Drug regulation or a power game?

Prescription slips will now bear generic names of medicines instead of the previously used company names. This has recently been directed by the Drug Regulatory Authority of Pakistan (DRAP).

Every medicine has a generic or salt name which is the active ingredient and a brand name which is given by the production company. In medical school, students are made to memorise generic names and as they enter their postgraduate years they have to add a new memory chip into their heads holding multiple brand names of the same drug which are then prescribed to patients. Now, a new U-turn has taken us down the memory lane back to generic names. Why is DRAP juggling between generic and company names? Is it in true drug regulatory spirit or a new power game?

The global pharmaceutical industry spends three times on marketing as compared to research and development. In Pakistan, pharmaceutical companies spend one-third of their total budget on marketing or convincing doctors into prescribing their medicines.

With innocence on their face, a graceful walk and a handbag full of drug pamphlets in tow, these pharmaceutical sales representatives are found in every corner of hospitals. The same hospitals which have wall signs labelled: “No pharma reps allowed”.

From a trip to your destination of choice, to building your private practice setup, to buying a fancy car, to as small as buying a medical textbook or stethoscope, a doctor has plenty to choose from, depending on the seniority and popularity, as long as the prescription slip has the respective company’s product name on it.

Doctors are equally at fault for the spread of this pharma pandemic. They conveniently give a lecture on medical ethics and then go through to the tea break organised by the company whose drug they are prescribing. Not long ago, we received a message by one of our professors in the unit where I used to work. It read, “from now onwards, all doctors are directed to write (said) antibiotic on discharge forms of all patients”. The reason for the change of drug was the change of alliance. The professor had joined hands with a new drug company.

Yesterday, we were on call in the ward waiting for sunset to break our fast when a well-dressed man carrying a handbag entered our room and greeted us with a big smile. He then started telling us about his company and its two drugs. He put the drug pamphlets on the table and started inquiring about the number of on-call doctors in our ward. “There is an activity” (a tea break), he said when he was told there are three doctors in the ward at the moment. When we told him our meal was on the way, he smiled and left. A drug regulatory crackdown is needed to contain such blatant unethical acts.

This incentivised prescription model rips off the patient population financially. The same drug is sold with different price tags by different companies. Similar drugs are available at prices ranging from Rs50 to Rs500.

Will DRAP’s strategy of not writing company names and instead using generic names solve this problem? No. Once the hold of drug companies on hospitals and doctors becomes weak they will bait in drugstore owners. Before new alliances and power changes are made, the government should intervene and implement a strict nationwide regulation of pharmacies and stop pharma sales representatives from getting involved with drugstores. Otherwise this move by DRAP will end up being a double-edged sword.

Doctors should trust their own abilities and hardwork and stop taking the bait from pharmaceutical companies. How long do we have to chant “we should teach medical ethics in our medical schools” before we actually see any change?