Most doctors seem to agree with grandma that you can live without cough syrups. Yet, the market currently has at least 2,000 brands of cough syrups, with almost every pharma company in India manufacturing it. Quick conclusion: Even if the government bans one or two cough syrups, the market is just too big to fail.
"Cough syrup is one of the easiest and most profitable things to manufacture. Even you can do it in a 10X20 room and some accessories," says a senior pharma company executive. "This is one of the reasons why it is impossible to know its exact market size as there are just too many players."
The government on Thursday banned a cough syrup formulation (Chlopheniramine Maleate + Codeine) where the leading market players are Pfizer and Abbott. Both the companies have gone to Delhi High Court. Pfizer got an interim stay on Monday. Abbott's hearing would take place today.
"The consumer has numerous options even if this ban is enforced. This market is saturated. You will even find some regional and sub-regional companies manufacturing it and doing really well in their market," says a senior Mumbai-based pulmonologist.
On Tuesday, FMCG major Procter & Gamble stopped production and sale of its popular brand Vicks Action 500 Extra, which is also a mixed combination drug to treat fever and common cold, as part of the same ban.
On cough syrup, though, there isn’t a single study to date that proves that a cough syrup actually helps in dealing with cough problems. Yet, doctors believe patients prefer taking it because of placebo effect – a beneficial effect produced not by the drug but because of the patient's belief in that treatment.
"You can just drink hot water for 2-3 days and your cough will be alright. Yet, the patients find it easier and comforting to purchase a cough syrup and gulp it down to their fulfilment," adds the Mumbai-based pulmonologist quoted earlier. "One factor which works in its favour is its alcohol like properties – it helps people suffering from cough go to sleep."
Drug abuse using cough syrup is rampant across India, too. Codeine-based cough syrups are globally known for their addictive properties. It is an opiate – the same as morphine and heroin – and its regular use can cause both mental and physical damage.
In several countries, including USA, its sale is regulated under narcotic control laws. (Rapper 'Pimp C' died in 2008 due to an overdose; he often rapped about his love for codeine). However, in India, its over-the-counter sale is common.
"It will be difficult for the government to enforce this ban. The multinational and large domestic companies may stop the sale of this syrup but the regional players will just change the name and keep the production going on. It is just too profitable," said a senior executive of a Gujarat-based pharma company.
However, a large number of health experts commended the government's step. "Enforcing the ban will always be an issue. But the fact that government has shown its intention of banning drugs – without coming under pressure from pharmaceutical companies – which are known to be harmful all across the world is praiseworthy," said a health expert from a leading consulting firm.