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Story of Ribavirin is interesting and shows how things may change and evolve over time.

During the late 1970s, Ribavirin was introduced in the market by a Canadian company ICN under the brand name ‘Virazole’. ICN had few products. Virazole was indicated in viral respiratory infections such as flu, common cold. Everyone knew that these were viral problems, but everyone also knew that these problems could not be treated with any specific medication. They jokingly said if you treated common cold, it would go away in only seven days; if you didn’t treat, it would take one week to go away. The course of common cold also became an idiom in literature. There was a famous saying ‘Infatuation, like common cold, must run its course’. All said and done, everyone accepted the fait accompli that nothing could be done about common cold. There was no vaccine to prevent it and there was no treatment. Now flu vaccine is available from GSK and Sanofi, but the edition is updated every year.

It was in this environment that ICN tried to sell Virazole in common cold. Of course, they had hard time getting the doctors to accept it. When it was used after all, the results were dubious. After some time, ICN settled with the claim that if Virazole was given in common cold, it would help to reduce the intensity and duration of the disease. Anyway, Virazole (ribavirin) never caught up.

Fast forward 1990s, Getz introduced ribavirin with the brand name ‘Ribazole’ and indicated it in Hepatitis B, which was a big problem. Pakistan Medical Research Council issued a report saying that 10% population of Pakistan was infected with Hep B virus, though all did not have active disease. This report also said the infectivity rate of these Hep B carriers was 36%. Antivirals were needed, and they were few and far between. Ribavirin was later joined by Lamivudine and Zidovudine. Ribavirin (Ribazole) was sold by Getz alone and at a fairly high price. No one else brought ribavirin on the market.

At the time Hepatitis A and B were identified. A third type had started emerging which was named ‘non-A, non-B’. No one was sure what to do with it. This was later labeled as Hepatitis C and sometime later it exploded and became a major epidemic in Pakistan and many other countries.

Then came interferon for the treatment of Hep C and it had to be given in combination with ribavirin for better results. Initially, Roche and Schering Plough introduced their brands of Interferon. Both companies did not have ribavirin. The doctors had to prescribe Ribazole along with Interferon. The market for ribavirin grew rapidly and steeply. Couple of more companies introduced brands of ribavirin.

Then came generic versions of interferon and competition intensified. Schering Plough did not stay long in Pakistan market and rolled back. Roche decided to offer ribavirin free-of-cost along with their interferon. They collaborated with Ferozsons Pharma, took their ribavirin at low cost and offered free to their patients.

Generic interferons marketing companies also followed suite. Since then, Ribavirin is distributed Free of Cost by all companies operating in Hep C market. From interferon to peg-interferon to sofosbuvir, Hep C treatment has changed many times over; Ribavirin remains free of cost.

Imagine a tablet selling at around 40 rupees a tablet coming down to zero. It is interesting and learning. This is what Andy Grove, co-founder of Intel® calls Inflection Point. It is when the very rationale of a product disappears. The product also disappears quickly.

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