Bitter Pills:Medicines & The Third World Poor | Page 65

"Somebody other than a doctor may choose a medicine
for you if brand names are abolished and doctors are
compelled to prescribe by generic name only."
This is a bogus argument as it implies that doctors are invariably well- informed
about the special properties and possible side-effects of drugs, or that there is
necessarily any significant difference between generics and brand name drugs.
It also ignores the fact that in India the great majority of drugs are not sold on
prescription.
"Simplicity or confusion?" Generic names are long and
complicated. Some are similar and could be confused.
The suggestion that generic names are more easily confused than brand names
is once again a non-argument. Whereas similar generic names like digoxin and
digitoxin or chlorpromazine and chlorpropamide can cause confusion, it is very
easy to compile an equally lengthy list of confusing brand names, like Aramine
and Avomine, Daritran and Dartalan or Jadit and Jonit.
In fact, generic names are often more helpful in giving clues about the nature
of a drug. For instance, the generic names ampicillin, cloaxac////« and carbenicillin indicate that all three are penicillins, whereas no clues are given by their
corresponding brand names Penbritin, Orbenin and Pyopen.'791 Brand names
decidedly do not make life any easier for a doctor. A Bangladeshi doctor wanting
to prescribe oxytetracycline, is confronted with the choice of Aldacycline Forte,
Clinmycin, Edrucycline, Imperacin, Kedoxyline, Oxaline or Terramycin.18"1
"Laymen think that all products with the same chemical
composition have the same degree of effectiveness. But
chemical equivalence is not the same as therapeutic
equivalence as any good doctor knows... Several critical
factors, which differ from company to company vitally
affect the effectiveness of a drug in patients. These
differences can, and often do, result in variations in the
degree and speed of the therapeutic response - how much
of the drug is absorbed, where in the body and howrapidly
it is assimilated...."
What the argument boils down to is: whereas a generic drug may well be chemically
identical to a brand name drug, it will not necessarily be as effective. The
implication is that a generic is usually less effective.
One key determinant of therapeutic effectiveness is bioavailability: the rate and
amount at which the active ingredient of a drug is absorbed into the blood stream.
This is a significant problem with a relatively small number of drugs. In the case
of one, digoxin, differences between brands that could prove fatal have been
found. A US Congressional investigation concluded that the vast majority
(85 % to 90%) of chemically equivalent drugs can be used interchangeably because
their therapeutic equivalence is not a problem.""' A British pharmacist, writing
58