In our country doctors are well aware that most of the patients do not understand much about medicines prescribed to them. Most of our patients would present their doctor’s prescription to the attendant at the chemist’s counter and quietly walk home with the drugs dispensed. It is well known that the chemist’s shop is usually managed by a matriculate boy who fills in for the mandatory pharmacist. As if the general chaos at the chemist’s counters was not sufficient, pharmaceutical companies have added fuel to the fire with confusing brand names. Also, it is common knowledge that most doctors’ handwriting does not look much different from an electrocardiograph tracing! Add the two together and what you get is an utterly confused patient. Chemists are known to substitute prescriptions under various pretexts and most of the time the unsuspecting patient blindly accepts whatever he gets without cross-checking with the doctor.
In these days of fierce competition among pharmaceutical companies the Product Management Team seems to lose sight of basic facts while choosing a brand name. The choice of a brand name itself appears like a big game. While the manufacturer to launch the drug first usually walks away with a name closest to the pharmacological generic name, those who lag behind try to ape the leader. The remaining pharmaceutical companies pick out words from the English dictionary and tweak it a little to get a catchy name. In some cases the manufacturer as well as the government agency assigned with the task of registering the names seem to get carried away by the name’s creativity that the needs of the patient, for whom the drug is made, is forgotten. One wonders whether the appropriate officer at the Drugs Controller General of India verifies whether a new name allotted to a drug is either similar looking or similar sounding to an existing brand.
Similar sounding/looking
Some of the names are dangerously similar! It is difficult to believe that the companies concerned were unaware of the prior availability of drugs with similar sounding names before their brand was launched. According to a recent study published in the March 2005 issue of Journal of Postgraduate Medicine, there are more than 8000 brands of drugs available in the country. A very large number of them have similar sounding or similar looking names, which is a reason for major concern among the prescribing physicians.
There are several look-alike brands e.g. Tibitol & Tobitil; Pronil & Pronim; Eltocin & Eltroxin. It would be shocking for our patients to know that these pairs of drugs are for diametrically different illnesses. For instance while the first brand is an anti-TB drug, its namesake is a painkiller! Similarly, Clear gel is a cream for treating pimples while Clearz cream is for removing dark patches from the skin. A third brand with a similar name, Clenz gel, is also now available for treating pimples.
These days marketing strategies seem to outweigh practical considerations while launching a new brand. There are numerous examples of pharmaceutical companies launching one antibiotic with much fanfare and once it becomes popular they launch a chemically different drug with the same name with the addition of just a suffix, e.g. (Taxim & Taxim-O; Acnesol gel & Acnesol-CL gel). Obviously, it is easy to register a new brand name in the doctors’ minds and generate quick prescriptions when it is similar to a well-accepted older brand. The discomfort of the chemist and the patient when the brand name is scrawled carelessly by the busy doctor can only be imagined. The patient usually ends up bearing the loss in the event of a dispensing error. If there is an error, which costs the patient his life or limb would anyone be held accountable?
Practicing doctors are deeply perturbed by our system of registration of pharmaceutical brands. One expects that any manufacturer desirous of marketing a new brand would apply to the authority concerned who would verify the existence of the proposed name or an identical sounding brand from the list of registered brand names. Considering the large numbers of drugs available in the market, which have deceptively similar brand names, physicians wonder if there is a system at all.
When brand names of two or more drugs are similar, faulty dispensing could result from one of the following situations:
1. Illegible handwriting of the prescribing physician (reading &/or writing error)
2. Incorrect dispensing by the pharmacist due to oversight (similar looking name)
3. Incorrect reading of the brand name by the patient while ordering the medicine by phone, which is a common practice in some cities in this country (similar sounding name)
All these factors should clearly be borne in mind by the Drugs Controller while a brand name is approved. Therefore no two drugs should differ just by an alphabet, syllable, suffix or prefix. There should be absolute clarity and differentiation of any two drugs whether the names are spoken or written.
The Drugs Controller should own up responsibility for their faux pas and as a first-step towards remedial action, take a close look at all recently launched brands and insist on the manufacturer to register afresh the confusing brands. There is also a definite need for a procedure to be put in place where a physician or a medical association can recommend alteration of a brand name if there is genuine similarity.
Until such a process is initiated the only damage control exercise would be for the manufacturer to request the doctor to write each spelling clearly or to educate chemists to dispense drugs carefully. All patients should meanwhile be advised to cross-check the confusing drug with the doctor. Physicians on their part could mention the manufacturer’s name in brackets, next to the brand name of the drug.
As a nation we have got used to imitating the West when it comes to framing rules and setting up regulatory bodies. Unfortunately, we have the entire constitutional framework for most aspects of healthcare but the implementation always seems to go for a six! With India becoming a signatory to WTO and Intellectual Property Rights convention it is only appropriate that we empower our physicians and patients so as to be on par with the rest of the developed world.
Medical professionals have now been brought under the purview of the Consumer Protection Act. As a result injuries occurring to patients due to faulty dispensing of a drug make both the chemist as well as the doctor liable to be prosecuted. Let us now take concrete steps to correct our mistakes in the interest of our patient’s health and avoid making blunders in assigning names to essential drugs.
(The author is a leading physician based in Mumbai)