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The generic dilemma
Brands are to individuals what flags are to nation states. They both denote belonging. Young, trendy teenagers wear Habit, IVPlay or Nike, while the middle-aged are more likely to adopt Yves St Laurent or what not. Brands define a way of life, a status (certainly for YSL enthusiasts). Any parvenu can suddenly attract attention and grow in stature by a switch from say Honda to Audi. It also appeals to one of our basic instincts, the tribe mentality. Those displaying the same brands (or at least of equal financial value) usually flock together. Brands have invaded all forms of goods, from clothes to cars, and clearly affect our shopping patterns. But now they are even threatening an important pillar of society, the health sector.
A casual inquiry at a pharmacy can now turn into a dilemma. There is a variety of medicines for one particular illness, each under a different brand manufactured by a different pharmaceutical company. But branded drugs, like in any area of retail, are costly. And a cheaper alternative exists in the form of generic drugs. Hence, last week’s invective by the Private Doctors’ Association is strange, if not disturbing. Though they claim to have nothing against generic drugs, this piece of negative publicity can only hurt patients’ and the government’s pockets.
Heavyweight pharma-industry </B>
There is a misconception in Mauritius that generics are not as good as branded products. However, they are usually made using the same ingredients and in many cases are as good as branded products. In England, for example, the National Health Service (NHS) uses over 60% of generic drugs to treat public patients. In Germany, they use nearly 40%. In Ireland, as the drugs bill has hit the €1 billion euro mark this year, a fierce debate has started about prescription patterns. Generics cost 25% less but represent only 7% of all drugs prescribed by hospital doctors. In the coming month, the Department of Health and Children will review its medicine purchase and there are indications that the focus will be on generics, in a bid to reduce the hefty bill.
Ultimately, the reason why fewer generics are prescribed revolves around the issue of marketing and lobbying. Drug companies form a formidable lobby in Ireland. The umbrella organisation for all brand manufacturers, the Irish Pharmaceutical Healthcare Association (IPHA), is very powerful. After all, Ireland is the biggest exporter of pharmaceutical products in the world, worth over €15 billion. It is now worth €37.4 billion, employing over 24 000 people in the Republic. Such a heavyweight industry will always have the ear of the government. Generic manufacturers blame this intense lobbying for under-prescription of the cheaper drugs.
At another level, drug companies employ an extensive web of salespersons to market their products. These drug representatives are the most potent sales tool in their marketing kit. They are either based in hospitals or travel the country to visit general practitioners. While, on the one hand, they provide educational material about the development of new drugs, on the other, their behaviour has been seriously questioned. Drug reps often lavish all kinds of privileges on doctors. Lavish weekends at spa resorts, expensive dinners in fancy restaurants or free drug samples are quite common.
The key question is exactly how the doctors respond to such pampering. According to the British Medical Journal, many respond positively. A study published by the paper indicates that doctors are more likely to agree to patients’ requests to prescribe drugs that are not clinically indicated. Also, doctors reporting frequent contact with industry representatives show a willingness to prescribe new drugs. Another study, by Gfk Market measures, despite the controversy surrounding Merck and its arthritis Vioxx (subsequently withdrawn after it was found that the drug increased the risk of heart attack and stroke), it still remains the second biggest selling pharmaceutical company in the world. Furthermore, Gfk, when it analysed what caused the uninterrupted drug sales, found that it came down to the work of Merck reps.
Another pernicious influence of reps concerns the educational material they provide to doctors, which come in glossy leaflets with swish design. But, behind the gloss, lies highly dubious research sponsored by the companies themselves. The literature is usually highly biased in favour of the drug they are trying to promote and some doctors buy into that. Irish doctors usually rely on the British Drugs and Therapeutic Bulletin, as an independent source for information on new drugs. However, this year, the Irish government, which previously made the journal available free of charge to doctors, has stopped the funding. It goes to show either incredible ignorance at the top level or worryingly, the influence of the industry in political circles.
EU to import from Asia ?</B>
As Avian flu comes knocking on Europe’s door, with both Turkey and Romania already hit by the deadly strain, the question of generics has resurfaced. This week, it was predicted that many countries will find themselves short of Tamiflu (though the drug will be useless in case of mutation of the virus). A debate has started whether the EU should import generics manufactured in Asian countries. It will be a serious test of morality for the pharmaceutical company in the way they respond to this challenge. Historically, they have shown very little in terms of concern for the lives of people. They have exploited the poor for their drug trials, as was the case with Pfizer, or they have refused to bring down their prices, to allow poor countries to produce cheap drugs. They have even sued some countries, which attempted to do so. India and Brazil are the most glaring examples.
But, for doctors, a serious question hangs over their ethical behaviour. Are they falling under the sway of the lavish treatment they receive from pharmaceutical companies? In Mauritius, there is a pathological snobbery when it comes to products that are locally manufactured, or those that come from, say India. Whatever the reasons for the doctors’ rant against generics last week, we have to take it with a pinch of salt, in some cases, with a good handful…
<B>Diren VALAYDEN</B>
<I>Outlook Correspondent in Dublin</I>
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