By Dr. K. Javeed Nayeem, MD
Even as I started writing my first article on the debate between branded versus generic drugs I had said that by embarking on this subject I was in danger of opening a Pandora’s Box. The deluge of responses I am getting has proved me right. While my mailbox and inbox are full of them, two letters have made it to the ‘Reader’s Voice’ box of SOM and some others may be on the way! I feel that Dr. Anand, the writer of one of the letters, needs a slightly more detailed introduction to readers. I consider this necessary because I want to highlight some principles of goodwill and co-operation that should exist between doctors. But I wonder why he has shied away from writing under his full name this time. Was it to avoid hurting my feelings?
Let me make it clear that as a writer I welcome criticism by any reader because writing is supposed to generate discussion and debate. Lt. Col. Dr. Y. N. I. Anand is my good friend and we regularly meet and discuss issues of common interest. Unlike most city-based doctors we both have been running out-reach clinics about seventy kilometres away from Mysuru in Chamarajanagar District which cater to the needs of a large number of rural patients who place a great deal of faith in us. These patients in a way can be called underprivileged because they simply cannot afford to travel all the way to Mysuru to see us and buy their medicines too. They can only do one of the two things. For them a trip to Mysuru entails forgoing a day’s wages and paying bus and autorickshaw fare and also paying money to fend for themselves by eating at hotels here. If they spend what little money they have to do this, they have to go back empty-handed without buying the medicines we prescribe for them and their families. That is why Dr. Anand and I prefer to see them in their own places.
While he goes to his out-reach clinic on Wednesdays I go to mine on Tuesdays. Because our clinics are located within the proverbial stone’s throw from each other, we often end up seeing the same patients on many occasions. But unlike some other doctors who dislike this kind of cross-consultation by their patients, from whom they expect unflinching loyalty, we actually encourage it. We have an unwritten understanding that we should be free to revise each other’s diagnosis and also alter each other’s prescriptions whenever necessary in the interest of providing the best care for our patients.
The outstanding difference in the way we practice is that while I prescribe branded medicines of reasonable cost for all my patients which they have to buy from chemists, Dr. Anand himself dispenses very low cost generic medicines for all his patients. But because he selects these from manufacturers of good standing as carefully as he selects jewellery for his wife, his generic medicines do much good to his patients despite lacking a branded lineage!
I simply do not have the time and patience to do this. Very often many of my patients very cleverly take a prescription from me and pick up the equivalent combinations from his pharmacy! But I just do not mind their doing this as I am sure that thanks to my friend’s eagle eye they and their families are safe. So the bottom-line here is that when you make sure that the generic drugs dispensed to your patients are from a good and dependable manufacturer you are doing them a lot of good.
But a consultant like me who does not do his or her own dispensing cannot ensure the quality of what patients get by way of generic drugs from the vast ocean of their availability. Like our Prime Minister, Dr. Anand too strongly advocates the universal use of generic drugs. But who can stand at every drug shop and monitor what each one dispenses? The only way to ensure quality in this field is to completely wipe out all the not-so-upright manufacturers who are having a field day in our country now. In fact such units greatly out-number the good players but in our corruption-riddled bureaucracy this is an impossible task.
Actually, Gujarat, the home State of our Prime Minister himself has the largest number of drug manufacturing units in our country. Among these are the small ones, the big ones, the good ones, the bad ones and the worst ones too!
Over the past few months more than a dozen of my own patients have nearly killed themselves with soaring blood sugar and blood pressure levels after consuming some very low quality medicines from the so-called generic outlets. After they had first-hand near-death experience of what a combination of cost-cutting and poor quality can do, they and their relatives are much wizened now and are back on branded drugs.
That is why I still defend my use of branded drugs. Our Prime Minister simply cannot phase out all branded drugs even if he is re-elected many times. It needs co-operation at an international level. Just see the progress he has made in unearthing ill-gotten Indian wealth stashed abroad, let alone in bringing it back into the country for public good. It was perhaps the item in his election manifesto that fetched him and his party the maximum votes but sadly it had to be tactfully pushed under the carpet of time.
Corruption may be rampant in our country but it is a universal phenomenon. The rest of the world may not have small scale corruption like a Traffic Policeman pocketing a paltry bribe from a helmet-less rider and letting him drive away. But it exists in mighty proportions even in the biggest and best governed countries. We simply do not realise the might of the international pharma lobby. It is as mighty and as powerful as the armaments manufacturers who call all the shots. These giants control mighty empires with international tentacles. Unknown to most of us, they fund Presidential elections and then manipulate the governments of mighty countries to their advantage. They are the ones who tell our governments during the international trade summits what guns we should buy, what cars we should drive, what food we should eat and also what medicines we should take when we fall sick!