Writer By Chance.

The Medical Council of India (MCI), through a notification dated 21/9/2016, in Chapter 1-B, Clause -1.5, put forth the following recommendation: ‘Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs’. Doctors were thus directed to prescribe drugs by their generic or pharmacological name, and not the brand name. For example, Paracetamol, the commonly used drug for fever and pain can only be prescribed as Paracetamol, and not as Calpol or Dolo, which are brand names, as baptized by the company manufacturing the drug.

The direction on capital letters is understandable, considering the abysmal quality of doctors’ handwriting, including mine. We doctors really need to go back to kindergarten classes with those four lined books in our satchels! As for the ‘rational’ clause of the recommendation, which is well-meant, it aims to control the tendency of certain doctors to shoot from their hips, when they prescribe. Some prescriptions resemble a document written (read scribbled) hurriedly under duress at gunpoint, (and therefore, the ‘legible’ part of the recommendation).prescription to a single patient often includes antibiotics, multivitamins, analgesics, tonics to improve appetite, drugs for ‘gas’, mental wellbeing, etc, etc, etc, that there needs to be a rationale while prescribing drugs.  Certain hospitals do have regulations, especially with regard to antibiotics. Antibiotics, especially the high-end ones cannot be prescribed without the approval of a board or committee which looks into the genuineness of indication and microbiological correctness. This indeed is a healthy practice which ought to be encouraged.

Existence of a ‘doctor-pharmaceutical nexus’ has been alleged since time immemorial. Charges that doctors prescribe drugs to favor pharmaceutical companies are frequently made in the media and other fora. Doctors prescribing these drugs are suitably ‘compensated’ by the companies, if not in cash, certainly in kind. Companies sponsor conferences and doctors’ participation in the same by sponsoring their travel, registration and stay. Which run to thousands these days, considering the exotic venues which host modern-day conferences and splurging indulged there-in. The bad side of the coin is that doctors get the pharmaceutical companies to sponsor their families too. It is alleged that money the pharmaceutical companies spend for this purpose is made up by hiking up the price of drugs they masnufacture, which the patient struggling to afford treatment is ultimately called upon to bear.  How many doctors can attend such conferences, shelling out money from their own pockets? Hardly very few. These include those super practitioners and the so-called seniors, who are ‘well-done’. What about the rare, the medium rare and the raw ones who really are the ones who need to attend conferences to upgrade themselves? They need to be supported monetarily, at least partially, if not the entire conference, in segments.viz; stay, registration, or travel.  It is to society’s advantage that doctors upgrade their knowledge and keep themselves updated on recent advances in their specialty by attending conferences, both national and international. But, these conferences are beyond majority of the doctors’ affordability. Sponsorship is the only means by which attending conferences is realized. If not by the pharma companies, by management of hospitals and the government for doctors working in the private sector and public sector, respectively. This is much more honorable, and worthy of consideration.  Sometimes the companies have been known to ‘finance’ things like fridge, and other household appliances,  automobiles, and even construction of consultation rooms in the doctors’ homes! Some of these charges are admittedly true, much to the disgrace of medical profession, showing doctors in poor light before the society and their patients. The doctor-pharma ‘nexus’, which amounts to bribing in a sense,  admittedly, had to be broken. It is here that the IMC stepped in, through a long overdue move. It is a fact that drugs manufactured by multinational pharmaceutical companies, which are, in many instances their own patented molecules are far superior in quality, though prohibitively expensive.  Quality of the drug is of paramount importance in healthcare, especially in the case of antibiotics, where those with questionable quality contribute to bacterial resistance significantly. There are innumerable brand names by which these drugs, manufactured by multinational pharmaceuticals and homegrown ones, with wide range of quality are known by. It is best left to the physician to decide which drug the patient deserves, depending on the severity and kind of ailment. Patients deserve drugs of best quality. If doctors are not allowed to prescribe the brand, it will be the dispenser in the medical shops, existing in every nook and corner of the country or the pharmacist, or even the owner of the shops, who will decide the brand of medicine which the patient ultimately receives, in exchange for ‘favors’ from the pharmaceutical companies. Pharmacies in hospitals will sell medicines which gives them maximum profit, also called ‘margin’. This could create dangerous, unimaginable, uncontrollable and unregulated mayhem in healthcare dispensation across India. The alleged ‘doctor-pharma nexus’ will take on the garb of a disastrous and more sinister ‘pharmacist-pharma nexus’, which will undoubtedly result in  a ‘no holds barred’ situation in treating diseases, which the country and it’s sick can ill-afford. It is therefore best left to the physician to decide the brand of drug the patient receives, much to the latter’s wellbeing. And physicians need to deal ethically and conscientiously with pharmaceutical companies and their representatives in a manner which befits the nobility of their profession.