By George Jacob

Kochi, Aug 17, 2023: The National Medical Commission (NMC), India’s top healthcare regulatory body, recently issued a notification to doctors regarding prescription of drugs.

The notification said, beside other things, doctors must avoid prescribing branded generic drugs.

What are generic and branded drugs?

‘Generic’ implies the pharmacological name of the active ingredient in a drug. For example; Paracetamol, the drug commonly prescribed for pain and fever is the generic name. It is marketed under various brand names — Crocin, Dolo, Panadol — depending on the pharmaceutical company manufacturing it.

Regulations issued in 2002 by the now defunct Indian Medical Council, too had mandated doctors to prescribe drugs only by their generic names. The NMC has gone a step further by proposing to cancel the license of doctors flouting that notification to practice.

The NMC contends that generic drugs are 30-80 percent cheaper than branded ones. This is true.

What necessitated such a notification primarily? The practice of pharmaceutical companies, especially multinational ones that manufacture and market costlier branded drugs, returns the favor to doctors by prescribing their patented products. This has led to a ‘doctor-pharmaceutical nexus’ that has come to the NMC’s notice. This is also true in variable extent.

Existence of such a nexus is based mainly on the practice of cash-rich pharmaceutical companies funding medical conferences. Companies shoulder substantial financial burden of such conferences by sponsoring travel and hospitality of delegates and participants and sometimes, their families.

They also sponsor food and beverages served at mega-conferences. It has been charged that humungous costs spent by pharmaceutical companies to sponsor conferences are passed on to patients in the form of costly drugs. This trend has changed significantly lately.

Pharmaceutical Companies are now increasingly hesitant to sponsor conferences. This welcome change has been brought about by the pandemic which made cheaper online conferences a reality. Moreover, there is an increasing trend among hospital managements to sponsor conferences for doctors employed by them, and to offer facilities existing within hospitals for conferences.

Medical conferences have also de-escalated pomp and splurging. Conferences have thus become cheaper to attend and organize. Resultantly, financial dependence on pharmaceutical companies has reduced significantly.

Why are branded drugs costlier, and effective at the same time? New molecules, especially antibiotics roll out of pharmacological companies into the market for human use only after considerable research and development and scientific, long-drawn multi-center trials, which are extremely expensive processes.

When a new molecule is introduced into the market by a pharmaceutical company, the company naturally attempts to recover the money spent in developing it through its sales. Clinicians can be assured of superior quality of the new drug manufactured by the company who originally manufacture it. Especially in terms of efficacy on patients.

Subsequent to introduction of the new molecule, numerous other companies begin manufacturing the new molecule after purchasing the patent from its original manufacturer. Cheaper versions of the new molecule flood the market under various names, but with compromised clinical efficacy.

A drug which was available in the market for 3,000 rupees when it was first launched would be available under a different brand name for 300 rupees, but with compromised efficacy, later. This is reality. The cheapest would always be such drugs manufactured and marketed in their generic version by fly-by-night pharmaceutical companies which flout quality standards. Such companies are dime a dozen in India.

What are the problems in prescribing generic drugs?

• Generally, generic drugs are manufactured by inferior pharmaceutical companies, which sprout like mushroom after summer rains in a very lucrative and expansive medical field. Numerous substandard companies that manufacture substandard drugs operate in a country like India.

• Drugs manufactured in their generic form by such unregulated and inferior companies lack clinical efficacy. This is clinically evident, especially in the case of antibiotics.

• Use of such drugs necessitates patients, who do not respond to them to spend longer days in hospitals resulting in bloated healthcare costs to governments and patients. Costs saved by using cheaper and less effective generic drugs are spent to pay mounting hospital bills, brought about by longer stay in hospitals and ICUs.

• Use of antibiotics of inferior quality result in antibiotic resistance which could be nothing short of disastrous to healthcare sector. Patients suffer ultimately.

• If a doctor prescribes a generic drug, it will be the man dispensing the drug at the pharmacy who will decide the brand. The once alleged ‘doctor-pharmaceutical nexus’ would move way to ‘pharmacist-pharmaceutical nexus.’ At the expense of health of the sickest in this country. A doctor is the best person to decide the brand of the drug most suitable for patients, depending on severity of their illness, and not the pharmacist.

In short, though prescribing generics will undoubtedly bring down healthcare costs, simply because they are cheap, quality of healthcare will take a bashing.

If NMC persists with its directive to doctors to prescribe generics, the onus is on them to ensure quality of generics and other cheaper versions of various drugs available in the market.

(Doctor George Jacob is a Consultant Surgical Gastroenterologist at Lakeshore Hospital, Kochi, Kerala.)