The prescription debate; The Judge know better than your doctor?

A recent urgently called meeting by the boss of my medical university , caught me off guard. The busy out patient of my department needed me more as I was the only consultant on duty. But you comply to orders from the higher up, the system minces no word . The long drawn , passionately debated meeting was regarding a recent court order by the high court of the state. The court listening to matters related to unethical and fraudulent practices of a hospital , which was owned and run by a non-allopathic practitioner , gave some blanket sweeping orders pertaining to a prescription of a doctor, allopathic ones( Irony ,never cease to amuse). It says , a doctor must write a prescription , with a legible handwriting or typed, with patient’s name , date and doctor’s name , signature , date and registration number . Also he must write generics only ,in block letters, with proper dose , frequency, route and duration.

Now , nothing seem out of place in the first look. The recent , MCI( Medical Council of India, apex body for allopathic medical practice) and Apex court directives take the same stand. And , not to get surprised , our populist prime minister outright threatens the deviant doctors.

So what is this hullabaloo? our group debated , some of the salient features , were:

  1. what about fixed dose/drug combination , where there can be as many as a dozen compounds in one combination. The commonly prescribed ones ,like multivitamins nutritional supplements and cough syrups to name a few
  2. Now , with this added burden, our already overburdened average doctor in this 3rd world country, will be drained further . How do you expect him/her to do this when he spends an average of 2 minutes , taking history, examining , making diagnosis, writing prescription and explaining , it all…oh by the way are you game for some more paradox? Recently , the Madras high court gave directives to the toll plaza managers , to make separate and special arrangement for the VIPs including the sitting judges, so that they don’t lose their precious time. Mind you, doctors and ambulances carrying critical patients were not in that coveted VIP list.

OK. so doctors wont write brands , and write only generics. what about medicines which are not available as generics , most of the recent medications and patented ones are not . Does that mean , we have to not practice , recent updates in the medicine world and keep our patients away from the cutting edge treatment modalities. Hmm.. now that’s a food for thought . The VIPs may take these treatments , as they can fly to the nearest destination out of the country to avail it. And .oh how may i miss this point? Now if doctor’s cant write these brands, then whats the point in marketing these medications, in India.

Imagine a situation where a pharmaceutical   company ,does not see any profit in developing a new drug , will that not stop their research in looking for better molecules . And research are costly affair . A brand is usually costly due to these indirect cost in manufacturing not just the direct ones . And can a socialist government really force pharmaceutical industry in making newer advances , without the incentive of profit . Another food for thought ..huh

Well if doctors are not going to write a brand , then who will decide , which product to be given to the patient , in cases of medicines , which does not have their generics. And there are a substantial portion. The pharmacist ? The patient himself ? Now when we want to buy any item , we have many choices and we are quite informed about their prices as well . They are advertised on all sorts of medias . The medicines are not . An average Joe does not know about the various products . so should medicines also be advertised just like the soaps we use for bathing . Its hard to imagine , at least my limited imagination fails me here . And if the pharmacists decide , then how would we ensure , ethical practice from them ? And on what ground they will decide ? would it not be the highest profit margin ?

Now at last , I thought I might as well dig deeper and understand what exactly is a generic. I for one was always unsure about the definition of this term . And. knock. knock.. MCI does not define it either . Thank god . I am not the only one . So I searched the literature , just like ,how I usually do when I am writing a research paper . I wonder the judges passing the blanket order , did that exercise . looks doubtful . So here it is .

Branded drug:
A drug that is marketed under a trade name by the
company that first brought the drug to the market, regardless of whether
or not the patent on the drug has expired. Branded drugs are promoted by
medical representatives to medical practitioners
Branded generic:
A drug that is marketed under a trade name by any
company other than the company that first brought the drug to the market;
this marketing usually happens only after the patent on the drug expires.
Branded generics are promoted by medical representatives to medical
practitioners. Sometimes, the same drug may be marketed by the same
company under different trade names for different indications; this happens
when the different indications are handled by different marketing divisions
of the company, and retail pricing may vary widely between the trade
names because of differences in the economics of the marketing divisions
Nominally branded generics:
Same as branded generics, except that
these drugs are supplied to distributors and retailers but are not promoted
by medical representatives to medical practitioners. Retailers use their
discretion in supplying these drugs to patients when the prescription carries
a pharmacological name
Generics:
Same as branded and nominally branded generics; this definition
ensures conformity of the suggested nomenclature with international usage
Pharmacological generic:
A drug that is marketed under its
pharmacological name. In popular parlance, such drugs are sometimes
called “generic generics
confused ?Hmm. Now my learned readers may decide for themselves .

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