Consumers in the Third World get third-rate treatment from the pharmaceutical industry, who sell them junk in the name of medicine. This includes formulations banned in the parent country of international giants (1). These companies have adopted a new technique: marketing new formulations under old brand names without informing consumers. These companies exploit people’s faith in brand names and the resistance to generic prescriptions. They also hide behind antiquated laws which do not ban the launch of new formulations using old brand names.

There are several examples of this practice. This account describes the substitution of contents in the brand Disprin manufactured by Reckitt Benckiser (India) Ltd.

Disprin is known for its aspirin content (acetyl salicylic acid with calcium carbonate and citric acid). The company launched ‘Disprin Plus’ with much fanfare. However, the new ‘Plus’ was actually minus the aspirin. By prefixing Disprin, the company wanted to retain old consumers. The suffix ‘plus’ (without adding anything), was to deceive them. Patients consumed paracetamol in place of aspirin, knowing little about the effect of the switchover. Cardiac patients taking aspirin for its platelet inhibitory effects were in for a shock when these facts were made public. Prescribing doctors were ignorant of this substitution till the press blew the whistle (2). The manufacturer had taken everyone for a ride.

This unsavory story goes back to 2001 when aspirin was brought under the Drug Price Control Order. The National Pharmaceutical Pricing Authority notified ceiling prices for aspirin and 20 other formulations. Soon, well-known brands of aspirin disappeared from retail outlets. Evidently the industry was not willing to market aspirin at the lower profit margin.

Then, two companies, Reckitt Benckiser and Nicholas, decided to use their brand advantage to introduce Disprin Plus and Aspro Plus, respectively, containing a different drug, paracetamol (3). Disprin was sold at Rs 2.25 for 10 tablets but the new price ceiling was Rs 1.70. Disprin Plus was sold at Rs 9.40 for 10 (taxes extra).

The ‘new wine in old bottles’ was launched with much publicity. There were many pages of advertisement but the information that the brand contained paracetamol, not aspirin, was in very small print.

In a rare case of solidarity, the Druggists and Chemists Association of Nagpur boycotted the new product. Their apex body, the All India Organization of Chemists and Druggists (AIOCD), brought to the company’s notice that the addition of the word ‘Plus’ created the impression that the drug was basically aspirin with an addition. This impression was reinforced by the similarities in design of the two strip packs. The highlighted addition of the words ‘new formula’ suggested that it was an improved formulation-not a different one altogether. The AIOCD also drew the manufacturer’s attention to sections in the Drugs and Cosmetics Act, 1940, which relate to misbranded and spurious drugs, warning them of the penalties (4).

The adverse publicity affected sales as consumers of Disprin switched over to other brands. In response, Reckitt Benckiser inserted an advertisement ‘for public information’, half-heartedly mentioning the difference between Disprin Plus and low-dose aspirin (5). But the damage control exercise failed. Finally, in July 2003, the company withdrew Disprin Plus and made Disprin re-available in India for a retail price of Rs 2.70 for 10 tablets (Rs 31.56 for 120 tablets, taxes extra). Old wine was returned to the old bottle.

For a change, chemists and druggists, activists and the media showed what collective power could do. If only such pharmaceutical activism can be seen more often, the pharmaceutical industry will stop taking the patient population for granted.