Let me start by nailing the canard that the medical community is somehow allergic to the concept of prescribing medicines generically rather than by their brand names…that is, for example, prescribing Fexofenadine instead of ‘Allegra’ ‘Agimfast’ or `Alafree’. This is pure fiction far removed from reality; fact is that an overwhelming majority of doctors are in support of this laudable idea and believe that it ought to be practiced as a rule in India as indeed it is in much of the developed world, in line with best global practices.
Far from resisting it we, therefore, welcome the government move to enact a law that would make it mandatory for doctors to prescribe molecules instead of brands. If for nothing then to tax our brains a little less than they already are: it would be much less vexatious to remember the names of a few molecules than dozens of brand names. On a more serious note, we really do believe that the choice of brand ought to finally rest with the consumer.
Why then did 73 per cent of doctors surveyed in a recent study stand against the legislation? This is because, beyond all else, the raison d’etre of the medical profession is the interest of patients. Molecule prescription for sure is the way to go but it cannot be allowed to take precedence over patients and their interest, which is what we fear, might happen if this legislation is enforced without adequate preparation and in the absence of a comprehensive legislative ecosystem addressing every aspect of the issue.
Our apprehension is based on several reasons: One, in India we do not have a fail-safe system that ensures the quality and pricing standards of medicines across brands. And, therefore, the same molecule could (and most often does) cost differently: that is, Allegra, Agimfast and Alafree may quite easily carry different price tags despite being the same molecule. Why must this be the case? It is for the government and not doctors (who are in no way involved with drug branding, retailing or pricing) to regulate this and enforce a one-molecule-one-price ethic with iron-handed firmness. If prices are standardised and divorced from its maker and brand names it would end the alleged doctor-drug company nexus and conclusively bury the suspicion of doctors favouring one brand over another for a few extra rupees.
Similarly, the new legislation assumes that the efficacy of a molecule regardless of its brand name is identical; ideally, yes. But as doctors we know that it is not invariably so and the effectiveness of two brands of the same molecule may vary, at times quite significantly, bringing to serious question the issue of quality. The government must move to standardise this too with a fail-safe system, if necessary with legislation.
Third, from experience doctors learn to trust certain brands over others based on their efficacy and, therefore, prescribe them guided by patient interest, which is without doubt the overriding objective of medical practice. Sure, as everywhere else, the medical profession too may have its share of black sheep…doctors who push certain brands over others tempted by pecuniary incentives. But as a senior member of the medical fraternity with more than thirty years in the profession, I can assure you that such doctors are extremely few in number.
Our contention is very simple: introduce and put in place failsafe legislative and systemic safeguards that ensure that all brands of the same molecule cost the same and are qualitatively identical before forcing doctors to prescribe generics. The prescribe-molecule initiative is an excellent one but it can be safe for patients only within a context of total standardisation, especially in a country like India where a huge majority of drug users are illiterate or barely literate.
We fear that enforcing the prescribe-molecule only law ahead of creating an adequate and patient-oriented legislative environment may result in a far more dangerous situation: instead of doctors a chemist, not bound by any commercial or ethical obligations on what he sells to patients so long as it is prescribed, may end up influencing which brand a patient buys driven purely by profit margins. Given a choice, would we want a doctor or a chemist to decide which medicines a patient consumes?
In summary, the medical fraternity offers to work collaboratively with government to shape and put in place a comprehensive regulatory framework, which primarily and above all safeguards patient interest by quelling unethical practices if any including unsavoury nexuses, ensuring that only medicines of the highest quality are retailed and finally, by standardising prices. This will ensure that quality medicines are not just available to everyone but also affordable to all.