India has announced a controversial plan to force doctors to prescribe generic medicines over branded drugs to slash an alleged nexus operating between pharmaceutical companies and doctors. Prime Minister Narendra Modi said recently that doctors prescribe medicines in such a way that patients have to buy branded medicine from private stores at high prices. "We will bring in a legal framework by which, if a doctor writes a prescription, he has to write it [so that] patients can buy generic medicines" and need not buy "a particular brand of medicine," he said. The move comes after the cost of healthcare has increased and reports have shown that Indians consume a disproportionately high quantity of medicine. People like Sunita Devi, a domestic worker, who has shelled out most of this month's earnings to pay the medical costs of her 4-year-old son who has typhoid. She had to pay nearly 2,000 rupees (US$29), one third of her monthly income, on medicine.
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"If medicine for treating typhoid fever costs so much, how will we cope if there is a serious chronic disease?" she said. With her husband, the family earns 8,000 rupees a month but sickness could make them "beggars," she said. Backbreaking nexus
Pharma companies promote their brand of medicine through doctors using company representatives offering expensive gifts like home appliances or even free foreign holidays. In return, doctors prescribe their medicine that can cost almost three times more than generic medicine. For example, the cost of a generic to treat fever, made and marketed under its chemical name without advertising, is about two rupees. However, its branded variety shoots up to around 11 rupees, The generic medicine and the branded product are equal in quality and effect, said Mathew Perumpil, secretary of the Catholic bishops' Office of Health. "More than the high cost of drugs, there has been irrational prescriptions given out by doctors and use of medicines by the patients," the priest said. According to "Global Trends in Antibiotic Consumption, 2000-2010," India has become the world's largest consumer of antibiotics with usage increasing from 8 billion units in 2001 to 12.9 billion units in 2010. The federal health ministry and the Medical Council of India had in 2012 issued a directive that generic drugs would not be sold under brand names and doctors should prescribe a medicine by its generic name. However, not much has changed on the ground and doctors still prefer prescribing expensive branded medicines to patients. Father Perumpil said "it is good move" to make a law on this. "But an effort should also be made to make the use of medicines more rational," he told ucanews.com. The priest said that the implementation of such a law would be difficult as doctors are used to prescribing brand names and have forgotten the generic names. "The government might regulate the public health sector but controlling the private sector will be a problem," he said. Medecins Sans Frontieres, has also welcomed Modi's move as "a path-breaking step." "It will not only benefit patients but the move will also strengthen public health in the country," Leena Menghaney, head of South Asia, told
an Indian news site. Most church-run hospitals take steps to prescribe cheaper medicine. For example, Father Arockia Dass, assistant director of Holy Family Hospital in New Delhi, said it has a committee of doctors and pharmacists to approve medicines with the interest of the poor in mind. "The emphasis has always been on low-cost generic drugs," he said, adding that other hospitals also needed to focus on benefiting poor patients instead of making money. Will the law succeed?
The proposal is misplaced and if implemented it will only hurt patients rather than the pharmaceutical companies, said industry expert D.G. Shah. Shah, secretary general of the Indian Pharmaceutical Alliance, told ucanews.com most medical products are not interchangeable. "Even if they are similar they are not generic," he said. "Again, with a generic, non-branded medicine, a patient will end up with a product that has not established its efficacy," Shah said. He sees a bigger issue. If the choice of a medicine is moved from a doctor to a pharmacist, then "whom would a patient trust more the doctor or the pharmacist? And, what would be his incentive to dispense a particular medicine?" he said. Industry experts said the proposed law would not adversely impact the pharmaceutical industry as they also make generic medicines. If branded medicines are not selling, they will then produce more generic ones. "In the West, selling and marketing costs constitute about 20 to 25 per cent of the revenue of the pharmaceutical companies. In India, as per the Reserve Bank of India data, the pharmaceutical industry spends just about eight per cent of revenue and so to change to generic prescriptions may not benefit the patient financially," Shah added.