“Myself when young did eagerly frequent
Doctor and Saint, and heard great Argument
About it and about, but evermore
Came out by the same Door as in I went.”

Reading the communiqués (that have appeared in your sister journal) dealing with the current conflict that has been raging between the “Generics” and the “Trade Namers”, I was reminded of the above quatrain penned by the wise old Persian poet Omar Khayyam.

The two major casualties (a sort of George Bush-type collateral damage!) in this fratricidal conflict have been the patient, non-affluent or otherwise, and the late Professor Seneka Bibile. The latter’s name and well-deserved fame have been used repeatedly by the Generics to bludgeon their opponents, while efficacy is the main weapon of their opponents.

As a medical man who has been on many cardiac drugs for well over 20 years, and as one who was a close personal friend of Seneka Bibile’s (a man for whom I had the highest admiration) and was privy to his thinking on this matter, from the very beginning, I would like to present my point of view.

I must point out that the proponents of generics “at all cost”, often overlook the most significant aspect of Seneka Bibile’s thinking, regarding drug prescription and drug usage. Dr. Bibile never for one moment advocated the use of a drug simply because it was the cheapest available in the market. His prime concern was the patient’s health. If the patient’s needs could be met equally well by drug A, which cost the patient less than drug B, then Dr. Bibile spared no pains to make the cheaper, yet effective drug available to the public, and he urged doctors to prescribe the cheaper drug.

But the import of raw materials from the source country (a procedure that helped to cut costs) by by-passing the powerful drug companies, went hand-in-glove with his unqualified insistence on effective quality control of the product, before it was put out for use by patients.

Seneka Bibile insisted that the drug used had to be of the highest quality, and this could be ensured only by having an effective and efficiently run quality control laboratory. This aspect of Dr. Bibile’s thinking cannot be over-emphasised.

It is unfortunate that quite often (not always) the fiercest advocates of the use of Generics are people who have had little or no first-hand experience of having been solely responsible for the actual care of a patient. There is a world of difference between knowledge gained by reading the papers and reports of others, or even by working in a laboratory, and the knowledge that is slowly built up over the years by personal experience of handling patients, observing their response to a particular drug, and most importantly, being totally responsible for and answerable to their patient and his/her family.

As a medical man, I am better placed than the lay-person to have some idea of the nature and efficacy or otherwise of the drugs I use. When I am convinced, and when this conviction is backed up by an experienced physician or surgeon that a cheaper and effective generic-named drug is available, then I would certainly go for the generic-named drug.

But if I have my doubts about the quality control methods used in testing that cheaper drug, or if an experienced and concerned physician cautioned me about the drug, then I would go for a drug from an established, reputed drug company, which generally (for purely business reasons) cannot afford to risk their reputation, even in a Third World country, by supplying sub-standard drugs. So, in practice, I use a mix of the two forms of drug, bearing the same chemical name.

The vast majority of doctors (unfortunately only the exceptions receive wide press coverage) are caring and not impervious to the difficulties that patients undergo from a financial point of view, and they do their best to give the patient the best. A patient would not want to risk (just as I would not) using a sub-standard drug, even if he is hard pressed to obtain a more effective drug at a higher cost.

At the end of this unresolved conflict, the average patient has been left more confused than ever. Perhaps the various medical and surgical colleges and associations could combine their wealth of knowledge, based both on theoretical considerations and long-standing experience, to set out guidelines for the average, perturbed patient.