LETTERS

DOI: https://doi.org/10.20529/IJME.2018.006


The brand of generic prescriptions

For some time now, a debate has been raging on the issue of generic drug prescriptions. Doctors are divided on this matter. Those against generic prescription cite possible poor quality and inadequate testing; while those in favour assert that the move would make cheaper medicines accessible to many more patients. The pharmaceutical industry attempts to introduce drug molecules that are safer and perhaps more effective. To enter the market each molecule would have been subjected to rigorous experimentation, at huge cost which needs to be recovered. The services of the industry are hence to be greatly appreciated, in spite of the criticism of the high pricing of their products.

The debate usually involves a two-sided scenario; with the prescribing doctors on one side and the industry on the other. Doctors assume that they are entirely responsible for the patients’ welfare. The industry too assumes that it provides the best quality drugs in the interest of the patient. The role of the third stake holder, the patient, is taken for granted. The question is, should the patient not have a choice? Today, patients are far more well- informed than in earlier years.

The patients’ right to make a choice of their own is supreme. Doctors are not in a position of patronage as we may think. We may just suggest options and help the patient make an informed choice. When different brands have the same amount of medication, but different pricing, the patient must have the autonomy to decide which one to buy. Let us also accept that, nowhere in the medical training course are doctors taught which brand is better or which brand to prescribe.

The behavioural psychology of prescribing has been mastered by the industry. It uses these methods to influence prescribing practitioners. Sometimes, it is the packaging, or the academic material they provide free, and at other times, medical representatives develop a personal relationship with the doctor. Thus, there is a conflict of interest and subconscious (or conscious) prescribing of certain brands, or all brands, of a particular company.

Prescribing generic formulations is a step towards empowering the patient community, without which the patient has no option but to use the prescribed medicines, nearly always expensive branded ones. Generic name prescriptions too raise other concerns. When we need to prescribe a combination of medicines, for example, a B-complex preparation or iron and vitamin preparation, the trade name makes it simpler.

Brand names present various problems. Some brands are withdrawn if the company merges with another one selling the same product, leaving patients confused as to why the drug is not available. Sometimes, patients insist on a specific brand name and the doctor may have prescribed an alternative one. Some clinicians argue that indeed a specific brand is more effective. This is generally not supported by any research study or evidence base; “Experience” they say. Apart from a specific brand being removed from the market, it may be unavailable with some chemists, or in some regions. Patients move from one doctor to another with their case notes and prescriptions. All doctors may not be aware of all available brands. The strength of the molecule could vary across brands, as also the cost.

Generic prescription has a significant benefit in terms of cost. Even if one is not available with a chemist, alternative brands can be offered. Patients too have the choice of the brand based on affordability. However, if only generics were made available, it would restrict the choice of medication. The prescription is in a language reachable to all doctors. It reduces controversial commercial concerns and conflicts of interest of the medical practitioner. Efforts must be made to establish standards in generic medicinal molecules through periodic evaluation by different laboratories. Making these certificates available on the internet helps the patient or family to judge the given medicine.

Hence, doctors should write prescriptions using generic names. At the same time, the government and the appropriate department would do well to invest in testing and quality assurance procedures of both generic as well as branded medications. Thus, we will have a new brand of generic prescriptions and medications!

BN Gangadhar (dirstaff@nimhans.ac.in), Director and Senior Professor of Psychiatry, NIMHANS, Bengaluru 560 029 Karnataka INDIA; Santosh K Chaturvedi (chatur@nimhans.ac.in), Dean, Behavioural Medicine and Senior Professor of Psychiatry, NIMHANS, Bengaluru 560 029.Karnataka, INDIA

About the Authors

BN Gangadhar (dirstaff@nimhans.ac.in)

Director and Senior Professor of Psychiatry,

NIMHANS, Bengaluru 560 029 Karnataka, India

Santosh K Chaturvedi (chatur@nimhans.ac.in)

Dean, Behavioural Medicine and Senior Professor of Psychiatry,

NIMHANS, Bengaluru 560 029 Karnataka, India

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