THIRUVANANTHAPURAM: A recent directive from the National Medical Commission (NMC) has sparked a debate on the age-old question of whether patients should rely on their doctors or pharmacists for their medication. While most patients naturally lean towards doctors for medical advice, the NMC’s directive introduces an element of choice, allowing patients to select medications promoted by pharmaceutical companies from the pharmacy.
The directive has sharply divided opinions between medical professionals and pharmacists. The common practice of prescribing a specific brand name has been scrutinised by the NMC itself due to reports of undue influence from drug makers on doctors. On the other hand, physicians argue that sticking to specific brands leads to better patient outcomes as they observe variations in the effects of seemingly identical drugs produced by different companies.
“Unethical practices in promoting branded drugs have raised suspicions among the public. While promoting generic medicines is essential to discourage these practices, I have reservations about the quality of generic drugs in the absence of a robust quality assessment system,” Dr Purushothaman Kuzhikkathukandiyil, a professor of paediatrics at MES Medical College, Malappuram, said.
Health experts are concerned that the power to promote specific brands will now shift from doctors to pharmacists.
Dr Sulphi N, state president of the Indian Medical Association (IMA), emphasised that promoting subpar drugs not only hampers recovery but also leads to adverse effects. “After patients, it is the doctors who are most invested in curing illnesses. Therefore, it falls upon them to ensure patients have access to high-quality medications,” he said. Generic medicines are noted to be 30-80 per cent cheaper than branded drugs, according to the NMC, which aims to increase medicine accessibility. However, experts say each drug has different quality, testing processes and other compounds, even if the formulations seem similar.
Dr Althaf A, an epidemiologist and professor at Thiruvananthapuram Government Medical College, suggested that the government classify drugs based on quality and price to help people make informed choices. He criticised a blanket order without addressing concerns as a flawed approach to rectifying unethical practices.
In the state, approximately 2.5 lakh batches of medicine are sold annually, and government labs can only test 5,000-6,000 batches, leaving most medications untested and potentially risking public health.
O C Naveen Chand, president of the Kerala State Pharmacy Council, praised the directive’s intent to empower the public in choosing affordable medications.
He cited the popularity of generic drugs in Jan Aushadhi stores as evidence of public trust and suggested that the directive could curb unnecessary prescription practices by some doctors while advocating for quality control at the manufacturing level.
The NMC’s commitment to the directive is evident in their notification on August 2, which warns that doctors failing to prescribe generic drugs could face penalties and, in extreme cases, suspension of their medical licences.
Generic drug & generic name
A generic drug is a medication created to be the same as a marketed branded drug in dosage, safety, strength, route of administration, quality, performance characteristics, and intended use. A generic name is the non-proprietary name of a drug. It is the name of the active ingredient in the drug and is the same for all drugs that contain that same active ingredient.
Branded generic drugs
These are formulations that have come off patent and are produced by companies under distinct brand names.
NMC directive
Example: Doctors can prescribe Paracetamol, a generic drug used to relieve fever and pain. They should not use brand names for paracetamol including Crocin, Calpol, or Panadol.
Advantage: Patients can purchase cheaper drugs, which prevents the influence of a particular company.
Problem:
Differentiating factors between branded and generic drugs: