Bitter Pills:Medicines & The Third World Poor | Page 63

were asked to rate various factors in an order of priority in deciding whether they
would enter a Third World market. Not surprisingly, the main consideration
chosen was "confidence in the future of the market". But, significantly, the second
factor they singled out was "pressures for generic prescribing and attack on brand
names". By contrast, "strictness of price control" rated fifth in order of
importance. (701

OPPOSITION TO GENERICS
Any moves to generic prescribing are resisted. A common reaction is for major
manufacturers and producers' associations to stimulate concern amongst doctors
and the general public that the quality of drugs may suffer without the guarantee
of brand names. Doctors are also encouraged to resist any curtailment of their
'freedom' of choice.' 70 National companies that have managed to establish their
own brands will also oppose a generics policy. As UNCTAD points out: "They
may fear a generic policy more than the transnational firms do because, owing
to their higher costs, they may be less well equipped to face competition in the
market for generics." (721
In 1980 the Indian Government made a significant step to encourage generic
prescribing by abolishing brand names on five commonly prescribed drugs. ( "'
Soon afterwards a spate of industry-funded advertising appeared in the Indian
press in an apparent attempt to discredit the new generics policy.(74) An example
of this propaganda is the advertisement reproduced on the opposite page: "Would
you rather have your doctor choose a medicine for you - or somebody else?"
The issues the advertisement raises are crucial to people's acceptance of generic
prescribing and consequently to cutting drug costs in poor countries, so we shall
take a closer look at the arguments advanced.
"The move to abolish brand names is motivated by the
erroneous belief that if there are no brands, drugs will
become cheaper."
We have seen that brand names do disguise big price differentials. For instance,
Limbitrol Forte, a tranquiliser promoted by Roche in Lesotho, contains
amitriptyline and chlordiazepoxide. This combination product was in 1980 five
times as expensive as the two single ingredients. (75) WHO is in no doubt that
"There is great pressure to use brand names rather than generic names for
pharmaceutical products. Use of the latter could facilitate the availability of
alternative, cheaper drugs that are still satisfactory from the medical point of
view." (7f" Hence WHO's recommendation: "To ensure standardisation and
reduction in price, generic names should be utilised in drug procurement in
developing countries." <77) (our emphasis) Many doctors concur including the
President of the Indian Medical Association: "Of course generic drugs will become
cheaper for the consumer and so far our experience with the drugs that are required
to be manufactured under their generic name has not been unhappy." (7H|
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