On Thursday,actor Aamir Khan will share his ideas about healthcare with a Parliamentary panel. It was the actors suggestion of generic drugs as a key to affordable healthcare for Indias poor as advocated in his weekly show Satyamev Jayate on May 27 and subsequently in his column in some newspapers that got him the call from the panel.
Experts,however,have said his idea of prescribing generic drugs is overly simplistic and potentially dangerous.
Doctors quote WHO figures of 20-45 per cent spurious drugs in India to counter Aamirs contention that they are taking patients for a ride. In a follow-up column to his television show,the actor had urged doctors to mandatorily add generic names in the prescription and let patients choose the brand so as not become victims of doctors vested interests.
For one,as some doctors point out,the recipe could make patients susceptible to the chemists business interests as opposed to the doctors who at least has the training to balance his business interests with what is called in management parlance as information bias. And it is a proposition that is defunct when it comes to patented anti-cancer and other drugs.
The World Health Organisation says 40% of drugs in India are fake. In case of generic medicines there is little guarantee of their efficacy or even safety. What if it is a fake? There is no way to determine that. A fake medicine will not allay symptoms,but that is the lesser evil. What if it creates a side-effect for which the patient needs 10 more medicines. Does that really make it a cost effective treatment option?asks Dr Anoop Misra,former professor of medicine at the All India Institute of Medical Sciences and chairman Fortis Centre of Excellence for Diabetes,Metabolic Diseases and Endocrinology.
Dr D R Rai,secretary general of the Indian Medical Association,says the issue of authenticity of the drugs is one among a host of concerns. There is no effective mechanism for regulation of drug pricing. A chemist will often give you a drug at half the marked price. If the government cannot even ensure that registered drug companies charge just price,how will it regulate either the pricing or the quality of generic drugs which is a far less structured industry? There is need for a price regulator and DCGI needs to be more proactive in quality control.
Speaking on conditions of anonymity,a senior doctor at a government hospital said: Every day I have rickshaw pullers and MCD sweepers coming in to say doctor saab write the best medicine for my child I will buy it from outside. They do not know but we know that a medicine is just not a chemical…the temperature,pressure and humidity at which it is packed or the foil used for that or even the weight of the molecule contributes to the efficacy of the drug.
Dr Anoop Kohli,consultant neurologist at Indraprastha Apollo Hospital,says in reality most common brands are in effect generic because the molecule is not patented by the company selling it. The only drug that was researched in India was LSD and about 50% of the Indian drug market is of generics meaning these are molecules whose patent period has expired and companies who are not originators of the drug are selling it. Beyond that it is a issue of quality control because a brand always carries a certain authenticity which doctors would not like to compromise on.
Doctors,however,agree that if generic drugs is indeed taken up at a policy level provided a system of certification for unbranded medicines is evolved it could be the way forward but the initiative in that case would have to come from the government rather than individual doctors. States like Rajasthan and Tamil Nadu with their respective medical supplies corporations have set a trend.