A large number of articles have appeared in many English newspapers and also a few in the Sinhala press during the last seven months on the subject of generic drugs and brand drugs.

The majority of these articles have been written by senior academicians such as pharmacologists and physiologists, probably with the intention of educating the doctors and the reading public. Only a few have been written by practiaing physicians with clinical experience. As I happen to be the practising physician who has written the largest number of articles on this subject, and as I have been prescribing both generic drugs and brand drugs for over 44 years, I decided to write this final article on the subject for the benefit of the reading public as some of my patients have told me that they have been confused after reading the articles written by some of the non-practising academicians.

It is noteworthy that practical clinical knowledge and clinical sense are far more important than ‘physiological sense’gained by working in a physiology laboratory and ‘pharmacological sense’ gained by reading pharmacology books and journals. Every doctor passing out of medical schools in Sri Lanka knows that physiology and pharmacology are only two out of sixteen subjects taught in our medical schools. A distinction in pharmacology obtained about sixty years ago is the only qualification in pharmacology which one of these non-practising academicians has been quoting in some of his articles written to the newspapers during the last seven months. It is common knowledge that pharmacology taught in medical school sixty years ago was quite different from that taught to medical students today and in the recent past. In this connection, I recall an incident over four decades ago when a very senior, highly respected and distinguished physician happened to remark to a batch of young final year medical students, that he had obtained a distinction in Pharmacology in the then Colombo Medical School. A young medico, noted for his loose tongue, straight- away said to the embarrassment of everyone "Sir, in your time, in pharmacology you had to learn only twenty drugs and went on to enumerate them, "quinine, digitalis, salicyclate, liver extract, chloroform etc."

The majority of practising doctors who have written articles on this subject have informed the reading public that although most generic drugs are cheap, some of these drugs are not effective and some of these cheap generic drugs are manufactured as a cottage industry in India and Third World countries.

It is noteworthy that with the facilities available in Sri Lanka, doctors are not able to test a majority of drugs for bio availably in our country. As a result, our quality control lab cannot test drugs such as antibiotics, pain killers like diclofenec sodium, chemotherapeutic agents etc. When doctors like to get a report, our Drug Regulatory Authority (D R A) has to send the drugs abroad. I realiably understand that our quality control lab can test only about five per cent of the 8000 odd agencies available in Sri Lanka.

When it was pointed out by practising physicians that to date no clinical trials have been carried out in Sri Lanka comparing the efficacy of generic drugs available in Sri Lanka with brand drugs, one senior academician informed the readers that he is planning to do a large scale clinical trial in Kandy with a view to compare the efficacy of the generic drugs with the corresponding brand drugs available in Sri Lanka. I do hope that this senior pharmacologist will publish the findings of his clinical trial for the edification of practising doctors during our lifetime.

As far as I am aware, a large number of generic drugs (said to be over 8000) have been allowed into our country with the approval of the Sri Lanka Drug Regulatory Authority (D.R.A.) and there are a large number of generic amoxicillin (over 100), large number of generic citizen, generic losarten, potassium, generic diclofenc sodium just to cite a few examples. Are such a large number of the generic preparations of the same drug necessary for a small country like Sri Lanka? Are all generic drugs as effective as the original brand drugs?

The majority of practising physicians, known to me personally, do not prescribe generic drugs available in our pharmacies and hospitals when they are faced with an acutely ill patient such as a heart attack patient, very ill ‘collapsed’ patient, a seriously ill pneumonia patient, a comatose patient or a patient in status asthmatics (very severe asthma). The same is true with regard to surgical emergencies such as severe pertonitis as only the practising physicians and surgeons who are actually treating these seriously ill patients and not the non-practising academics are responsible to the patients and their families.

If there is a medico-legal problem and if a case filed by a patient’s relatives seeking damages in the case of death of a patient, the practising physician or the surgeon, cannot quote articles written by senior academicians in a court of law as such academicians have not practised clinical medicine for four to sex decades and such academicians will not be invited to give evidence in a court of law to defend the practising doctor.

I would like to quote a few extracts from an article in a recent popular Sunday newspaper by a highly respected physician in Kandy.

"As a medical man, I am better placed than the lay person to have some idea of the nature and efficacy or otherwise of the drugs I use. When I am convinced and when his conviction is backed by an experienced physician or surgeon that a cheaper and effective generic drug is available, then I would certainly go for the generic drug.

"But if I have doubts about the quality control methods used in testing that cheaper drug, and if an experienced and concerned physician cautioned me about the drug, then I would go for a drug from an established, reputed drug company which generally (for purely business reasons) cannot risk its reputation even in a Third World country by supplying substandard drugs. So in practice, I use a mix of the two forms of drugs bearing the same chemical name.

"There is a world of difference between the knowledge gained by reading the papers and reports of the others or even by working in a laboratory and the knowledge that is slowly built up over the years by personal experience of handling patients, observing their response to a particular drug, and, most importantly, being totally responsible and answerable to their patients and his/her family.

"The vast majority of doctors (unfortunately, only the exceptions receive wide press coverage) are caring and not impervious to the difficulties that patients undergo from a financial point of view and they do their best by the patient. A patient would not risk (just as I would not) using a substandard drug even if he is hard pressed financially and would somehow endeavour to obtain the more effective drug even at a higher cost".