By Dr. K. Javeed Nayeem, MD
Of late, there has been much discussion in the lay press about branded and generic drugs ever since reports started appearing in the media about doctors and hospitals swindling patients by making them buy costlier drugs when much cheaper ones are easily available in the market.
In yesterday’s Star of Mysore, my friend N. K. A. Ballal has tried to bring out a comparison between branded and generic drugs. I appreciate his good intentioned gesture because this ongoing controversy has been creating much confusion in the minds of people who are led to believe that they are being cheated by some kind of a scam. Since many patients and their relatives now regularly ask me what this whole controversy is all about and since many of them even do not know the meaning of the terms: ‘branded’ and ‘generic’, I felt that it would be appropriate to use my writing space to clarify their doubts.
This is especially so because today there is hardly any household where someone or the other is not on regular medication. And, regular medication only comes at much expense that eats away a considerable part of the already much stretched monthly family budget. Today if you live in a family where no one is on regular medication you can safely assume that you are living in paradise and thank God for keeping you there! What I am saying is no exaggeration because in this era of high costs and mounting expenses on one hand and single families on the other, with no one to look after the infirm and elderly, there is no greater asset than simple good health. If you are still young, please ask someone in their twilight years to know what I mean.
Leaving aside the few seething rich amongst us who can afford anything and everything and who can hire people to look after them in their sickness and old age, the ordinary citizen can ill afford to grow old let alone fall sick. And when you fall sick there is no other option than to go to a doctor who prescribes medicines which he or she thinks are appropriate for the malady that afflicts and bothers you. Here comes the tricky part. The doctor who sees you can prescribe a medicine by writing its chemical name or its brand name on the prescription. For instance, he or she can write the chemical name as Tab Paracetamol 500mg or the brand name as Tab Calpol 500mg. The first constitutes the generic name and the latter the brand name and because of the traditional way of prescribing drugs over the years, most brand names are better known to most people.
Incidentally, it is easier for most people to remember brand names instead of generic names, most of which can be real tongue twisters if not complete jaw-breakers. For instance, if you come to me complaining of loose motions and I ask you to go to the corner medical shop and buy yourself a tablet of Diiodochlorohydroxyquinoline instead of Bioquin or Ambizole I am sure that you will find yourself in a complete mess by the time I complete writing the prescription!
Besides, how will you remember what to take the next time you or someone in your family falls sick with the same symptoms? Irrespective of which company manufactures the drug, the generic names cannot change and they remain more or less the same except sometimes as in the case of Paracetamol which may also be known as Acetaminophen. But the brand names can be anything coined by the company which wants to make its product well-known by it.
So when we talk of a drug by its brand name, we also talk of a drug with unquestionable quality if it happens to be manufactured by a reliable and reputed manufacturer. That is why, to ensure that you get a drug of good quality your doctor who has faith in a reputed company prescribes a drug by its brand name.
It is no doubt true that most branded medicines are considerably expensive. That is because as Ballal says, the companies that first introduced them would have spent billions on developing them and those amounts have to be recovered before the patents for their manufacture expire, allowing all other to start manufacturing them. Once you have a prescription from your doctor you have to head to your chemist to buy your medicines and here comes the trickier part.
If you have a prescription with the brand name of the drug the chemist is duty-bound to dispense that particular brand and you get a drug in which your doctor has faith. But if you have a prescription with only the generic name, your doctor has absolutely no control over the quality of what you get. The chemist you go to is at liberty to dispense a drug manufactured by any company irrespective of whether it is a reputed and reliable one or not.
What matters here for him is that to keep him legally safe the drug should be from a licensed manufacturer. Other considerations like getting himself a higher margin of profit can then take precedence over what you get out of the deal. It is not his responsibility to ensure its quality. The government should have done it.
But in our country where corruption rules the roost, any Tom, Dick and Harry can set up a drug manufacturing unit without anyone stepping in to ensure quality. That is why we have spurious drugs flooding our markets and many instances of people dying of their ill-effects.
It is a little like going to a grocery store and asking for detergent powder or cooking oil or instant coffee without mentioning its brand name. You should then be willing to accept whatever you grocer hands out and you can then be sure that he will naturally hand out only whatever reaps him the best profit. But do we allow this to happen? Never.
Now, when we do not allow this to happen with our groceries can we allow it to happen with the drugs on which our health and lives depend? Ask yourself.