Generic Drugs: The Murkier Side

By Dr. K. Javeed Nayeem, MD

Last week, I explained the difference between branded and generic drugs and also told you why most doctors prescribe branded drugs exclusively although they may be considerably more expensive than the latter. Today in our country most branded drugs are manufactured by very reputed companies and because their very survival depends on the efficacy of their product they are duty-bound to ensure quality and purity. Every one of their products has a brand name that is linked to them which keeps or kills their reputation. Doctors and patients too over the years have come to associate such companies and their products with good quality and efficacy and have developed an abiding faith in them.

Many multinational companies, by sheer goodness of their products which have become household names in our country, have stood the test of time over many decades. The happy note is that many Indian companies too have braved much competition and succeeded remarkably in establishing their own brands just by ensuring quality through good manufacturing practices. Although I do not wish to mention any names here, you know very well that despite the arrival of many more fanciful products of late, when it comes to pain killers, cough syrups, nutrition supplement powders, infant feeding formulas, cosmetics and toiletries, you are still buying for your grand children the same brands which your grandparents used to buy for you. This only goes to show that when you have a brand name to protect on which your survival depends, you will go to unusual lengths to ensure quality.

On the other hand, when you are an anonymous player in the field without a brand name to identify your presence, you can get away with all kinds of cost-cutting, both during the procurement of raw material and the manufacturing process too. This is exactly what is happening with the production of generic medicines in our country. Only a handful of good and reputed drug manufacturers are producing generic drugs of good quality although they do not carry their brand name. These are the ones who are in the business of manufacturing drugs for the export market where the buyers regularly inspect their factories and analyse random samples from their output. But an alarming number of generic drugs are being manufactured without any kind of quality control, albeit in fully legal manufacturing units.

The point to be noted here is that this legality is often ensured by keeping bureaucratic palms well greased from time to time. This is not surprising as we all know that in our country every business, big or small survives only on this shameful give and take policy. While this arrangement may not be very life threatening in other areas, in the health care sector it is positively lethal. If the drug you trust and take to cure a problem is incapable of doing so effectively, simply because it does not have quality ingredients, you could get caught in a literal death trap. On top of this, if that drug also contains some harmful impurities that get into it as a result of using cheap raw materials it becomes a deadly poison by itself.

It is a well-known fact that many generic drugs available in our country do not have the full quantity of the active ingredient that is mentioned on the package. They consequently can deliver a grossly inadequate dose of the drug that is required to cure a particular problem resulting in much morbidity and even mortality. That is why many patients who had no relief earlier often discover that the mere changing of the same medication from one brand to another by their second consultant results in a dramatic improvement. If branded drugs are banned by law or if their use is discouraged by aggressive government publicity, a confused public stands to lose much, both by way of money and peace of mind.

The marketing of generic drugs has a murkier side too. To ensure that retailers and end-users like dispensing doctors are attracted to buy them, they are marked with very high MRPs and then actually sold at laughably low prices. Anyone who has bought something at the generic counters would have experienced this. Every drug sold there is billed for almost half the marked MRP if not much less. People actually feel happy about this while there is nothing to feel happy here. These medicines are so priced only to make a hero out of the medical practitioner who dispenses them. The patients feel that their doctor is doing them a great service by charging them much less than the MRP for the medicines dispensed at the clinic! The happy doctor in turn remains loyal to the company and continues to patronise their products! It is a case of ‘you scratch my back and I’ll scratch your back’!

Secondly, now that the government itself is masquerading as the Good Samaritan and establishing generic drug outlets called ‘Jan Aushadhi Kendras’ in all government hospitals, a big racket is reportedly operating in their allotment. While most of these outlets are being given to people with political clout, a good number of them are actually owned by the politicians themselves who have ‘Benami’ owners and managers to run them. This is not very surprising as many high-tech private hospitals themselves are actually the ‘Benami’ establishments of many political bigwigs. If you care to trace their rather tangled roots you’ll find them leading to some very well-known personalities!