'Generic' diktat to doctors raises queries

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By Our Special Correspondent
  • Published 23.04.17

New Delhi, April 22: The Medical Council of India has asked doctors across the country to prescribe medicines only using their generic names or face "disciplinary action", the fresh circular issued on Friday reiterating earlier orders from 2002 and 2016.

The move by the MCI, the country's top regulatory agency for medical education and practice, follows a pledge by Prime Minister Narendra Modi last Sunday that the government would take legal steps to get doctors to write generic names.

Friday's circular cites the 2016 revision of the MCI's code of conduct, binding on all doctors in India, that said that "every physician should prescribe drugs with generic names legibly and preferably in capital letters". It adds that all registered doctors are being "directed to comply" with this "without fail".

The circular, sent to all medical college principals, hospital directors, state medical councils and state health secretaries, says that "any doctor found violating" these provisions could face "suitable disciplinary action".

The move is intended to help patients obtain the relatively inexpensive generic drugs instead of branded original drugs that many consider too costly.

However, some doctors and industry analysts said they were uncomfortable with the likely consequences of the order, which would end up shifting the choice of the brand from the doctor to the retail chemist.

"This has the potential to create havoc," said Vijay Malhotra, president of the Delhi Medical Council. "Instead of doctors, retail chemists will choose which brands to give to patients - and they will select brands that give them the highest profits."

Doctors say that leaving the choice of brands to chemists could work in an ideal situation where every brand of a medicine is equal to another.

"In principle, we would have no problem writing generic names, but all brands in the market are not perfectly equal," said A. Marthanda Pillai, a former national president of the Indian Medical Association, the country's largest private body of doctors.

Routine sample-based screening of medicines suggests the presence of substandard medicines in the market, typically between six and seven per cent of the samples picked, that fail standard quality tests.

"We completely support the need to lower the costs of medicines, but this is not a practical route," said Ramendra Tandon, secretary of the Indian Medical Association. "The best way to lower drug costs is to bring all medicines under price control."

He added: "We've been expressing our concerns about this proposal to the MCI and to the government. We will do so again."

Doctors also highlighted that many medicines were fixed-dose combinations of multiple drugs, each with unique concentrations.

"How can you expect a doctor to write the generic names and concentrations of three, four or even six drugs?" Malhotra said.

Patients' rights advocates have been urging the government to introduce cost-based pricing of medicines, imposing price caps after taking into account the manufacturing costs and margins along the drug distribution chain.

The current price caps are calculated on the basis of a formula that takes into account the average market prices of certain brands. Analysts say a cost-based pricing will be transparent and likely to lower prices more effectively than the market-average formula.