Recently, in India guidelines have been issued for doctors to prescribe drugs under generic names instead of brand names. The generic name is the chemical name of the drug i.e. the composition. For example, Paracetamol or acetaminophen or para-hydroxyacetanilide, Amoxicillin, Metronidazole
Let me try to put the records straight.
I was and still am a strong proponent of generic medicines.
Most of us are.
I am aware of the standard practice in the developed countries.
Most of us are.
For that you need to have high quality, quality controlled, cheap and widely available generic drugs!
And you need to stop manufacturing of ALL brands (except the brands which are actually research products of any company, like Sporanox of Janssen, Zovirax of GSK or Aklief of Galderma ).
But here in India we allow hundreds of ‘me too’ brands along with the original one as the ‘original’ brand is costly and not affordable by public in general.
The same molecule is allowed to be marketed under different brands and under different price tags!
Now here comes another twist in the tale.
The upper and upper middle class Indians who are widely traveled, read, connected and has relatives in some developed countries have become aware of a new word ‘Generic’.
This has become a fashionable word.
And any government would love to polish its own image as sensitive, aware and knowledgeable !
And why not, play Robin Hood.
So, let there be ‘generics’ and there was ‘generics’.
This is not for the same reason we fought for generics three decades back, not for the same perspectives either!
Let’s look back before we look forward.
1. Hathi committee in 1975 advised for generic medicines as a step for future complete nationalisation of health care
2. In 1978 WHO declaration came as “Health for all by 2000 AD”
3. Bangladesh announced a drug policy making it mandatory to prescribe only generic medicines.
Fast forward to 2023
1. India has left the path of soft/pseudo socialism and opted for the path of open market
2. All the companies are allowed to manufacture and market branded medicines
3. So called generics are being made by the same companies which produces branded medicines at a different price.
4. Branded generics are a peculiar hybrid of these two.
5. Brands are being created by spending millions(Amitabh Bacchan for Mankind is just one example)
6. All the online platforms sale branded products
7. A generic is also manufactured by a company.
8. In 2016 the then MCI made prescription of generic medicines mandatory. This remained as an announcement only.
9. Target is finally a modern medicine doctor who ‘should’ prescribe generic medicines
Simultaneously Branded medicines are allowed to be manufactured and marketed
To make the matter even more complicated, if not worse, in recent years we have ‘generics’ here produced by some shady companies without any quality control and in most of the cases this so called generics are costlier than most of the brands available in the market!
That is a sad(and mad) situation.
As a result of which now in India we have
1. Original brands(patented and comparatively newly developed products which are the research product of the developer)
2. Hundreds of ‘me too’ brands(branded generics)with different brand names, different price tags and understandably different quality and efficacy. But these are supposed to be passed through stringent quality control.
3. Government promoted ‘generics’ almost without any quality control and mostly with higher price tags.
We allow all these three categories to continue at the same time which is the crux of the critical situation we are in.
How can a doctor or patient ensure the quality if pure generic drug by salt name is forced ? Then the patients will be at the mercy of the chemist who will simply sell the brand with maximum profit.
The primary interest of any doctor anywhere in the world is to cure the patient. Because, he knows well that the reputation of curing the patient is the capital of his profession. Therefore, he does not compromise on the quality of his prescribed medicines for his own sake. But a druggist or a chemist does not have that responsibility. If the disease is not cured, the doctor gets bad name, not the druggist!
Now, without making these ‘generic’ and branded generics(me too) producing companies accountable and without stopping these hundreds of ‘me too’ brands(which the government is not in a position to do) there is no point fixing the trained and qualified medical fraternity in the firing squad and pretend that the problem will be solved this way.
What is needed is a radical change in drug policy consisting of these policy positions
1. To establish a transparent , efficient and effective drug control department
2. To develop proper infrastructure of drug testing to maintain proper quality of drugs
3. Drugstores must have a pharmacist at all times, not just on paper for the license, but in practice.
4. To restrict licenses to multiple chemist shops in one locality which is needed to control the unhealthy competition of local drug stores,
5. To fix a ceiling of the price of medicines,
6. Tax-exemption of life-saving and long-term essential drugs,
7. To take effective measures to prevent the sale of fake medicines ,
8. To strictly ban the sale of kinds of medicines(like schedule H) over the counter,
9. To ban quackery.
We need to put the horse in front of the cart and not the other way round.