Jithin (name changed) was an autorickshaw driver in Kerala, ferrying schoolchildren through the crowded lanes every morning and evening. His modest earnings barely covered food and his children’s education. Then came cirrhosis, complicated, unforgiving, and an infection that tipped him into hepatic encephalopathy, his brain clouded by rising ammonia levels.
He was referred to Dr Cyriac Abby Philips, clinician-scientist and one of the country’s leading science communicators, based in Ernakulam. The treatment plan was clear: ammonia-reducing therapies, with rifaximin at the centre. “I prescribed it for six weeks,” recalls Dr Philips. But just four weeks later, Jithin returned not for routine follow-up, but in a coma, the worst stage of brain failure. He spent two days in the ICU and nearly a week in the hospital. His wife, desperate, borrowed ₹80,000 from neighbours and friends to pay the bills.
At first, Dr Philips thought Jithin had ignored medical advice. But the truth was far more devastating. Jithin had taken rifaximin for 15 days. Then the money ran out. At ₹42 a tablet, two a day, the drug cost him ₹2,520 a month—an impossible sum for a man living hand to mouth. He chose food and education for his children over medicine for himself.
The deeper tragedy was his fear of generics. Jithin was too afraid to buy a cheaper version—afraid it wouldn’t work, afraid he would be scolded, afraid of the stigma. Dr Philips, too, was hesitant, unsure of their quality and wary of backlash if things went wrong. That fear, shared by doctors and patients alike, is what keeps affordable healthcare out of reach. It is not evidence, but opinion, hearsay, and habit that fuels this mistrust. And it is ordinary people—like Jithin—who pay the price.
Determined to uncover the truth behind this concern, Dr Philips turned to Mission for Ethics and Science in Health (MESH), a non-profit organisation where he serves as president. Together, they launched what became the largest crowd-funded research on generics globally. In just a week, more than 1,000 people contributed, without conflict of interest, to support the cause.
The study helped resolve a major dilemma for clinicians: how to ensure patients continue treatment without interruption due to cost. Medical expenses, especially on medicines, remain a crushing burden, with patients often forced to discontinue therapy midway. In fact, approximately 62% of all money Indian households spend on healthcare goes directly toward buying medicines. For chronic illnesses, adherence to prescribed protocols is the most critical factor in safeguarding patients’ quality of life and treatment outcomes.
Generic medicines were designed to address this issue. They contain the exact same active ingredients as branded versions and are sold after the original patent expires. The Indian government promotes them through initiatives like the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana (PMBJP), while states like Kerala distribute them through their medical services corporations.
Yet the question of “quality” lingered. Doctors and patients alike worried that cheaper drugs might be less effective. That fear has now been addressed by the MESH study. The research found that generics are equally effective, despite costing 5 to 14 times less. On average, generic medicines were nearly 50% cheaper than branded ones.
The larger lesson
Jithin’s story is not an isolated one. It reflects the everyday struggles of millions of patients who face impossible choices between medicine and survival. The evidence now shows that generics can bridge this gap, providing effective treatment at a fraction of the cost. For clinicians, the challenge is to overcome ingrained mistrust and embrace evidence-based prescribing. For patients, it is about reclaiming access to affordable healthcare without fear.
Dr Cyriac Abby Philips, clinician-scientist and president of the Mission for Ethics and Science in Health (MESH) explains the motivation behind the study, its surprising findings, and what this mean for patients and doctors alike.
Why is there so much debate on branded vs generic medicines?
Medicines are a major financial burden in India, and many families doubt whether cheaper generics are as effective as costly branded drugs.
Why did you decide to conduct a quality study on drugs?
Government reports on banned drugs are opaque and often misunderstood, creating the impression that generics are of poor quality. The study aimed to clear this confusion with evidence.
What is the most important highlight of the study?
Quality is not linked to price. A ₹1 tablet performed just as well as one costing ₹10, disproving the myth that cheaper means worse.
What were your criteria for choosing drugs, and why focus on chronic diseases?
We tested commonly prescribed medicines for chronic diseases because they have a wide therapeutic range. This means checking pharmaceutical equivalence is sufficient. For narrow-range drugs like immunosuppressants, bioequivalence testing is also needed. But that’s a far more expensive process.
What were the challenges in conducting such a study?
We tested 131 samples across 22 therapeutic categories, each requiring 40 drugs. Getting the same batch for all types was tough. To reflect real-world purchases, researchers acted as “mystery shoppers” and bought medicines from seven sources.
Were you surprised by the results?
Yes. Every single drug passed.
What are the limitations of the study?
We assessed pharmaceutical quality, not clinical effectiveness. Sampling was random, but only one batch was tested.