Recently our prime minister has announced he will bring a law to make prescription writing in generic name compulsory. He thundered he will not mind the unhappy pharmaceutical companies as people's welfare is his primary goal. A laudable initiative indeed! But, the important questions are whether the country is ready to move with him so fast and how he is going to achieve his goal with sleeping, lazy and corrupt government bodies like PCI and MCI?
These bodies not only have members with poor foresight but also have other ambitions than taking profession and country forward. In this game these Councils are not alone even government ministries are filled with such people. For example, when PCI brought in far reaching reforms like abolishing D. Pharmacy course and making B. Pharm degree as minimum qualification for practising the profession of pharmacy by visionaries in PCI decades back, Union health ministry not only put the proposal in cold storage but instructed PCI to go slow on reforms.
That was sufficient for selfish elements in this Council. Till today - even after 15 years - they are not ready to revive and get nod for the proposal. That is now standing before the forward movement of the profession as a solid rock. Yes, pharma retail sector is not ready to handle the generic prescriptions if at all written by all doctors. It is said there are more than 70,000 branded drugs marketed in India. Finding generic equivalent for all is next to impossible. Even for all essential drugs generic versions are not yet manufactured and approved. Sufficient time is not given for the manufacturers to produce and market them by bringing to the knowledge of doctors. In this fluid situation retail sector is manned by just D. Pharm pharmacists. Even those minimally qualified personals are not available and non-professionals are handling prescriptions in many shops. It is not to discourage the progressive move by the prime minister, but to point out further steps required to wake up and shake up the PCI and Drugs Control Department.
Backward march
Instead of abolishing D. Pharm and making B. Pharm as minimum qualification, the PCI is going in the opposite direction. PCI is further strengthening D. Pharm, if its recent move to conduct exit exam for D. Pharm is any indication. There was some justification for MCI when it introduced exam for fresh MBBS graduates as many were getting their degrees from foreign countries. But, introducing exit exam for diploma obtained in India, looks odd and indicates something fishy. By this, PCI is indirectly accepting its failure in controlling D. Pharm colleges and the exams. Is it not the result of corrupt administration? Is it not due to mushrooming of pharmacy colleges? Is it not revealing the influence unscrupulous elements have over the Council and government? In these circumstances is it not best to put a full stop for the course itself? Time and situation demands it, why standing on false prestige?
Vested interest in pharma trade are preventing abolition of D. Pharm, appointment of pharmacy inspectors, upgradation of retail pharmacies, etc with the help of corrupt elements. How our prime minister is going to build multistory building with such a weak foundation?
Pharmacies of developed countries
If pharmacies of developed countries are handling generic prescriptions it is due to highly qualified pharmacists employed there. These countries recognize only pharmacists with 6 years pharmacy degree (Pharm. D or M. Pharm) as retail pharmacists. Obviously these pharmacists with more years of professional education than an MBBS are capable of handling generic prescriptions. Compare this with our 2 years D. Pharm and that too with doubtful presence in our retail counters! Modiji, are you aware of this pathetic situation of our pharma retail sector? Did the people around you inform you one of your department has recently inclined to permit salesmen of retail pharmacies as pharmacists after a still short term course? If not dear prime minister your well intentioned schemes will not benefit common people but you will just end up in creating enemies and confusion. Before flying high look at the ground realities. As pointed out by this author earlier in his article "Why not online pharmacy?" (Pharmabiz 3.2.16) "Pass SSLC first before seeking admission in MSc!".
Steps to reach the destination
There are many preliminary steps to be taken by our beloved prime minister towards his ultimate goal. They are - for revamping retail sector: Make B. Pharm as minimum qualification to register as a pharmacist as in other countries. Grade pharmacies as I, II, III according to the qualification of pharmacist employed and facilities available. Abolish D. Pharm forthwith and make it mandatory for existing D. Pharm pharmacists to complete B. Pharm Practice Course within a time limit, say 10 to 12 years. Ensure presence of pharmacists in all retail pharmacies by strengthening and watching Drugs Control Dept. Punish the violators severely including imprisonment for non pharmacists for dispensing drugs and permanent cancellation of license.
For introducing generic medicine
As it is not possible to introduce generic medicine for all proprietary drugs and risk the lively hood of entire lot of sales team, implementation of generic name prescriptions should be step by step. First of all trade names should be abolished for all the 100 and odd essential drugs and its combinations listed by WHO. (Even now it is in force in India for few drugs like Piperazine salts). All the essential drugs should be manufactured, marketed and prescribed only by generic name. Existing licenses permitting trade name for those essential drugs should be cancelled immediately. All other drugs can be permitted to be marketed in existing trade names time being. By this arrangement the job of lakhs of sales persons will not be killed in one stroke. After successfully implementing the above bring more drugs under generic category. All the present manufacturers of essential drugs under whatever names should be mandatorily made to continue the same under generic name. Nobody should be allowed to stop or reduce the production on any account. Prices of these essential drugs should be fixed as per DPCO and all drugs with same ingredients should be of same price whoever may be the manufacturer. Thereby there will not be any complaint against both the doctor and pharmacist that they prescribed or dispensed costly medicine. Patients should be educated about non essential drugs prescribed by doctors in trade name. It should left to the decision of patient to go for cheaper alternative. Medical or sales representatives should be encouraged to switch over to ethical business ventures like Jan Aushadhi stores. They should stop compromising the welfare of crores of poor Indian patients for the sake of few multinational and other pharma companies and doctors by listening to their voice of consciousness. Simultaneously patent expired drugs should be immediately marketed in generic name after strict quality control tests including BA/BE tests.
Will the people concerned listen to above suggestions made in good faith and act? The views expressed are author’s own considered views.
(Author is ex president, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)