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(June 08, Colombo, Sri Lanka Guardian) As a layman I have tried to assimilate the contents of the fast raging debate on Brands Vs Generics and it is my considered view that most writers have missed the bus and even the footboard!
Despite highly educated Physiologists, Pharmacologists, Dermatologists, Cardiologists, Industrialists and even Civil Servants who have joined the fray, the line of discussion has been mostly confined to ideology, losing sight of the much needed pragmatism in tackling an issue which involves the speedy curing of patients.
An important question upon this subject is - “are all generics equally effective or do they render identical therapeutic benefits to all patients?” To my mind it is most unlikely, not only due to compelling scientific reasons such as dissolution, additives, packaging etc but also due to the bio-chemistry of individuals varying in consequence to a variety of reasons.
On the other hand, would not the psychological acceptance/rejection also vary? I am thoroughly aware that many people prefer capsules to tablets and yet others prefer multiple dosing of a larger quantum of tablets to single or lesser doses. For example 3 of my acquaintances - the lawyer wife of an International Civil Servant, a classmate who is an Engineer cum Civil Servant and the wife of yet another friend, are all on a prescribed medicine called Levothyroxine. However, all 3 of them did not respond well to a generic of that medicine manufactured in Sri Lanka (cost of only 0.25 cts per tab, but they are doing well with a generic manufactured by a company in the UK. Clear proof that all generics are not equal.
Another important aspect to consider is the dispensing of prescriptions by semi or unqualified pharmacists employed by most pharmacies in the country. Some of these individuals who can barely communicate in English, could very well misread prescriptions unwittingly endangering unsuspecting patients. Given this scenario, should it not be the primary concern of the Ideologists and Social Engineers to lobby for an effective method to have all medicines dispensed only by qualified Pharmacists?
As a patient myself, I seek the advice of a Physician at considerable cost and inconvenience, only due to my desire to obtain a quick and safe recovery. It is also my contention that I contract the doctor, through payment, towards curing my sickness swiftly. Therefore, the task of making decisions for me upon the requisite medicines should solely lie on the Physician of my choice and certainly not on a Pharmacy Worker of questionable competence.
Reducing the number of pharmaceutical brands available for doctors and patients as recently as suggested by so called experts and debated in the media would be short-sighted in the extreme.
When it comes to healthcare, the country and its citizens should be afforded the widest possible choice. It is interesting to note that inquiries made by me from well informed friends, indicate that countries such as India, Pakistan, Bangladesh and also England, Australia, France, Singapore and Malaysia have a plethora of brands, even of a single entity, available for sale in the private market. Why then should Sri Lanka be any different? Limiting numbers apart form creating unhealthy business practices such as cartels, smuggling and price-rigging would also compel patients to procure their medicines of choice from foreign climes at much higher costs and through avoidable inconvenience. Should we permit the creation of such a climate?
Please Mr. Minister, as a PATIENT willing to buy my medicines, about which I know nothing, I would not want restriction on choice. The prevailing system has been successful, so why make radical changes? Incidentally, even though every conceivable item has gone up in price, prices of medicine have remained stable.
As an adolescent in the 70’s, I had acne on my face for which I was prescribed a drug called Doxycycline. In the 70’s the drug cost Rs. 5 per capsule and being a chronic sufferer from the ailment all my life I still have to buy this drug from time to time. How stable pharmaceutical prices have been is proven by the fact that today I pay only Rs. 6 for the same Doxycycline - just a rupee more than I paid 38 years ago goes to show what a great system we have in place in our country.
We could ill-afford to experiment with health and it is my fervent hope that the decision makers will see through the Polemics, Semantics and Rhetoric of the interested parties (especially with an intelligent and clever Minister such as the Hon. Nimal Siripala de Silva, in the saddle) and opt to define and implement a pragmatic Medicines Policy sans the imposition of ideological theories. Health is wealth and health needs to be addressed in a healthy way! Who will disagree?
- Sri Lanka Guardian
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