Chaos over drugs

There was absolute confusion amongst pharmaceutical companies and doctors after Health Minister Nimal Siripala de Silva was reported in the media as saying a ban on prescribing branded drugs by doctors would be enforced from January 1.
The reports were based on a public speech made by the minister outside Colombo and implied that government doctors will be only permitted to prescribe drugs with generic names while private doctors would be allowed to prescribe brands along with their generic names.

The whole purpose of the exercise (in government hospitals), according to a circular issued by the Health Ministry, is to ensure that drugs are made affordable to patients.

The debate over the high cost of drugs is a growing one in Sri Lanka and the rest of the world. The Sunday Times FT and other sections in the newspaper have often raised the issue of the exorbitant cost of drugs and too many brands being marketed in the country.

The latest furore stems from the fact that the private medical profession is yet to be informed of the rules, if they are being applied to private doctors as well. Our report says the government has no say as far as private doctors are concerned which makes it even more unclear what the minister’s position is. “Will we be penalized if we write brand names in a prescription? That’s what we want to know,” one doctor said, adding that only the Sri Lanka Medical Council has the right as the profession’s regulatory body.

While patient rights movements have been pushing for the use of generic names and also a reduction in the number of brands that have been approved by state agencies in a bid to cut drug prices to patients, doctors and the pharmaceuticals industry have been resisting these moves saying prescribing generic names only would put the patient at risk.

There are always two sides to the story and that is clearly evident in this case. On one side, the cost of drugs is rising and when you add to that the cost of seeing a consultant (and hospital charges, etc), it makes a huge dent in one’s purse. Even poor patients are now consulting doctors at private hospitals, desperate to get the best advice and treatment. Private hospitals, particularly where the most popular consultants are available, are packed like sardines and often resemble the government hospitals of yesteryear when private, channeled practice by government doctors was not permitted.

On the other hand, prescribing generics and asking the patient to make an informed choice is – to many people – an even bigger problem.

How can patients decide on an issue that may cost them their lives? They are not experts. When a doctor prescribes a particular brand, he takes responsibility (or is supposed to) for recommending that particular drug because (in most cases) he knows the efficacy of the drug (which may vary from brand to brand). Doctors are raising a very valid point now – who takes responsibility if a drug doesn’t work, if there are complications? The pharmacist?

These are issues the Health Ministry must take into consideration when rushing with regulations and guidelines that deal with people’s lives. In government hospitals, the system is ad hoc as of now. Some doctors prescribe brands and generics while others may write only the generic names. The ministry circular is also confusing. It says that the ministry wants to promote prescribing of generic drugs as branded drugs are costly and hence has banned medical representatives from visiting hospitals to promote their products. However why should the ministry refer to the cost of drugs at government hospitals when all drugs are expected to be freely available to all patients including outpatients? Or is it because some drugs are unavailable in hospitals and then have to be purchased outside by the patient?

The industry accuses the government of no proper guidelines on drugs. “All kinds of brands are imported … dozens of them and then the government says don’t prescribe branded drugs,” one industry player said, adding that there is a need for a national drugs policy. That probably would be the best solution for the impasse over drug prices, an issue that has been debated for many years.