Bitter Pills:Medicines & The Third World Poor | Page 66

to the Daily Telegraph to counter arguments against generic prescribing, confirms
that "the variation in bio-availability indifferent brands has been shown to have
a negligible effect involving less than 0.5% of patients." {S2) The problem of
bioavailability is not sufficiently widespread to justify its blanket use against all
generics.
"When a c ompany markets a product under a brand name,
it stakes its reputation on the brand. This is a less expensive
way of ensuring quality than administrative controls."
But brand names are no guarantee of quality. According to UNCTAD, "The US
Food and Drug Administration has shown that branded and generic producers
can have substandard products with about equal frequency. A non-branded
product from a reliable firm is just as likely to be effective as a branded
product." 1811
Substandard drugs can present very real problems in developing countries. One
estimate puts the incidence in India as high as 20%. Foreign firms and large national
producers have excellent records on quality. The.problems arise with the mass
of small firms.(841 Nonetheless, the fact that substandard generics are produced
is no argument for reliance on brand names, only for the crucial importance of
adequate quality control facilities to test all drugs.
WHO is similarly dismissive of the claim that a brand name ensures quality:' 'The
image of drug quality is often linked with the brand name and the name of the
producer... However, exaggerated claims of high quality may not be related to
better therapeutic performance of the product but may be used to justify higher
prices and to increase market power." 1851
Dr. Hye, formerly Director of Drug Administration in Bangladesh, explains: "One
common practice of multinationals is to set the quality specifications of their
branded products a little higher or above the specifications laid down in the official
Pharmacopoeia, involving additional refining or processing. This is unnecessary
so far as the efficacy or usefulness of the drug is concerned, but very useful for
the company to justify branding of the product and for claiming that it is a superior
product to other similar products. It also helps to justify higher prices." |8f"
Another factor that makes a nonsense of the claim that brand name drugs arc
intrinsically superior to generics is that brand name producers sometimes buy drugs
in final dosage form from identical sources to generics producers. For example,
in US Senate Committee hearings it was revealed that one generics manufacturer
was producing capsules of chloral hydrate for seventeen companies. The identical
drug, was then marketed both by generics producers and research—based
companies. The only difference being that under the exclusive Merck Sharp &
Dohme, and Squibb trademarks, the drug cost three times more. |87 ' It was also
reported in 1979 to be standard practice for small British generic producers to
manufacture brand name products under contract to the big-name manufacturers.
"The extraordinary situation arises in which the same drug is made in two guises
in the same factory for sale at two different prices, the branded price often being
at least twice the unbranded." |SSI
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