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Thursday, April 20, 2017

Generics Vs Branded Drugs: Views & Counter-view

This article is a counter-view to a blog written by my dear friend and collegue Dr Amit Thadani (http://amit-thadhani.blogspot.in/2017/04/myth-of-doctors-prescribing-expensive.html?m=1) who is against the move by government to prescribe only generics. 

Woah, what a detailed blog Amit. However sorry to say there are a lot of holes in it specially for the company market cap study as it needs an apple to apple study for retail giants vs export giants. 

Also the main reason why prescribing generic will be an issue is government(govt) has not considered the active Vs inactive ingredient portion of the components in the drug as both matter sometimes for efficacy in terms of absorption time etc which has not been touched upon by you as the main issue here. 

When we speak of generics it's mostly for core active molecule and the move by govt is based on international best practice to prevent financial moral degradation and to reduce nation's's economic wastage when technically something cheaper can be procured (http://www.health.harvard.edu/blog/generic-drugs-dont-ask-just-tell-201301075766). Imagine the potential to reduce insurance premium costs. United States of America and many developed nations are already considering options to do so.

Also the generic names are long names many times and do not include convenient combinations and that could be an issue. 

We are facing this move by the government as it was expected some time due to the huge huge moral degradation which I have seen, researched and experienced during my ekohealth times. That is not a myth. The moral degradation is so rotten that even unaffording poor patients are prescribed unaffordable brands when a cheaper brand/generic is easily available. 80% of all debts in Indian Families are due to healthcare expenses & the major contributor to that expense is medicine.

There may be some rare breed of docs who don't take cuts etc, and a lot of docs genuinely won't know about many upcoming quality pharma firms if the ground marketing reach is inadequate. But the research clearly says the degradation is as high as 99% (forget research, we all know the ground reality. you yourself accepted that many hospitals get high MRP printed on cheap drugs for the high margin sale & don't even give a choice to patients to buy another cheaper drug)

I don't know why doctors are the first ones to react so negatively specially on generic medicines if pricing is not an issue. The haa hoopla just on quality is nothing but the insecurity of losing their commissions and nothing else. I can share studies which show that quality and efficacy don't change with different companies (check citation at the end). Also big pharma firms like ranbaxy do not many times adhere to quality and are fined and even small firms like mankind rise in popularity on word of mouth. So that is a different domain altogether and doctors need not worry about it. Govt and FDA will. I'm not even touching upon the rut in diagnostics domain.

I personally consume all medicines which are cheaper than popular ones. The biggest myth is that generics don't have a brand name is false. All medicines which are retailed at chemists have a brand name as per FDA rules and therefore all medicines are branded. Many times the same big manufacturer like Cipla manufacturers multiple different brands of same molecules at different MRP for different markets for retail and export with different MRPs.

So I feel doctors should be concerned with their fees and not the cuts from the sale of medicines. If quality is a concern, doctors can spend some time reading the efficacy reports, articles or peer review. There are some awesome pharmacovigilance portals which doctors can prescribe to know what brands are better effective based on actual practical use. Doctors will be surprised to know that there is hardly ever any difference among different brands/generics & even most popular brand sometimes has a problem and low cost brands equally never do.

It's time docs stand up with courage and hike their fees to what they deserve/desire and stop hiding behind the cover of some drug myths to show a cleaner face and blame everything on the government policies. 

The quality will always remain an issue and the same issue needs to be dealt by govt for all manufactures whether their MRP is low or high, known or unknown brand/generic. 

You yourself contradicted yourself by saying some hospitals buy at 300 and sell at 3500 as their own brands. Then why is that acceptable to the same doctors who cry on quality?

I sincerely hope there is a price cap on all medicines to bring a level playing field, so no MRP manipulation can happen. Price cap will bring better efficient process to manufacture and bring in stringent quality checks to prevent wastage & returns/rejections.
I had suggested to the govt to bring in a negative price list where only as exception some medicines are beyond price cap and by default all medicines are price capped. High time this happened to prevent any doctor favouring a particular brand only for sake of commissions.

Time has come to improve our moral compass & stop taking cuts or commissions or gifts or holidays to prescribe a certain medicine. Time has come to engage with patients and give them informed choices so they can buy a brand of medicine they want. Time has come to shed our skin of hypocrisy & accept the fact that only doctors can improve the confidence in the general public which is eroding at a pace we cant even imagine. Time has come to being a 'doctor sahab' we once used to be perceived as. That will go a long way as a great patriotic service for the nation. 

Time has come to understand the ground realities of moral degradation which has led to a huge collateral damage unfortunately.

Additional readings:
http://bit.ly/generic1
A widely cited research on how generics and branded drugs have same quality and effectiveness and generics are for obvious malefic reasons being disregarded for monetary reasons.