Replacing brands with generics

In the second week of January last, a High Court bench ordered the relevant authorities to issue a notification asking doctors to use capital letters while writing their prescriptions or deliver printed copies of the same to patients. 
The bench, responding to a public interest litigation (PIL) writ petition, filed by a human rights organisation, also issued rule upon the same authorities to explain in four weeks as to why they should not be directed to take effective steps to issue prescription for patients in capital letters or offer them a printed copy of the same and to mention the 'generic' names of medicines in prescriptions. 
It is not known whether the Ministry of Health or the Bangladesh Medical and Dental Council (BMDC) has issued any notification complying with the HC directive. Any such order was not found posted on the official websites either of the ministry or the BMDC. 
The order issued by the HC, in fact, has been long overdue. In most cases, doctors write their prescriptions illegibly. Many suspect that the practice of ineligible writing is followed deliberately in line with a wrong tradition. The doubters tend to make a point while putting forward the 'suspicion' theory. Their point is that doctors concerned were not supposed to pass their written exams having such illegible hand-writing.  
The HC order is very much pertinent to the physical safety of patients. While delivering medicines on the basis of prescriptions written illegibly, pharmacists or pharmacy employees remain vulnerable to making mistakes.  In the event of wrong delivery of medicines patients remain exposed to serious risks. 
The order that came out from the Bangladesh High Court is nothing unique. Higher courts in a number of Indian states issued identical order for the benefit of patients. 
However, the court order contained another important element that should not be ignored by all concerned. It was about the use of generic names, instead of brand names, of medicines in prescriptions. 
The issue has far wider implications, in terms of patients' expenditure on medicines and business interests of pharmaceutical industry.  But resistance would obviously come from large pharmaceutical companies and a section of physicians if the government asks physicians to write generic names. 
One of the main reasons for the unabated hike in the prices of medicines in recent years is the cost involved in the promotion of brand medicines by drug manufacturers. Major pharmaceutical companies do employ a large army of medical promotion officers (MPOs) in Dhaka and major towns and cities of the country. The deployment of MPOs, who earlier used to be known as 'medical representatives', is quite an old business practice. 
The other means followed by the companies to convince the senior doctors, particularly those serving in large government health facilities, to prescribe their medicines, in most cases, are foul and unethical.  
Allegations are there that large companies offer incentives, both in cash and kind, to physicians or sponsor the latter's participation in international medical conferences and leisure travels abroad. 
The promotional activities, according to industry insiders, involve a substantial part of the operational cost of drug companies. The cost is, however, passed on to consumers. 
Once the doctors are made to write generic names of medicines in their prescriptions, the consumers will have wider options. The companies, instead of spending money on physicians, would cut prices of their products to attract consumers. A price war is not unlikely among pharmaceutical companies. 
In such a situation, major players in the industry and physicians as well are likely to raise the issue of dupability of consumers by companies involved in the production of inferior quality medicines. Doctors would argue that since they mention the brand names of medicines, the consumers get quality medicines.  However, such an argument will not hold water because of the fact consumers, particularly those belonging to the middle and upper class, are well aware of the companies that produce quality medicines. 
Besides, the onus of ensuring the production of quality medicines by all registered manufacturers lies with the Drug Administration (DA). The allegation of widespread production and sale of low-quality and substandard medicines does only confirm ineffectiveness of the DA. 
A pharmaceutical company may be small, but it is not expected to produce low-quality or substandard medicines. In fact, a number of small drug manufacturers have been producing quality drugs. Some of their brands are even market leaders. Even large companies, despite all their promotional activities, could not compete with them. 
The worries about consumers being lured by little-known companies in the event of doctors writing generic names of medicines would not be there if the DA does carry out its responsibility of checking quality of medicines produced by all companies, large and small, diligently. The consumers should not be made to suffer due to the failure of the DA. The government should stick to the requirement of using generic names by doctors. 
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