Generics vs the validity of reasonable choice
We were visiting some friends some weeks back and their teenaged son was sulking about the cable connection being cut, the subscription to the internet refused, and even his demand for a new smartphone denied.
‘Why have you taken these drastic steps?’ I asked.
‘His first board exams are just two years away and these are mere distractions,’ replied my friend smugly, ‘This is how I can help my son focus on his studies.’
Come on, when have bans helped? Bans can only spawn disruptive ideas because reasonable choice is being disabled. Bans, I told him, are nothing but democracy being strangled right inside our homes. Teenagers must be taught how to exercise reasonable choice and balance entertainment with their performance in exams. Every sort of technology helps awareness step up and banning it all simply means promoting an environment where access to wider and more comprehensive learning is curtailed and sometimes immobilized. My friend was in no mood to listen to logic and now when I read about this hullabaloo about generics being made powerful enough to elbow out branded drugs, I guess it is time to talk about it all.
Rumani Saikia Phukan wrote in an article ‘Generic Drugs in India: More Awareness Required’ on November 07, 2014, that the reasons for promoting the concept of generics was to make them more affordable for the masses as ‘more than 70% of India’s population lives in the rural areas, out of which around 35% is either below the poverty line or close to it.’ We know how expensive medical treatment can be for a majority of people who find it difficult to make both ends meet… and private medical treatment as well as branded drugs can cost a lot. Even I prefer to compare costs before deciding which brand to go for… for instance, while buying modafinil at https://eumeds.com/modafinil/ or even a low dose Acetyl Salicylic Acid (or aspirin, as some will know it), I examine the cost versus the reliability of the manufacturer associated. But if I were to be given a generic, which can be found here: https://www.rxoneshop.com/pharmacy-distributor, at the whim of a dispensing chemist, he just might attempt to push one where he gets a higher margin. I am certainly not going to pander to the profit intentions of a dispensing chemist, and, therefore, I prefer exercising my informed choice.
Talking of choices, there are known cases of even doctors or medical practitioners pushing brands https://www.rxoneshop.com/pharmacy-distributorbecause of the marketing pressures induced by drug companies. There are instances of doctors being offered free junkets abroad, incentives being doled out, or even ‘prescription pacts’ being executed in lieu of money exchanged. These are all as true as profit-engineered choices that dispensing chemists thrust upon unsuspecting customers. We have been reading of such incidents in the newspapers… and we also have the case of expensive medicine-coated stents being encouraged by a collusion of doctors and manufacturers. The unethical practices of exorbitantly priced branded drugs being pushed by doctors is further aided by the emergence of combination-drugs. I agree that there are instances where a certain combination is what the patient needs to be prescribed and there are reasons ranging from easing the number of orally ingested pills to the cost of the combos being lesser. But even among doctors this remains debatable as some vouch for every drug to be prescribed separately because dosage titration is much easier then. If we talk of the choices being made available to patients while buying their medication, some doctors too want the choice or option to titrate drug doses. And they are equally right. We know of a number of drug combos that have already been banned by the Union government and they include Aceclofenac, Paracetamol, and Rabeprazole; Diclofenac, Tramadol, and Chlorzoxazone; Nimesulide and Diclofenac; Dicyclomine, Paracetamol and Domperidone; Nimesulide, Cetirizine, and Caffeine; Nimesulide and Paracetamol dispersible tablets; Nimesulide and Tizanidine; Paracetamol, Phenylephrine, and Caffeine; Paracetamol, Cetirizine, and Caffeine; Diclofenac, Tramadol, and Paracetamol to name a few.
Vivek Bannerji, a medical practitioner from Saharanpur (and I’m sure there will be a lot of other doctors echoing the same emotion) feels disheartened about generics being pushed so strongly and wrote in a Facebook post that ‘the rampant distrust and the accumulated angst in the society towards my profession in general and doctor in particular, and I want to quit being one. I see the attacks and manhandling of doctors and it fills my mind with an indescribable anger. And when I see the abuse the Medical profession is being subjected to on social media, it pains me no end’. He adds that ‘the power to choose brands of drugs is on the verge of being taken away from Doctors and handed over to Chemists and those running medical stores as if their (the chemist’s) knowledge, experience, competence, honesty and personal integrity is way more than doctors’.
It appears that a lot of doctors are getting disheartened by the new proposed regulations to usher in generics. They assume that their sincerity is being questioned. I’m sure this is not the case. For every one sincere and involved professional, there will always be many times more corruption-laden pros… and this is true with every profession, including the medical practitioner. For instance, not every divorce lawyer or engineer or even politician is there to succumb to temptations and degrade his vocation. There are, obviously, a lot of doctors too who have been behaving like misguided dolts. When you are suffering from an injury, check out Personal Injury Lawyer Brisbane that will care for that burden, enabling you to focus on getting better.
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They should not be the reason for good and involved doctors to get disheartened. So far as policies are concerned, the think tank at the helm does try new things in the hope that it will make things better… and sometimes it does. When it doesn’t, that policy is thrown out making way for a new idea. We are all living with such dynamic changes taking place all the time and thus assuming that the advent of generics is going to be a mandatory evil is incorrect.
An article in Business Standard mentions the perspective adopted by the Organisation of Pharmaceutical Producers of India (OPPI) and Kanchana T K, Director General is quoted as having said that ‘A Medical Council of India notification of September 2016 mandates every physician to prescribe drugs with their generic names. Further the Drug Technical Advisory Board has also recommended amendment of the Drugs & Cosmetic Rules requiring mention of generic name of the drug on the label in a font size that is two sizes bigger than the trade name. It is in the paramount interest of the patients that stringent quality control systems for manufacturers and effective regulations for the pharmacists are put in place before amending any other law.’ Valid suggestions and just as patients as well as doctors like Dr Gabriel Hershman have the right to exercise their choices, even the government and the legislatures have the right to amend laws and regulations keeping public interest in perspective.
By the way, there has also been a lukewarm attempt to introduce and promote a scheme called Jan Ausadhi in 2008 where the objective was to open generic stores all over the country. Not many have come up, so I guess the government can always begin with implementing this scheme in earnest. This would mean a section of the medical practitioners and patients who are unhappy with branded drugs, to opt for the generic route.
The truth is that there are issues with both branded as well as generic concepts and neither of these two options is fool-proof. What is important is that instead of doing away with a choice, multiple options be validated. It is far more vital for patients to be aware of the ways they could be cheated and misled and through their awareness they need to find the best way suited to them. Our masses need to be empowered by access to information and it is the people who will then have the power to reject an option that doesn’t come up to their expectations. Generating public opinion through meaningful debates is the way our government should be functioning.
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Arvind Passey
16 May 2017
