Brands vs Generics

There have been many articles on this subject of generic prescriptions vs. brand prescriptions. But unfortunately not many comments have come from one of the biggest stake holders - the pharmaceutical industry. Alas they couldn’t have been able to do much in this slinging match between the professionals and the politician.

As the chairman of one of the leading pharmaceutical importers, I would like to point out that there is a case for drawing the attention of all concerned parties to some of the points which have been missed out in the process of ‘Looking for the forest and missing out the trees’.

A distinction should be drawn between pure generics, branded generics and the “original” brands. In most of the articles the connotation to the exorbitant prices charged by brands applies only to a very few ‘original’ brands. As per the last available IMS data, the sale of these original brands is only a negligible percentage which does not deserve the unholy attention being focused on this issue currently. The prevailing healthy and sometimes unhealthy ‘dog eat dog’ competition in the market place which is the direct result of an open economy has enabled the availability of commonly used products in Sri Lanka at much cheaper prices than the exporting country. A classic example is the availability of essential antibiotics like Amoxycillin, Ciproflaxacin, Erythromycin, Clarithromycin, Ampicillin and even Amoxyclav as branded generics at lesser prices than in the exporting countries like India, Pakistan and Bangladesh. This is the direct result of availability of large number of branded generics and tough competition among companies. Even some of the life-long prescription drugs like Clopidogrel, Losartan Potassium, Atorvastatin, Simvastatin, Captopril, Omeprazole, etc are available in the country in branded form from internationally renowned pharmaceutical manufacturers at cheaper prices, often 200 – 300% lesser than in the western countries.

All newer molecules under patency period are available only in original branded form and Sri Lanka being a signatory to the Paris Convention cannot market the generic versions of these products during the patency period. Then what is the need for all this clamour in the name of generics? The country should be thankful that there are so many of these enterprising pharmaceutical companies willing to fight it out in the market for very nominal ROI. Many of these companies fold up faster than they come due to the unviable price situation existing in the market. The CDDA is doing a commendable job given the limitations under which they perform. The elaborate process of registration of a drug, the large number of authenticated data requirement before a drug is awarded registration are safeguards in eliminating import of spurious or sub-standard drugs into the country.

That does not mean that the process is 100% tamper-proof. The instances of drug recall due to post marketing defects/deficiencies do occur even with the most sophisticated and stringent Drug Authorities like USFDA. The physician should be the one and only authority to decide what drug he should prescribe to a particular patient for a particular disease. This right of the medical professional is sacrosanct and should not be tampered with. In a small country like ours a mechanism could be established to warn and correct the errant professional who indulge in prescribing expensive brands for personal gains.

The pharmaceutical industry works very closely with medical professionals and their associations often funding their academic activities and CME programmes. Most of the industry people will agree with me that these are becoming a big drain on the already tight profit margins of the companies. Has the government allocated any funds for these academic activities? Of course the companies do recover these expenses through marginal price adjustments. But look at this from a different perspective. A pharmaceutical company doing basic research and developing a new drug is allowed to charge 300 – 400% extra for 12 years (now 20 years) in the name of ‘original’ brand. In the light of this recovering these small contributions which help advance the academic pursuits of our medical professionals cannot be excessively faulted. Often it is the pharmaceutical industry which facilitates this knowledge upgradation in rural towns by holding CME programmes for rural doctors where consultants from major towns conduct workshops on current trends in treatments.

The profession of Medical Representatives has been made a “Villain” by derogatory remarks emanating from certain quarters. The M.R. is a link between the profession and the industry. They are the disseminators of technical information, painfully collected and processed by the industry and presented to the busy professional in an easy concise form. In most countries they are either pharmacy graduates, graduates from Bio stream or in some cases even medical graduates. Due to constraints of educational facilities in the country, we are compelled to recruit A/L students or brilliant school leavers as Medical Representatives. That in no way dilutes the contribution made by these professionals for aiding the doctors. Many of our medical professionals who start their day at 8 am and end the day by 11 pm have hardly the time and inclination to upgrade themselves continuously. The pharmaceutical companies through the channel of Medical Representatives do provide some assistance to doctors on therapeutic advances, newer indications and above all the surfacing of dangerous side effects with existing drugs.

As in any profession there may be black sheep, or may be some unscrupulous companies who use Medical Reps as a conduit for unethical practices. But that does not deserve the discredit heaped on this profession by a biased segment of doctors and administrators. The difficulties they face due to increase in the number of M.Rs can be dealt in a much dignified manner. Moreover the government and the medical profession should find ways and means of according a better status to Medical Representatives by demanding higher calibre professional interaction to facilitate healthier service to patients. The Minister of Labour will do well to assess the damage at the instance of more than 3000 M.Rs and their dependants along with many intra-dependant businesses like vehicle hiring, printing, advertising, hotel industry, etc may receive a setback from the so-called ban on Medical Representatives. It cannot be a case of the ‘baby going with the bath water.’ I urge the pharmaceutical chamber and other related bodies to apprise the authorities of the wider implications of their decisions.