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| Sunday, 17 July 2005 |
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Features |  |
| News Business Features Editorial
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Towards a
national drug policy
Consumer ombudsman by National Consumer Watch Consumer watch is greatly interested in the ongoing discussions and decisions leading hopefully to the formulation of a National Drug Policy in this country. At a time of increasing cost-of-living to unbearable proportions, senior citizens and particularly those with fixed income, would be greatly concerned about the cost of medication which can be an intolerable burden. At a time like this families with two or three children of schoolgoing age would also be greatly concerned as children tend to fall ill. From time to time the cost of hospitalisation, the cost of medicine and the cost of consultation of doctors can be a very big burden on most families and it is therefore timely that the authorities have taken steps to formulate a National Drug Policy. Consumer Watch is gratified that the authorities are at long last taking meaningful steps towards this end. If one were to look back at what has happened hitherto, although there has been some sort of a drug policy, there has been no comprehensive document setting out what that policy is. Attempts were made to develop a national medicinal drug policy (NMDP) in 1991 and 1996. It has been reported that while the relevant documents were accepted by the Ministry of Health they did not reach finality with acceptance by Cabinet followed by the requisite legislation. The result is that even today there is no comprehensive document setting out the national drug policy. However the principal stakeholders in this area have now come together and have developed one document based on World Health Organisation's documents through a series of discussions. One can only hope that the necessary politicians will be present to push this to the level of acceptance by Cabinet and that the requisite legislation will follow. It is a matter of common knowledge that from 1970 to 1977 we had a national drug policy based on principles worked out by Professor Senaka Bibile, of hallowed memory who has been referred to as prophet of modern medicine. What he has done was to identify and prioritise some 200 to 300 essential medical drugs which were necessary for the public of this country. This policy was hailed by the WHO and recommended for implementation worldwide. Today some 150 countries are known to follow the salutary Bibile policy and these countries have no cause for complaint. It has been observed, to quote in a recent editorial comment, that "tragically and with grave consequences, Sri Lanka was forced to discard the Bibile principles, the national Drug Policy and the essential drugs lists after global pharmaceutical giants backed by the US Government virtually threatened Sri Lanka with dire consequences". The result is that even today almost three decades later, we have no national drug policy. The above quotation brings to the forefront the power of these global pharmaceutical giants. They have been able to, with the backing of a foreign government to "virtually threaten" the government of a sovereign State to yield to the demands and interests of the private sector at the expense of the health of a nation. This shows what power these giants and multinationals have. Particularly, after 1977 with the introduction of a liberal economic policy doors appear to have been widely opened for the flooding of the local market with a multitude of drugs, imported under different brand names. Instead of some 300 essential drugs recommended by Professor Bibile, it is estimated that some 8000 varieties of drugs are imported and sold in the local market. Many of these drugs are said to be non-essential and unnecessary. They are said to be counter productive and even dangerous. There is little by way of quality control or post-marketing surveillance. What is startling is that a responsible comment has been made that even the most expensive drugs could be counterfeit with flour inside. This is truly tragic from a medical point of view and yet it is the medical profession that has been recommending these drugs otherwise they would not have been imported and been marketed locally. For a poor nation like Sri Lanka, with a majority of people earning less than one dollar a day, the billions of rupees that are expended on expensive drugs imported by brand names could only be characterised as criminally wasteful. The cost is in the region of Rs. 5 billion per year. How much of this money would have been more meaningfully spent on upgrading infrastructure facilities in hospitals and avoiding salary anomalies and other financial problems which appear to be plaguing the medical sector? It has been computed that while Sri Lanka would need to import only about 1500 drugs, more than 6000 are now imported and are being sold. For example, in Britain under the National Health Service only five varieties of the antibiotic "Amoxicillin" is permitted, while we have out-done Britain, poor as we are and have allowed the importation and sale of some 80 varieties of this drug, some of which are said to be the most expensive in the world. What appears to be tragic is that the medical fraternity while prescribing drugs by their genetic name in public hospitals, when they function in private hospitals or clinics are said to be prescribing the same drug in expensive brand names. The public is not aware that the generic names contain the scientific or chemical name for the active ingredients in the drug. The brand name on the other hand is just a trade name for commercial purposes. Why the medical profession resorts to this practice is perhaps because medicine by the generic name may be what is available in government hospitals. On the other hand the patients who consult them at private clinics may be from the well-to-do segment of the society and therefore doctors perhaps prescribe the drugs by the brand name for the reason of the patients' affordability. What is however, disappointing is that it is an open secret that these Companies provide a range of incentives including sponsorships and scholarships to the medical fraternity and their families. If therefore the private trade corrupts the professionals by giving such incentives to them to induce the professionals to prescribe brand medicinal drugs while the equally effective but much cheaper generic drug is available, all ethical considerations are seen to have been overlooked for pecuniary and material gain. If so, the timely introduction of quality drugs at affordable prices which is now about to be formulated as a national policy has not come the day too early. One must be thankful to the WHO's Regional Advisor and others who have been involved in the recent discussions which appear to have now reached finality. It is however disturbing to note that all is not over, as the pharmaceutical giants are said to be operating through various Associations objecting to the inclusion of cost and need criteria for the registration of medical drugs. If the basic policy is that medicinal drugs should be registered on the basis of quality, safety, efficacy, need and cost- effectiveness, then with some political will, the day will not be far off when at long last a national drug policy which is also rational would have emerged in this country. Even internationally there has been increasing resentment against multinational drug companies earning enormous profits by drug invention followed by aggressive production and marketing. A recent article in the press referred to a recent Harris Poll in the US recording a 35% decline in consumer approval of the multinational drug industry. It had declined from 70% in 1997 to 44% in 2003. Research and Development of these drug companies is said to be directed towards diseases prevalent in the U.S., Japan and Europe and less on developing countries. This is because the more profitable markets are in the developed world rather than in the poorer, developing countries. This in a sense is understandable as the cost of marketing in industrialised countries would cost more. There is therefore a tendency for generic drugs to be prescribed even in countries like Australia, Finland, Germany, New Zealand, Norway and U.K. in preference to the more expensive brand name drugs. The tendency towards "Socialised Medicine" and the availability of health insurance, among other factors, may have led to less concern being paid to the cost of medicine. However, since 1980 the scenario has changed and Governments and health insurance funds and consumers no less are looking critically at the cost of drugs with a view to reducing costs. If this is the tendency now prevailing in the developed world, the need to promote generic drugs is much more compelling in the developing world. why are we in Sri Lanka so slow to diligently advocate generic drugs? The reason given by knowledgeable sources is simply misinformation promoted by brand name pharmaceutical companies and vested interest medical establishment. It is this misinformation that has made the public to believe that generic drugs are of poor quality and that brand name drugs are always of superior quality. Dr. K. Balasubramanium , Co-ordinator Health Action International Asia Pacific in a recent article says as follows: "Every drug is a single molecule of substance with its own unique chemical structure. Each drug in the world market has been given an official name by the WHO. The name is based on the chemical structure of the molecule. The official name is also referred to as the generic name. The generic name is the name used in every country in the world for such particular drug. Generic names are exclusively used in all undergraduate and postgraduate medical and pharmacy education throughout the World...While the WHO gives a drug an official or generic name, the multinational drug company that invented it gives that drug its own brand name". He gives an example of paracetamol, the generic name given by WHO, while the brand name is Panadol - a name we are so familiar with in Sri Lanka. The difference to be noted by the consumer is the difference in cost. Dr. Balasubramaniam says while one tablet of paracetamol supplied by the SPC costs 50 cts, the cost of a tablet of Panadol is Rs. 1.50 - a 300% difference! Doctors prescribe paracetamol in government hospitals. He says "unfortunately, in the private sector Panadol is prescribed." In a table accompanying this article, Dr. Balasubramaniam lists several commonly used drugs to show the cost differential between generic drugs and brand name drugs - some differences as a percentage are a staggering figure of 1050 and 4160. Consumer watch is thankful to Dr. Balasubramaniam for disclosing this vital information to the public of this country. The public must now organise themselves to pressurise the authorities to vigorously promote a National Drug policy on the lines suggested, and resist the pressures of pharmaceutical Multinationals. Consumer Watch hopes the authorities will have the political will to push what has now been agreed upon at recent discussions as there can be no controversy that what this country requires is a drug policy based on efficacy needs and access to generic drugs as this will meet the public need. All consumers, that is all citizens, will be ever thankful to the State if this policy is implemented soon and the Consumer Watch will be watching the progress of this exercise in the hope that it will see the light of the day before long. Any comments on the national medicinal drug policy could be sent to Consumer Watch at 143A, Vajira Road, Colombo 5. |
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