Cannot treat without understanding.

Indian pharmaceutical companies have reduced cost of medical care in many countries by supplying cheap generic drugs, "Yet, too many Indian citizens do not get access to medicines owing to high costs." Exports of pharmaceuticals is big business because India is able to manufacture cheap generics. Why do doctors prescribe branded medicines which are much more expensive? A branded strip of Cetirizine cost Rs 27.16 in 2011, compared to Rs 2.24 for the generic version by the same company. Doctors want to be sure of the bioavailability of a drug, which means the quantity of active drug that is able to withstand the highly acid environment of the stomach and first-pass metabolism in the liver and enter the circulation. Secondly, a daily wage earner loses money for everyday that he is unable to work. Poor people avoid tests, which they see as a waste of money, but want effective drugs so that they can get back to work quickly. Thirdly, margins for generic drugs are much higher, and the chemist is sure to push products of those companies which offer the highest margins, possibly because those are substandard. Thus, the control of treatment passes from the doctor to the chemist, while the doctor remains responsible if anything should go wrong. Recently there was an uproar when parents of a 7 year old girl, suffering from Dengue, were asked to pay Rs 1.6 million. The girl died. Everyone is scandalized that 661 syringes were used in 15 days, that is 43 syringes per day, and 2,700 pairs of gloves, but the most important fact is that doctors' fees were just Rs 53,900 for 15 days care in ICU, while room rent was Rs 1,74,000 and diagnostics cost a whopping Rs 2,73,394. The government has left healthcare to the private sector which will obviously maximize profits, wrote R Singhal. An official survey shows how burden of diseases has changed and how it varies between different states, in India. In 1990, the Disability-adjusted Life Years, or DALYs, were 61% for infectious diseases and 30% for Non-communicable Diseases, or NCDs. By 2016, NCDs were 55% while infectious diseases accounted for 33%. These figures do not reveal whether the incidence of infectious diseases has fallen so that NCDs now account for a higher disease burden, or whether NCDs have increased markedly while the incidence of infections diseases has remained constant. However, malnutrition and tuberculosis still afflict the largest number of people. Poor nutrition and diabetes are known precursors of tuberculosis. While disease burden is increasing, government spending on healthcare has dropped from 1.47% of GDP in 1986-87 to 1.05% in 2015-16. Obviously, healthcare is not a vote winner. Can always blame God. Or fate.