Times Editorial - Doctors urged to prescribe cheaper drugs - 16/6/2006

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The generics game
The time has come for patients to start demanding more information about their prescriptions.

Medicines are often expensive but some are cheaper than others and generics are often the cheapest of the lot.

In the past, cheap medicines were often treated with justified suspicion. There is a lot of truth in the saying that if it looks like a duck, talks like a duck and walks like a duck, it probably is a duck. Cheap drugs were often low quality and with medicines there is far less room for error than there might be with other products.

The setting up of the Medicines Authority changed all that. There is now a rigorous procedure to ensure that drugs - branded or generic - have the biological, chemical and clinical impact they claim.

So, if we start off from the premise that branded and generic drugs are now of the same quality, the next question is why there is such a difference in price between them.

A pharmaceutical company recoups the cost of development and testing of its drugs (and of all the drugs that never make it to the market) during the life of the patent. After that, generic companies can copy them and can do so for far less.

Drug manufacturers often complain that this is piracy, draining resources they would otherwise spend on research and development of new drugs. The figures are staggering: an estimated $104 billion in lost revenue until 2010 out of a total market of some $533.7 billion.

But don't worry too much about the pharmaceutical industry. Every year there are fewer and fewer small companies, all swallowed up by the so-called Big Pharma. The Big Pharma still survive, still make healthy profits and still develop new drugs. Many of them even make their own generics: If you can't beat them, join them.

But, in the meantime, patients worldwide benefit from the considerable cost savings of generic drugs, especially in the developed world where branded drugs would be beyond the reach of most. The fight against many diseases in Africa depends on generics (the WHO has pre-qualified 45 generics out of 85 drugs aimed at making health care accessible). The lower prices mean twice or three times as many people can be treated.

The problem in Malta is getting doctors and pharmacists to tell patients about generics. The president of the Chamber of Pharmacists, Marianne Sant Fournier, said it was in a pharmacist's interest to tell patients about generic alternatives: A happy customer is a repeat customer. However, patients are reluctant to risk offending their doctor even when generics are suggested by their pharmacist. So the responsibility to tell patients about generics rests with the doctor.

The Medical Association of Malta does not have a policy on this. In general, doctors will only suggest generics when the patient asks. Or when they think a patient cannot afford branded drugs...

Shouldn't all patients have a right to make an informed choice? Why should drugs be any different to any other product?

In the public sector, the active compound - not the brand - is prescribed. Why shouldn't it be the same in the private sector?

Over the years, the medical profession has fought hard to dispel the perception that prescribing is influenced by pharmaceutical companies' "promotions". The best way for the profession to avoid such suspicion is prescribing by compound name - and then letting the patient decide.

If they do not do so, then it is up to patients to demand to be told. It could save them hundreds of liri a year.

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