The Parliamentary Standing Committee on Health and Family Welfare tabled a Report in Parliament on May 8, 2012, on the functioning of the Central Drugs Standard Control Organization (CDSCO).  CDSCO is the agency mandated with the regulation of drugs and cosmetics in India.  The Report covers various aspects of drug regulation including organizational structure and strength of CDSCO, approval of new drugs, and banning of drugs, among others. Following the Report, the Minister of Health and Family Welfare has constituted a Committee to look into the procedure for drug regulation.  The Committee is expected to make its submissions within a period of two months. This post focuses on irregularities in the approval of new drugs by CDSCO.  It discusses the regulations relating to drug approval and the Standing Committee's observations on the working of CDSCO. Approval of new drugs Drugs are regulated by the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetic Rules, 1945 [Rules].  The CDSCO, under the Ministry of Health and Family Welfare, is the authority that approves new drugs for manufacture and import.  State Drug Authorities are the licensing authorities for marketing drugs. New Drugs are defined as:

  • drugs that have not been used in the country before,
  • drugs that have been approved by a Licensing Authority but are now being marketed for different purposes, and
  • fixed dose combinations of two or more drugs that have been individually approved before but are proposed to be combined in a fixed ratio that has not been approved.

The Rules require an applicant for a new drug to conduct clinical trials in India to determine the drug’s safety and efficacy.  These trials are necessary for both domestically manufactured and imported drugs.  However, the authority can exempt a drug from the requirement of local and clinical trials in the public interest based on data available in other countries. Observations and recommendations of the Committee The Committee found that a total of 31 new drugs were approved between January 2008 and October 2010 without conducting clinical trials on Indian patients.  The Report mentioned that drug manufacturers, CDSCO officials and medical experts colluded to approve drugs in violation of laws.  Following are some of the Report’s findings:

  • Under the Rules, the Drugs Controller General (India) (DCGI), the head of CDSCO, can clear sites of clinical trials after ensuring that major ethnic groups are enrolled in these trials to have a truly representative sample.  This rule was violated by the DCGI when sites for clinical trials were approved without ensuring diversity.  The Committee recommended that the DCGI approve sites for trials only if they cover patients from major ethnic backgrounds.
  •  The Report found that certain actions by experts were in violation of the Code of Ethics of the Medical Council of India.  A review of expert opinions revealed that several medical expert recommendations had been given as personal opinions rather than on the basis of scientific data.  Additionally, many expert opinions were written by what the Report calls ‘the invisible hands’ of drug manufacturers.  The Committee recommended that CDSCO formulate a clear set of written guidelines on the selection process of experts with emphasis on expertise in the area of drugs.
  •  The Rules ban the import and marketing of any drug whose use is prohibited in the country of origin.  CDSCO violated this rule by approving certain Fixed Dose Combination drugs for clinical trials without considering the drugs’ regulatory status in their respective country of origin.  Drugs such as Deanxit and Buclizine, which have been prohibited for sale and use in their countries of origin, Denmark and Belgium, respectively, were approved for clinical trials.  The Committee recommended an inquiry into the unlawful approval of these drugs.
  • The Rules require animal studies to be conducted for approval of a drug for use by women of reproductive age.  CDSCO violated this rule in approving Letrozole for treating female infertility.  Globally the drug has only been used as an anti-cancer drug for use among post-menopausal women.  The drug has not been permitted for use among women of reproductive age because of side effects.  The Committee recommended that responsibility be fixed for unlawfully approving Letrozole.
  •  Rules require Post-marketing Safety Update Reports (PSURs) on drugs to be submitted to CDSCO.  PSURs are used to collect information on adverse effects of drugs on Indian patients as a result of ethnic differences.  When asked by the Committee to furnish PSURs on 42 randomly selected new drugs, the Ministry was able to submit PSURs for only 8 drugs.  The Report contended that this action reflected a poor follow-up of side effects on Indian patients.  The Committee recommended that manufacturers of new drugs be warned about suspension of marketing approval unless they comply with mandatory rules on PSURs.

Recently, Delhi witnessed large scale protests by various groups demanding stricter punishment and speedier trial in cases of sexual assault against women.  In light of the protests, the central government has constituted a Commission (headed by Justice Verma) to suggest possible amendments in the criminal law to ensure speedier disposal of cases relating to sexual assault.  Though the Supreme Court, in 1986, had recognised speedy trial to be a fundamental right, India continues to have a high number of pending cases. In 2012, the net pendency in High Courts and subordinate courts decreased by over 6 lakh cases. However, there is still a substantial backlog of cases across various courts in the country.  As per the latest information given by the Ministry of Law and Justice, there are 43.2 lakh cases pending in the High Courts and 2.69 crore cases pending in the district courts.[1]

After the recent gang-rape of a 23 year old girl, the Delhi High Court directed the state government to establish five Fast Track Courts (FTCs) for the expeditious adjudication of cases relating to sexual assault.   According to a news report, other states such as Maharashtra and Tamil Nadu have also begun the process of establishing FTCs for rape cases.  In this blog, we look at the status of pending cases in various courts in the country, the number of vacancies of judges and the status of FTCs in the country. Vacancies in the High Courts and the Subordinate Courts One of the reasons for the long delay in the disposal of cases is the high number of vacancies in position for judges in the High Courts and the District Courts of the country.  As of December 1, 2012, the working strength of the High Court judges was 613 as against the sanctioned strength of 895 judges.  This reflects a 32% vacancy of judges across various High Courts in the country.  The highest number of vacancies is in the Allahabad High Court with a working strength of 86 judges against the sanctioned strength of 160 judges (i.e. vacancy of 74 judges).   The situation is not much better at the subordinate level.  As on September 30, 2011, the sanctioned strength of judges at the subordinate level was 18,123 judges as against a working strength of 14,287 judges (i.e. 21% vacancy).  The highest vacancy is in Gujarat with 794 vacancies of judges, followed by Bihar with 690 vacancies. Fast Track Courts The 11th Finance Commission had recommended a scheme for the establishment of 1734 FTCs for the expeditious disposal of cases pending in the lower courts.  In this regard, the Commission had allocated Rs 500 crore.   FTCs were to be established by the state governments in consultation with the respective High Courts.  An average of five FTCs were to be established in each district of the country.  The judges for these FTCs were appointed on an adhoc basis.  The judges were selected by the High Courts of the respective states.  There are primarily three sources of recruitment.  First, by promoting members from amongst the eligible judicial officers; second, by appointing retired High Court judges and third, from amongst members of the Bar of the respective state. FTCs were initially established for a period of five years (2000-2005).  However, in 2005, the Supreme Court[2] directed the central government to continue with the FTC scheme, which was extended until 2010-2011.  The government discontinued the FTC scheme in March 2011.  Though the central government stopped giving financial assistance to the states for establishing FTCs, the state governments could establish FTCs from their own funds.  The decision of the central government not to finance the FTCs beyond 2011 was challenged in the Supreme Court.  In 2012, the Court upheld the decision of the central government.[3]  It held that the state governments have the liberty to decide whether they want to continue with the scheme or not.  However, if they decide to continue then the FTCs have to be made a permanent feature. As of September 3, 2012, some states such as Arunachal Pradesh, Assam, Maharashtra, Tamil Nadu and Kerala decided to continue with the FTC scheme.  However, some states such as Haryana and Chhattisgarh decided to discontinue it. Other states such as Delhi and Karnataka have decided to continue the FTC scheme only till 2013.[4]

Table 1: Number of Fast Track Courts and the pending cases in FTCs                     (As on March 31, 2011)

State No of FTC No of cases transferred until March 31, 2011 Pending cases
Arunachal Pradesh 3 4,162 2,502
Bihar` 179 2,39,278 80,173
Assam 20 72,191 16,380
West Bengal 109 1,46,083 32,180
Goa 5 5,096 1,079
Punjab 15 58,570 12,223
Jharkhand 38 1,10,027 22,238
Gujarat 61 5,37.636 1,03,340
Chattisgarh 25 9,4670 18,095
Meghalaya 3 1,031 188
Rajasthan 83 1,49,447 26,423
Himachal Pradesh 9 40,126 6,699
Karnataka 87 2,18,402 34,335
Andhra Pradesh 108 2,36,928 36,975
Nagaland 2 845 129
Kerala 38 1,09,160 13,793
Mizoram 3 18,68 233
Haryana 6 38,359 4,769
Madhya Pradesh 84 3,60,602 43,239
UP 153 4,64,775 53,117
Maharashtra 51 4,23,518 41,899
Tamil Nadu 49 4,11,957 40,621
Uttarakhand 20 98,797 9006
Orissa 35 66,199 5,758
Manipur 2 3,059 198
Tripura 3 5,812 221
Total 1192 3898598 6,05,813

Sources:  Lok Sabha Unstarred Question No.498, March 3, 2012; PRS

 


[1].  Rajya Sabha Starred Question no 231 dated December 10, 2012.

[2].  Brij Mohan Lal v Union of India (2005) 3 SCR 103.

[3].  Brij Mohan Lal v Union of India (2012) 6 SCC 502. [4].  Rajya Sabha Unstarred Question no 2388 dated September 3, 2012.