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Is prescribing generics the panacea?

The MCI notification on prescriptions is a mixed bag.

The Medical Council of India, in a notification dated September 21, 2016, recommended: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.” Doctors were thus directed to prescribe drugs by their generic or pharmacological name, and not the brand name. For example, Paracetamol can only be prescribed as Paracetamol, and not as Calpol or Dolo, which are brand names.

The direction on capital letters is understandable, considering the abysmal quality of doctors’ handwriting in general. Some prescriptions resemble a document written (read scribbled) hurriedly under duress at gunpoint (which the ‘legible’ part of the recommendation addresses).

The ‘rational’ clause of the recommendation seeks to control the tendency among certain doctors to shoot from their hips when they prescribe. Prescriptions often include antibiotics, multivitamins, analgesics, tonics to improve appetite, drugs for ‘gas’, mental well-being, and so on, and this calls for ‘rationale’ while prescribing drugs. Certain hospitals do have regulations with regard to antibiotics. Antibiotics, especially the more powerful ones, cannot be prescribed without the approval of a board or committee that scrutinises the genuineness of indication and microbiological correctness. This is a healthy practice that ought to be encouraged.

The existence of a ‘doctor-pharmaceutical nexus’ has been often alleged. Charges that doctors prescribe drugs to favour pharmaceutical companies are made in the media and other fora. Doctors prescribing these drugs are suitably ‘compensated’ by the companies, if not in cash, in kind. Companies sponsor conferences and doctors’ participation in them by meeting the costs of their travel, registration and stay. Some doctors get pharma companies to sponsor their family members too. It is alleged that money the pharma companies spend for these purposes is ultimately paid by the patients.

It could also be asked how many doctors can afford to attend conferences by paying from their own pockets. What about the juniors and the greenhorns, who are the ones who need to attend conferences to upgrade themselves? They need to be supported monetarily, at least partially, in segments. That is, in terms of stay, registration and travel. It is ultimately to society’s advantage that doctors upgrade their knowledge and update themselves on recent advances in their specialty by attending conferences, which a majority of the doctors cannot afford. Sponsorship helps them attend conferences. These could be by the pharma companies, by hospital managements or the government, for doctors working in the private sector and public sector respectively. This will be much more honorable.

Besides conferences, companies are known to ‘finance’ even household appliances, automobiles, and consultation rooms for doctors!

Some of these charges are admittedly true, much to the disgrace of medical profession. The ‘doctor-pharma nexus’, which amounts to bribing in a sense, had to be broken. It is here that the IMC stepped in.

It is a fact that drugs manufactured by multinational pharmaceutical companies, which are often their own patented molecules, are superior in quality, though prohibitively expensive. The quality of the drug is of paramount importance in healthcare, especially in the case of antibiotics; those with questionable quality contribute to bacterial resistance significantly. There are innumerable brand names by which these drugs, manufactured by multinational and native pharmaceuticals, with a wide range of quality, are known by. It is best left to the physician to decide which drug the patient deserves; patients deserve drugs of the best quality.

If doctors are not allowed to prescribe the brand, it will be the dispenser in the medical shops, or the pharmacist, or even the owners of the shops, who will decide the brand the patient ultimately receives, in exchange for ‘favours’ from pharma companies. Hospital pharmacies will sell medicines that give them maximum profit. This could create dangerous, unimaginable, uncontrollable and unregulated mayhem in healthcare dispensation across India.

The alleged ‘doctor-pharma nexus’ will take on the avatar of a disastrous and more sinister ‘pharmacist-pharma nexus’, which will result in a no-holds-barred situation in treating diseases, which India and its sick can ill-afford. It is therefore best left to the physician to decide the brand of drug the patient receives for the latter’s well-being. And physicians need to deal ethically and conscientiously with pharmaceutical companies and their representatives in a manner befitting their noble profession.

earaly@hotmail.com

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Printable version | Feb 22, 2020 9:36:40 AM | https://www.thehindu.com/opinion/open-page/Is-prescribing-generics-the-panacea/article16907711.ece

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