National Medical Commission's suggestion on generic drug prescriptions riles doctors’ body

India’s largest body of doctors on Monday decried the apex regulator’s suggestion for medical practitioners to prescribe generic medicines, noting that such a move would cause “injustice to doctors” and “impacts patients’ care and safety.”

The Indian Medical Association said that the National Medical Commission’s ill-advised step was an emergency and a matter of great concern since this would directly impact patients' safety. “Running trains without tracks is how the present promotion of generic drugs by the NMC appears to be,” the IMA – a body of around four lakh doctors, said in a statement.

The criticism comes in the wake of a gazette notification issued by the Ethics and Medical Registration Board of the NMC detailing the professional conduct of doctors.

“Every registered medical practitioner should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets,” says one of the clauses of the Aug 2 notification.

Doctors and pharmaceutical industry watchers observe that such a move will shift the choice of a medicine from a medical practitioner who is primarily concerned, trained and responsible for the patients’ health than a chemist/person sitting in a chemist shop, who is selling drugs. “This won't be in the best interest of the patient,” IMA said.

“The problem with generic medicines is that in the case of substandard medicines how to identify and punish manufacturers?” Chandra M Gulhati, editor, Monthly Index of Medical Specialities and a former consultant to the WHO told DH. “Instead of lecturing doctors to stop prescribing irrational FDCs, the government should ban them.”

Gulhati pointed out that elderly patients required multiple medicines and rational FDCs were needed for them. “By their very nature they need to have brand names. So for them generic medicines are not the right answer. Nearly 52% formulations sold in India are FDCs. There can not be generic alternatives of such products,” he said.

The NMC on its part argues that India’s out-of-pocket spending on medications accounts for a major proportion of public spending on health care and since generic medicines are 30-80% cheaper than branded drugs, prescribing such drugs may bring down health care cost and improve access to quality care.

Experts are of the opinion that issues surrounding the quality of generic drugs have not been addressed by the NMC and the Union government before coming out with a notification.

“If doctors are not allowed to prescribe branded drugs, then why should such drugs be licensed at all, given that modern medicine drugs can be dispensed only on prescription of doctors of this system. The notification is an injustice to doctors who always hold the interest of their patients as non-negotiable,” the IMA said.