Medicinal drugs generic names, brand names and cost

Prof Herbert A. Aponso, Emeritus Professor of Paediatrics, Consultant Paediatrician

Medicinal drugs have non-proprietary and proprietary names. Non-proprietary or generic names are the official approved names. Proprietary names are the names given by pharmaceutical companies, which sell the drug (under different names, at different prices).

These are also referred to as brand names. For example, ‘paracetamol’ (‘acetaminophen’ in USA) is the non proprietary name of the common fever reducing and pain killing drug. It is sold under many proprietary names such as ‘Calpol’, ‘Cetapyrin’, ‘Panadol’.

Drugs sold under non-proprietary names are usually much cheaper (sometimes as much as one-fourth) than those sold under proprietary names. If a doctor prescribes a drug by the proprietary name, the pharmacist is obliged to supply the preparation that has been mentioned.

If it has been prescribed by its generic name, the pharmacist could use his discretion to supply either a cheap generic drug or an expensive brand preparation;* it should be noted that the pharmacy earns a certain percentage of the sale price*. No sensible doctor would like a pharmacy salesman to decide which particular brand should be dispensed, especially when it is known that some brands are imported by drug firms with questionable track records.

To give an illustration of the role played by doctors in increasing the cost of medication, we quote this situation, which is certainly not uncommon.

Doctor A prescribes, for a wheezy child, the most expensive amoxycillin syrup, the most expensive salbutamol syrup, an expensive brand of steroid tablet when the cheap tablet of prednisolone is equally effective(are they trying to cover the fear of some patients for prednisolone?), and the most advertised and expensive paracetamol syrup, when the very same drugs are available much cheaper and with the same efficacy, as prescribed by Doctor B.

It is unfortunate that there are some doctors who do not know, or do not care to find out the cost of the medicines that they prescribe. They ‘remember’ only the ‘catchy’ and expensive brand names of drugs. Some members of the ignorant public are also made to think so. Patients (or their parents) go to a doctor, trusting him/her to do the best for them.

Does a doctor think that prescribing an expensive drug is a hallmark of a competent doctor, and that those who continue to prescribe the generic or less expensive drugs are perhaps lagging behind the latest developments? Nothing can be further from the truth.

At present, there are well over 100 brands of amoxicillin, the cost ranging from about Rs 2 to about 3 times that amount. A common drug prescribed for severe pain and/or high fever is diclofenac.

The price of a 50mg tablet varies from 60 cents to ten times that amount. And so it is for many, many drugs. Patients have the right to find out from the doctor whether a less expensive, but reliable drug by the generic name is available, especially in the case of expensive drugs. The million dollar question is: “are they are equally effective?”

Generics

In this connection, it should also be mentioned that some generics are not presently available in the form that is indicated in a particular situation; eg. rectal preparations of diclofenac and diazepam.

It is an unfortunate fact that ‘rich’ ties (“I’ll scratch your back, you scratch mine”) between some doctors and some pharmaceutical firms is one of the main reasons for the escalating cost of drugs.

Most medical professionals and their Associations lean heavily on the patronage of pharmaceutical firms for maintaining high standards in the organisation of their meetings, seminars, symposia and the accompanying ‘fellowship’; in the final analysis, it is the patient who pockets these bills.

How many poor people are compelled to beg and borrow, and perhaps forego the essential family needs such as adequate food and clothes for the rest of the family, because doctors have not cared to give a thought for the high cost of medical care, resulting from unwarranted prescription of expensive drugs (not only in the private sector, but in the State sector as well, where poor patients are asked to buy expensive drugs - also expensive investigations), when equally effective drugs may be available at a cheaper price.

A former President of the Sri Lanka Medical Association, of the recent past, called upon all doctors to refrain from advertising any brand drugs at their workplaces. However, we regret to observe that some popular brands are being advertised, all over the country, on the name boards of several private hospitals, dispensaries and surgeries, pharmacies, and even boutiques.

It should not be misunderstood that what is being advocated is that expensive drugs should be withdrawn. Sometimes an expensive drug becomes very necessary, if a less expensive one is deemed to be less cost-effective, or not available.

It should also be pointed that the quality of some drugs that are available under the generic name are not always reliable. The key word is reliability. Well accepted brands are reputed to take stringent measures in maintaining the quality of their preparations. ‘Well accepted’ are two relative words. Who is the judge? The authorities, as well as the public, should always be vigilant that substandard drugs or vaccines are not purchased and released to pharmacies; the criteria should be efficacy and not merely the cost.

It is a good thing that there are ‘watch dogs’ in the country serving this important duty. However, they should be discreet in making public sensational statements about drugs or vaccines, without having made a thorough study, lest they become ‘barking dogs’ that cause unnecessary agitation, pain and anxiety among the public; their one and only duty should be to search for the truth and negotiate with the authorities without causing panic in society.

If drugs, both generic as well as brand ones, are to be reckoned to be effective and reliable, it would be absolutely necessary for the State to take measures to ensure a strict quality control, such as continuous random testing of all medicinal drugs. At present, there is no quality control laboratory to test the bio-efficacy of drugs, though there is a Sri Lanka Drug Regulatory Authority.

Implemented

It is only when these meaningful steps could be implemented, that the free import of drugs could be banned, and doctors provided the necessary guidelines. It is then up to the medical profession to fall in line with the desirable practice of generic prescribing, as far as is possible, with the honest intention of keeping in mind the best interest of both the medical and the socio-economic situation of the patient, family, community and country.

Recently, S. Africa and Brazil, where a large majority are poor and are also affected by HIV/AIDS, have defied the international patent laws, especially those relating to drugs for HIV/AIDS, for the benefit of the poor patients.

Developing countries are demanding that big drug companies match generic prices. The drug industry is on the defensive. Under pressure from protesters, Western companies started to back off efforts to defend patents in the Third World.