Generics drugs - some questions - a reply

by D. P. Atukorale

I refer to the letter to Editor (The Island 28th January 2008) by Janaka Perera (J.P.). I fully agree with J.P. that, some doctors prescribe expensive drugs because of their high quality. When I was working in the Government hospitals I had to prescribe only generic drugs and cheap branded drugs if the above drugs were not effective or not available in the government hospitals. I used to request the Director or Medical Superintendent of the hospital to purchase the required drugs from a private pharmacy. Of course, in an emergency, we used to buy some of the very urgent life- saving drugs-from-private-pharmacies with the money we had collected in a fund called "Cardiology Unit Trust Fund"

When doctors do practice, they usually prescribe more effective, slightly, more expensive brand drugs, depending on the doctors previous experience, ‘because, when we are treating private patients, we have to prescribe very effective brand drugs. Although one non-practising physiologist has recently suggested that we should do double blind clinical trials, we practising doctors don’t have money to do these very expensive clinical trials. I think clinical trials should be done by the academicians including clinical pharmacologists attached to Medical faculties and publish their results, to show whether expensive brand drugs are more effective than cheap brands.

It is noteworthy that some of the non-practising politically oriented senior doctors who advise the ‘common man’ to buy cheap generic drugs, almost always buy the most expensive (original) brand drugs when they or any of their family members fall ill. I am aware of a nonpractising collegue of mine who had not done any ward round for 45 years and who advised the doctors who are more qualified, and more experienced in the diagnosis and treatment of patients, to prescribe generic drugs, when they do private practice; he says that the prescription of generic and cheap drugs can reduce Health Ministry drug bill and reduce the foreign exchange situation. One of these senior academicians who was posted to a government hospital on completion of Internship, lost all the first five patients he treated and resigned from the Health Ministry and joined the University as a lecturer and is now engaged in advising more qualified practising doctors as to how they should prescribe drugs.

There is a rumour-monger in our profession, who has shown jealousy towards his practising colleagues, and spreads false rumours that some doctors get part of the profits made by the- drug firms, when they prescribes expensive drugs. He has thought it fit to write to the newspapers about ‘his cock-and-bull stories’ instead of complaining to the correct authority, namely the Sri Lanka Medical Council (SLMC) to which any citizen can complain regarding any corrupt practice of any doctor. SLMC does not take action on newspaper slanders.

Although an academician has inquired from me why I don’t do a clinical trial when I get a seriously ill patient, this academician does not, know the value of a human life. The very brilliant physician (late) Dr. R. P. Jayawardene under whom I had three years of clinical training at National Hospital Colombo, always used to advise doctors never to do experiments using very seriously ill, dying patients. He always used to advise us: "First save life and later think of clinical trials" By the way, the above physician’s late P. J’s medical college record cannot be broken by any other Sri Lankan doctor as he obtained first classes in all the Medical College examinations and distinctions and Gold Medals in all Medical College subjects. He obtained MD. FRCP and he is the first Sri Lankan to have obtained FACC.

I must admit that (late) Prof. Senaka Bibile’s ‘list of essential drugs’ which is about 45 years old, was very useful to Sri Lank during (late) Prof. Bibiles (S.B.’s) time as we had severe foreign exchange problems during the period 1971 to 1977. We did not have enough foreign exchange to buy our oil and essential food. (Late) Prof. Bibile did a great service not only to Sri Lanka but also to all the’ third world countries. He had a brilliant medical college record. He was a very good lecturer; but I learnt most of my pharmacology from (late) Prof. N. D. W. Lionel who was a brilliant lecturer. The latter Professor conducted a large number of post graduate classes (free of charge) for all of us who were doing M.D. (Ceylon) which was the most difficult examination in the world during that time and only two or three candidates (out of about 60) used to pass the M.D. each year.

We did not have a Post - Graduate Institute of Medicine (PGIM) during those good old days.

Osu - Sala And  SPC Outlets

There is a misconception among some Sri Lankans that Osu-Sala and S.P.C. outlets issue only cheap drugs (cheap generics and cheap branded drugs). I refer a majority of my patients to buy drugs to Osu-Sala. Osu-Sala has generic -drugs plus cheap branded drugs (which are called SPC drugs), expensive brand drugs and (original) brand drugs (which of course are very expensive). The majority of my patients, especially those belonging to lower and middle income groups and pensioners, and patients over the age of 55 years (as these patients get a 5 percent discount) are advised to go to Osu-Sala and SPC outlets.

As far as I am aware, if any expensive branded drug is not available at Osu-Sala, the pharmacists advise the patients to go to another pharmacy and Osu-Sala pharmacists never try to "force" you to buy generics and cheap brands.

As J.P. has quite correctly suggested, our country should have a fully equipped quality control laboratory so that any of us can get any drug tested for quality. The Hon. Minister of Health Care and Nutrition, I am sure will attend to your suggestion.

I am very happy, that one of my academic colleagues who was the kingpin behind the move to force doctors to prescribe drugs using generic names has calmed down now and, in one of his latest articles, he has advised the practising doctors to prescribe drugs using generic names and to write the brand names within brackets as proposed by the Medical Council.

J.P. if any of your family member’s fall ill, it is always advisable for you to take the patient to your family physician or any other physician known to you. Don’t go to politically motivated doctors and academicians who have not done any ward rounds during the last four to five decades. If necessary, your physician will refer you to another practising consultant for any further advice. It is noteworthy that family physicians can treat a majority of your illnesses. Have faith in your family physician and in spite of very elderly non-practising academicians and armchair specialists advising you to buy cheap generics, always buy the drugs recommended by your family physician who knows all about your past medical history.



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