Innovator drugs and generics complementation

Originally posted on June 13, 2011.

There was an interesting but controversial article yesterday in the Washington Post written by a physician, Dr. Ranit Mishori, Some doctors insist on brand-name drugs even when cheaper generics are available.

Dr. Mishori quoted the American Journal of Medicine article where “researcher doctors noted that out of a sample of 5.6 million prescriptions written for more than 2 million patients, nearly 5 percent “were designated as dispense as written by physicians and patients.””

So Dr. Mishori in effect is questioning the nearly 5 percent of physicians (in the US) why they do not allow drug switching anytime anywhere for all patient cases. Not a big number then. But let us pursue her points. She wrote further,

So why do some doctors prescribe a brand-name drug when a generic is available? Researchers report that many doctors still don’t trust generics. In one recent survey, published in the Annals of Pharmacotherapy, nearly 50 percent of the doctors participating acknowledged holding some negative perceptions about the quality of generic medications.

It is also habit. Brand names are the names doctors most easily remember. Drug samples left in physicians’ offices — seemingly a free gift for doctors to dispense and patients to receive — make them more memorable. Often, sales representatives will treat a physician and his staff to lunch, and leave behind an array of pens, coffee mugs and USB memory sticks branded with the name of their drugs….

On the first paragraph, I think Dr. Mishori did not mention some considerations by physicians, pharmacists and pharmacologists before they would recommend drug switching to any generics equivalent — bioequivalence, pharmaequivalence, cGMP, etc. The same drug, patented or generic, branded or non-branded, by the same manufacturer given to two patients with the same disease may produce different results. This is because although they have the same disease, the two patients have different biological and physical conditions (one is older than the other, or one has diabetes or hypertension while the other has none, and so on).

On the second paragraph, both innovator and generic manufacturers are doing those things — giving free drug samples, mugs/pens/USB/bags with the name of the drug or manufacturer. In the Philippines for instance, the biggest advertiser of drugs are not any of the multinational innovator companies. It is Unilab, the biggest pharma company here, it is a local and generic manufacturer firm. One can see Unilab’s products on tv, newspapers, billboards, pens, and so on; hear it on radio, etc.

A short rebuttal to the WaPo article was made by Ms. Kate Connors in her blog post, Setting the Record Straight: Patients Need Innovation, Not Just Generics. She wrote,

I reiterate that we do not discount the importance of generic drugs to patients and to the healthcare system as a whole. However, let’s not forget that without innovative brand medicines, there would be no generics.

Our CEO John Castellani has a great line: “We love generics. They’re our grandchildren. We created every single one of them.”

Today’s groundbreaking medicines will likely someday find their way to patients as generic options, as well.

But at the end of the day, if we rely solely on generics, innovation will stagnate. The future of medical progress lies not just in generic drugs, but in brand-name medicines.

I agree with her observations there. Both innovator and generic drugs are important, they have their uses to patients and their physicians. Where drug switching is allowed by our physicians, then let us go for generics, they are cheaper and safe at the same time.

But some patients are more impatient than others, they want to get well soon; not next month or next week, but the next 2 or 3 days. They want more powerful, more disease killer drugs, even if these are more expensive than those currently available. And that is the role of continuing drug innovation.

Well, at least Dr. Mishori did not advocate in her article the abolition of patent and IPR system in drugs, unlike what the socialists and some libertarian anarchists would suggest.


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