Saturday, July 21, 2012

Generic or Branded Medicine?

Most of us use branded shirts, shoes...and even branded rice & Salt...

When it comes to life saving medicines, whether on should consider "unbranded" or "generic" medicines is the debate...

Why the branded medicines are expensive?
Why generic medicines cost less than 1/10 of branded?
Given a choice, whether a doctor would prescribe/ recommend a "generic" drug to his near and dear?

this article throws some light on the topic...

If you have to take medications for an illness or injury, you know those medications aren’t free. You’ll pay for them out of pocket, through insurance and insurance deductibles, or through retirement funds such as Medicare or Medical Insurance. While you might opt for the less expensive drug, such as a generic drug, are you compromising your health with that choice? Or, will Medicare or your insurance put up roadblocks to choosing a less expensive, but just as effective medication? What does your pharmacist have to say about your prescription, no matter if it’s a brand-name drug or a generic substitute? Learn more about what constitutes a generic drug, and whether they stack up against name brands.

Generic Drugs

MedicationsGeneric drugs are copies of brand-name drugs. They have the same dosage and strength, intended use, effects, side effects, administration instructions, risks and safety as name brand drugs. One way to tell the difference between a generic drug and a name brand is to look at the name of the drug. Brand names are capitalized, where generic names are not.
While some people are concerned that generic drugs are “less” of a drug than a name brand because of lower prices, the U.S. Food and Drug Administration (FDA) requires that generic drugs be as safe and as effective as the brand-name drugs that they copy. There is no truth in rumors that suggest generic drugs are manufactured in deficient laboratories or that they are created in non-sterile environments. The FDA applies the same standards for all drug manufacturing facilities, and many companies manufacture both brand-name and generic drugs. In fact, the FDA estimates that 50 percent of generic drug production is by brand-name companies.
The only reason that generic drugs are less expensive is because the manufacturers don’t have the expense involved in developing and marketing a new drug. When a company brings a new drug on the market, the costs can be astronomical. Drug developers spend money on:
  • Research and Development: Also known as drug discovery, this is the time when drugs are discovered or designed. The process of drug discovery involves the identification of candidates, synthesis, characterization, screening, and assays for therapeutic efficacy. Once a compound has shown its value in tests, a company will begin the process of drug development prior to clinical trials
  • Clinical Testing: This step allows a company to test the drug for safety and adverse reactions. These trials can take place only after satisfactory information has been gathered on the quality of the non-clinical safety, and Health Authority/Ethics Committee approval is granted in the country where the trial is taking place. Clinical trials are expensive, and a full series of tests may incur costs that cannot be borne by the company. Sometimes, an outsourced partner, such as a contract research organization (government, pharmaceutical or biotechnology company), will step in to pay for those trials.
  • Patent: The company and its partners then seek a patent that provides exclusive right to sell the drug as long as the patent is in effect. When that patent nears expiration, other manufacturers can apply to the FDA for permission to make and sell generic versions of the drug. Over the next decades, about 120 brand-name prescription drugs will lose their market exclusivity.
  • Marketing and Promotion: Nationwide, and sometimes global, marketing and promotion for brand-name drugs is expensive. Additionally, drug companies and manufacturers must follow strict protocol in marketing and promoting drugs, according to the FDA. This government agency also helps health care providers recognize misleading prescription drug promotion and provide them with an easy way to report this activity to the agency.
Trademark laws do not allow the generic drugs to look exactly like the brand-name preparation, but the active ingredients must be the same in both preparations, ensuring that both have the same medicinal effects.

Generic Medicines, Insurance, and Pharmacists

PharmacistGenerally, most insurance companies are not concerned with the type of medication you are taking or how much it costs. As long as you cover your deductible and are getting the health care you need, the insurance plan should agree with your health coverage. You probably need to check your health insurance coverage to make sure that your insurance covers medications as well as treatment outside medicines before you make any decisions about optional health care or before you become seriously ill. Sometimes, insurance companies do not cover preexisting conditions.
Some state governments now promote generic medicines. This obviously reduces the budgetary expenditure. One important way to control costs is by negotiating with drug manufacturers for rebates. Another way to reduce costs is by managing enrollees’ use of prescription drugs. By using differences in co-payments and other methods, plans can encourage enrollees to switch from brand-name drugs to their less expensive generic equivalents. This practice is known as generic substitution.
The FDA recognizes this substitution practice, and condones it as long as the doctor writes that a substitution is appropriate on the prescription. A pharmacist, however, can make a substitution based upon the Approved Drug Products with Therapeutic Equivalence Evaluations.  Substitution by the pharmacist, may not hold good if patient develops a complication following substitution.

Generic Medicines and Your Health Care

PrescriptionsWhen you receive treatment, and the doctor or nurse practitioner wants to prescribe medication for you, ask if an equivalent generic form of your brand-name medicine is available. You can also discuss the difference in price between the generic and brand name medicine, to rest assured that price, not quality, is the difference between a brand-name drug and its generic counterpart. Currently, not all medicines are available in a generic form, so your doctor may prescribe a medicine that is available only in the brand name form.
If you and your health care provider agree that a generic medicine is not the best choice for you, ask your doctor to write, “Do not substitute” on your prescription. This comment tells your pharmacist that only the brand name is to be used in filling the prescription. Depending on your health plan, you may have to pay more for, or cover the entire cost of, the brand-name prescription.

Consumer Beware!

1. Generic medicines/ Branded Generics are not necessarily cheaper than Branded medicines!
Generics/ Brand Generics pass on close to 800% margin to the retailer, while the price may be just cheaper by 40% (click here for info) or check table:

In some corporate hospitals price of the Brand Generic can be higher than Branded medicines as brand generic suppliers can stamp the MRP dictated by the administrators! 

Example: Injection Meropenem: Meromac -branded MRP is Rs 871, Merofit- Brand Generic: Rs 2494. The hospital supply rate for both are around Rs 750. 

2. No pharmacist can substitute a Brand Generic medicine, without doctors prescription/ permission. (Reference: Rule 65 of the Drugs and Cosmetics Act, 1940 and Rules 1945, amended till 1995)
3. Debate required on : whether a hospital can insist on medicines to bought in its own pharmacy, where choices are limited, and drugs from non FDA listed drug companies.
4. Remember: you have placed your trust with your DOCTOR. He knows what is the best for you. It is well within your right, to expect "no substitution" and choice of medicines at a pharmacy. Restrictive trade practices have been banned in India! (through MRTP Act, 1969)

While even your cooking salt is branded, why settle for an unbranded life saving medicine?

Thursday, July 19, 2012

To shoot, or to help?

Pub going girls attacked in Mangalore: cameramen from Media had the info about the time and place of attack...still they chose to "cover" the event, rather than protecting the modesty of the girls...

Hapless cow trader Hajabba got stripped naked by an angry mob....Press photographer from Udupi chose to click him naked, rather than cover him with clothes...while his associate was shining the headlight from the bike, for a "better" capture...

This time round, media has found a new breaking news in the orchestrated by media molestation of an innocent girl in Guwahati, Assam!

a good writeup by Karan Singh Tyagi, Courtesy: The Hindu

The Guwahati incident shows that journalists do not always adhere to the ethical standards of behaviour that they demand of others

I remember watching “The Death of Kevin Carter: Casualty of the Bang Bang Club,” an American documentary about the suicide of South African photojournalist Kevin Carter, at a film festival organised by my law school in 2010. The documentary that was nominated for the Academy Awards depicts the gut-wrenching tale of Carter’s enduring depression by the carnage he witnessed as a photographer in warzones.
In 1993, Carter took a trip to Sudan. There he saw a little girl, bent over with hunger and dehydration, eyed by a nearby vulture. Careful not to disturb the vulture, he waited for 20 minutes until the vulture was close enough, positioned himself for the best possible image, fixed his frame and shot.
The photo won him the 1994 Pulitzer Prize. At a conference, he was asked what happened to the girl. He didn’t know. Didn’t he do anything to help her? No. Carter came under heavy criticism for just photographing — and not helping — the little girl. Two years later, heavily disturbed by the incident, Carter committed suicide.
The documentary poses a moral dilemma. I was left asking myself — how many journalists would frighten away the vulture and help the child? How many would take the photograph? Witnessing the outrage against the journalist who shot the Guwahati molestation video, my mind wandered back to Kevin Carter. Should journalists put the camera down and help or should they remain objective observers?
Despite an increasing concern that many, including the Chief Minister of Assam, have expressed about the ethical obligation of the Guwahati journalist, there are others who remain extremely sceptical. Mr. Raghu Rai, India’s noted photojournalist, expressed solidarity for the journalist by commenting that a journalist’s only job is to report the story. He said that professionally speaking, journalists have to cover such things, no matter how distasteful.


Strong arguments can be made in support of Mr. Rai’s position. Journalism perhaps requires a certain clinical detachment from and disregard for some of the ethical niceties and sensitivities of everyday life. Moreover, journalism often requires rushed thinking and action, leaving little time for deep reflection. Further, by taking the video of the girl, that communicated an utter state of horror and despair, the journalist made a larger comment about the situation of women in India and helped promote the important debate on safety of women in our cities.
Interestingly, many years ago, Martin Luther King gave similar advice to a photographer from Life Magazine, who on seeing small children being shoved to the ground by policemen, stopped taking pictures and went to their aid. Ron F. Smith’s book on journalism and ethics mentions King’s statement to the photographer — “The world doesn’t know this happened, because you didn’t photograph it. I’m not being cold-blooded about it, but it is so much more important for you to take a picture of us getting beaten up than for you to be another person joining in the fray.”
So, what does the outrage against the Guwahati journalist tell us? Is it merely a case of people, far away from danger, from their living rooms, claiming the position of superiority? Or is it necessary for media persons to reflect upon this incident to enable them to clarify their intuitions, concepts and beliefs regarding journalistic and media practices?
On a basic level, the entire incident raises the bigger question of motivation behind telling a story. Here, I make the normative claim (and I am no journalist) that a journalist’s motivation should always be to tell the story at a deeper level than what has actually happened. The guiding force behind reporting facts should be to focus on the deeper reasons behind the issue.
Was the manner in which the girl’s private grief, impotence, and despair put on display for all viewers, without her consent and regardless of any sympathy in consonance with this deeper motivation? In the very act of deploring the tragedy, the underlying motivation behind the Guwahati video seems to be an appalling curiosity and morbid delight in the tragedies of others. And, therein lies the problem. In fact, such depiction is routine in the media. We have seen in the past journalists asking someone whose friends or parents have been killed in a plane crash “how they feel”!


Although most journalists would consider it to be their professional duty to catch such events on tape and later put them up for display, journalistic professionalism need not come apart from ethical responsibility. As Oakley and Cocking claimed in regard to virtue ethics and professional roles, “goodness is prior to rightness” — (Oakley, J. & Cocking, D. (2001), Virtue ethics and professional roles). Rightness, properly understood, can only be derivative of goodness, insofar as what is right must be based on what is valuable in regard to certain notions of the good.
Similarly, journalistic rightness needs to be understood in the larger context of the role the media plays in our society. Given that the news media's function, at least in part, is to seek out and expose wrongdoing, it had better not be guilty of the very same sins it exposes in others if it is to avoid the charge of hypocrisy. That is, journalists and the news media must themselves consistently aim to respect the very same ethical standards of behaviour that they demand others should adhere to. A proportionate response in the Guwahati case would have been to focus only on the wrongdoer’s faces in the video, and try to protect the girl by either volunteering assistance or immediately informing the police.
I am not denying that probably many critics of media practices (including me) may possess only a superficial grasp of the realities of journalistic and media practices. Hence media criticism and ethical debate tends to contradict the complex cases and dilemmas that actually arise. But this is not to deny the point and purpose of critical reflection. Undoubtedly, it is the job of the journalists to depict and report facts as they happen. But, in doing so, they should not lose sight of the bigger question — what is their investment as human beings? Shouldn’t journalists be defined by who they are intrinsically, rather than what they do?
Kevin Carter ended his life grappling with the same questions.