical information they need to challenge the monopoly of knowledge the manufacturers and doctors currently hold. Given the necessary information, ordinary men and women without special medical or scientific training can exercise good common sense and judgment about illness, treatment, and the needs of their own bodies. Even illiterate or marginally educated people can do so, but doctors and drug companies treat even highly educated patients with astonishing condescension rather than share information respectfully.

Working with a team of skilled researchers organized in his People's Drug Information Center (PDIC), Anil will collect and disseminate clear, sound fact sheets on 1,100 of the most commonly prescribed drugs in India without advocating for or against them. Included will be directions for proper use, a complete list of all known side effects, relevant research data, descriptions of the diseases for which the drug is prescribed, a list of all components, and directions for dealing with an overdose or a missed intake.

In addition to distributing the fact sheets to consumers, Anil will also make the information available to all interested health care providers, thereby achieving a twin goal: reducing the medical establishment's near total reliance on the drug industry for information of all new and existing drug formulations. With Anil's fact sheets in hand, health care professionals may be more inclined to rethink their treatment strategy, concentrating on a patient's essential needs rather than fancy packaging or miraculous cures promised by the drug manufacturers.




THE PROBLEM

India has the world's largest number of drug formulations for sale, numbering nearly 60,000. The large majority are nonessential (the World Health Organization lists only 277 drugs as necessary or very important in medical treatment), yet they are widely distributed by foreign and Indian drug companies, eager to take advantage of the large Indian market.

Doctors are often inclined to prescribe these new formulations, either as a result of slick marketing campaigns or because they receive free or highly subsidized supplies by companies eager to have their products used - and reused. Reliable, lifesaving or pain-reducing formulations do enter the market and provide benefits to many seriously ill people. Yet, large numbers of new drugs that are not critical to the maintenance of health or life continue to be prescribed. The losers in this cycle are almost always the consumers, with the result that profits accrue to drug companies and perks to doctors; the ordinary citizen loses control of the treatment of his or her illness.

Currently, consumers must rely on the information distributed by the drug industry, which often (legally) brushes over adverse effects, provides overly complex technical data, and does not communicate directions for the medication's proper use clearly. Drug information in India's regional languages is scarce to nonexistent.

Patients and their families consequently often make unnecessarily enormous financial sacrifices to pay for prescription drugs or, equally harmful, do without. Traditional and homeopathic remedies, even where their curative powers are better suited to the illness, now are often pushed aside as mere folk wisdom in favor of "new" and powerful allopathic "wonder drugs" - another cost of ill-informed patients.




THE STRATEGY

Anil will continue to collect textbook medical information on his 1,100 target drugs, field-testing the fact sheets when a critical mass of 700 formulations has been documented. The unbiased information is collected from standard textbooks and medical manuals, as well as from published scientific research. Thus far, 250 drugs have been researched. In addition, prototype fact sheets have been developed in order that large-;scale field trials can begin. Before the materials are disseminated, a panel of medical experts will be convened to review their accuracy and potential value to patients.

Anil and his team hope to receive a great deal of feedback from medical practitioners and patients. This will help them know how best to improve the fact sheets. Revised versions will then be disseminated through the large network of citizen organizations working on health issues throughout India. These citizen organizations will, in turn, make them available to local groups and individuals with which they work. Anil will ask the citizen organizations for a minimal fee (perhaps one rupee, or about three cents, per sheet) believing that anything received for free is undervalued. Fact sheets will also be distributed to doctors and other health care professionals.

The initial fact sheets will be in English. Distribution will first be concentrated in the North and around major cities like Bombay and Calcutta. Eventually, the fact sheets will be translated into regional languages and dialects, and tailored for a variety of literacy levels. The actual translation, printing, and distribution of fact sheets will be handled by the citizen organization network wherever possible, but PDIC will be prepared to undertake these tasks when either the funds or infrastructure is not available at the local level.

Over the next several years, Anil plans to expand his outreach throughout India. He and his team are refining software that would make their information available, online, to citizen organizations, research institutions, universities, and libraries with computers. Periodic updates and refinements could then be produced and distributed on computer for a minimal cost.

After the initial phase, Anil plans to support the project's future work from fees and with small contributions from individuals, leaving him and his team answerable to the people for the value of their work.




THE PERSON

Despite degrees in both subjects, Anil describes himself as a "former" biochemist and microbiologist. He has rejected the medical and scientific establishments to work as a consumer health advocate and activist, and has been a founding member of several organizations and initiatives dedicated to health rights. From his base in Bombay, Anil writes, researches, and speaks about people's science, health, patients' rights, and the need to challenge the power of the Indian drug industry over consumers.

Three years ago, he helped found a pilot rural medicine counter in the village of Malshiras, Maharashtra, run by and for the community. Local residents, including women, are trained to dispense medicines. The project has been very successful in distributing prescription drugs to a poor population at minimal cost. It has also been a testing ground for some of the first drug fact sheets produced.




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