Once upon a time, there lived a conman. He decided to make some quick buck. He sold 1000 lottery tickets, each at a price of $ 5. The bumper prize was $1000. So you could buy a ticket for 5 and if you are lucky , get $1000. He marketed it, saying if you lost, you just lost 5 $. But think of what you will get if you win – $1000. 200 times your initial investment. Or an insane profit of close to 20000%. There was a mad rush to buy the lottery. The numbers on the ticket were 8 digits long and were alphanumeric. It was a clever ploy. Had he numbered the tickets sequentially from 1 to 1000, people would easily remember that. His alphanumeric system precluded that possibility. A few days later, the results were released. Photos were flashed of the winner getting a cheque.Many who had bought the tickets were disappointed. But they went about their lives as usual. After all, the loss was tiny. One of the guys who lost it was a little suspicious. No one he knew had won the prize. He decided to dig deeper. When he confronted the conman with questions, he was told to prove his theory in court ( a legal battle that would ruin him financially) or take his $5 as refund. The poor guy got his $ 5, while the conman made $ 4995. No one actually won the lottery.
Recently I was asked by a patient about the effectiveness and side effects of two drugs called BGR -34 and IME-9. I must admit I hadn’t heard of those drugs.As an allopathic doctor and an endocrinologist, the name sounded odd to me. Such names are reminiscent of candidate molecules being tested. Nevertheless I decided to dig deeper and find out more.
BGR -34 is an ayurvedic medicine developed jointly by National Botanical Research Institute (NBRI) and Central Institute for Medicinal and Aromatic Plant (CIMAP) — both funded by government. BGR 34 stands for Blood Glucose Regulator with 34 active phyto ingredients. The NBRI website unfortunately doesn’t give much details. The drug is touted as having 67 % ‘success rate’ based on animal studies. No human data are available. The senior principal scientist AK Rawat has said, “The drug has extracts from four plants mentioned in Ayurveda and that makes it safe”. I have no idea how that will make a drug safe ! Tell me if you do.
IME 9 stands for Insulin Management Expert. It’s developed by another government body called CCRAS (Central Council for Research in Ayurvedic Sciences). This one doesn’t have much information listed either.
I decided to check for any publications on BGR 34 and IME 9. Unfortunately I coudn’t find one. Next I proceeded to the AIMIL pharmaceuticals page( the company that is licensed for manufacturing and marketing this drug). When I tried to see the products page, it told me helpfully that I was not authorized to view that page and that I should login! Why should I login to view a company’s drug landing page? I ve never had to ‘login’ to see the details of any drug in the past!
Even more brazenly, the privately owned entity has used DRDO logo in its website to give itself an ‘official’ veneer. In an event attended by Dr Man Mohan Singh and JP Nadda, the company has also been awarded the AYUSH company of the year!
So I turned to the mother of all search engines, Google for help. There were a few blog posts. One of them had lamented that the drug had actually increased the blood glucose in his mother ! Now the ridiculousness of checking blog posts for evidence of efficacy is an injury. To watch youtube videos on the same topic is insult to that injury. Nevertheless, I did that too. The comments on the YouTube videos were mostly negative[There are tools to make formal ‘Sentiment Analysis’, though I haven’t done here]. Yet one common thread was the feeling that native medicines were side effect free. How many more years will it take for people to understand that there is no such thing as a drug without side effects? (Paracelsus said this thousands of years back)
All drugs are poisons. Only dose makes the difference.
Curiously these drugs are marketed as 5 rupee medicines for diabetes. Metformin and sulphonylureas, the two most commonly used diabetes medications with a huge evidence base, cost much less than 5 rupees. Yet no one had ever marketed them as 5 rupee wonder drugs! There’s even a Facebook page for this drug with a rating of 4.5 ! Ever seen Facebook pages for drugs before? Me neither. It is available in Amazon, Ebay and Snapdeal, not to mention some less well known online retailers.
Just like we can’t accept anecdotal evidence for the efficacy as valid, we can’t accept anecdotal evidence for the lack of efficacy as valid too. As much as I would hate it, I was forced to say that this drug’s efficacy was ‘unknown’.More importantly the safety was questionable too.
We have no data at all.So who is tasked with regulating this market? Why is our tax money used to fund such projects incompletely? What prevents them from testing the drugs? How are they made to trend in pill selling apps like 1 mg? Why are they marketed as government approved drugs? Why are these drugs marketed to patients directly?Too many questions , too few answers.
At the end of the day, diabetes is as much a disease of behaviour as it is of beta cells. The lure of a cheap drug without side effects with no need for any pesky life style changes , becomes irresistible to the common man. Thus clever marketing always works (just like it works for pharma on doctors). Direct to consumer marketing must be banned, regardless of the system of medicine practiced. For the simple reason that the patient isn’t qualified to make an informed choice. Otherwise we will always have the lottery tickets and dubious drugs.
Science shouldn’t be sacrificed at the altar of business.