Generics again

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IT'S been 17 years since the Philippines passed the Generics Act, a comprehensive law that required the use of generic names in the labeling, prescribing and dispensing of medicine.

The law is still hailed today internationally as an example of progressive health legislation; yet it has been opposed every step of the way, from the time it was filed to the present, by the Philippine Medical Association and the multinational drug companies, with much black propaganda and misinformation. Even today, the opposition is still strong, preventing the law from being implemented to its fullest so consumers can benefit.

'Lang'

More and more, physicians neglect the generic names in their prescriptions, forcing their patients to buy the brand name the physician prefers. Likewise, drugstores don't always inform consumers about the possible choices. Sadly, too, government has concentrated on parallel imports to bring in some lower costing branded preparations, while the
generic drug industry -- which is largely Filipino-owned -- languishes.

But I also see some hopeful signs around generics. At the South Star pharmacy I've been going to, the sales clerks ask, whenever I present a prescription, "Sir, generic 'lang' [only]?" Mercury Drug doesn't do that, although they have, as with South Star, a thick computer printout listing drugs by their generic names and their equivalent brand names.

Ultimately though, it's still an informed consumer that will make the difference. In one Save-More drug outlet, while waiting for my prescription to be filled, a man came in and rattled off three different drugs by their generic names. He was empathic in adding, after he had finished naming the medicine: "Generics lang." Sadly, the sales clerks said they didn't have generic versions for the two of the medicine he needed.

Nevertheless, I was impressed that the man was aware of generics. Maybe he was a health professional, but I suspect he was simply an informed consumer. And we need more of such consumers to spur the demand for generics.

The Department of Health needs to revive the campaign around generics, and for starters, we could get prescribers, sales clerks and consumers to stop saying "generics lang [generics only]" and be more assertive: "Generics ang gusto ko [I want generics]."

What's in a name

OK, I know I might be jumping way ahead, and that there may be readers who still haven't figured out what generics are. All drugs have generic names that are internationally recognized. For example, there's propranolol, a medicine used for high blood pressure. There are all kinds of brand names for propranolol, but no matter where you are in the world, if you go into a drugstore and write out propranolol or point it out on your medicine wrapper, they'll know what you need.

In many countries, even without a generics law, they will give you different brand names to choose from, including medicine produced without a brand, meaning sold simply by their generic name. The generic version is almost always cheaper than the branded ones. How cheap? In Thailand, you can get propranolol 40 mg for as low as P1.50 each, while in the Philippines, sold under the brand name Inderal, you'd pay P12.50 each. The friendly clerks, whether in Bangkok or in Manila, will also tell you what other brand names are available, many still cheaper than the multinationals' branded products.

What's in a (generic) name? A lot, in terms of money saved.

Ah, but now we have to deal with the black propaganda, the claims from manufacturers of branded products that generic drugs are inferior, or even "faked." This is nonsense. Counterfeiters aren't going to try to imitate generics because they cost so little; what they go for are the most expensive branded preparations. I'd be more worried about counterfeit drugs when getting branded products.

The counterfeiting issue also obscures the point that all drugs -- branded or generics -- need to be approved by a country's drug regulatory agency, in our case the Bureau of Food and Drugs, which doesn't just look at the medicine but actually inspects the manufacturing and packaging facilities to make sure they observe what are called GMP, or Good Manufacturing Practices. As Dr. Alfredo Bengzon pointed out in a recent talk, substandard drugs have been found even among the large multinational companies' branded preparations.

Informed use

There's more to the safety issue than quality control in manufacturing. Knowledge of generic names is the foundation for informed use of medicine. A few years ago, my mother had a household helper who suffered a severe allergic reaction to the painkiller Alaxan. The helper was perplexed, saying that she had taken Alaxan in the past without problems. I had to explain to her that the drug had recently been reformulated and now had an ingredient to which she was allergic. Of course, there was no way for her to know that because her loyalty was to the brand name, with little knowledge about the generic names of the active ingredients.

Always check for the generic names of active ingredients in a new medicine you're taking. You might discover that you're taking needless duplicates. For example, my mother recently wanted to start taking Circulan, but when I looked at its ingredients, I pointed out she was already taking two of the three drugs listed, under other brand names.

Many of the so-called "natural products" are also problematic with their brand name hype. To protect yourself, learn to look at the labels. I've found many Chinese products will mix medicinal plants and very potent western medicine such as steroids and sedatives. Without knowledge of generic names, you can't find this out.

Another tip here: generic names are a bit like surnames. Drugs with common stem endings are "related": for example, ibuprofen and ketprofen, or propanolol and atenolol. If you have problems with one of them, you need to check with a health professional if you can take the other "cousins."

Drug safety is really drug economics as well. A lack of knowledge about our medicine, sometimes linked to our ignorance about generics, could mean wastage in terms of inappropriate medicine or, worse, adverse reactions to the medicine.

There are all kinds of books and Internet websites with valuable information on the use of medicine. But to be able to maximize the value of these resources, you have to know your medicine's generic names. In many countries, you'd be lucky if the medicine's ingredients are even listed. In others, including the United States, the generic names are found in small print. In the Philippines, we're lucky that the law requires it to be in big bold letters, in a box on top of the brand name.

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