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Comment by techaddict009 | Hacker News Reader

Its pretty open in India.

Drugs prescribed by a Doctor can be bought and is mostly available only from the store he mentions in the prescription.

Big doctors have their own store.

You go anywhere else very rarely you can find the same drug.

Most of the times doctors will prescribe additional 2-3 generic seasonal medicine which you mostly do not need just to achieve targets so that they can claim their gifts (TVs, Foreign Trips, etc.)

This a serious issue in India which no one is batting an eye on.

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In France, the prescription is valid in any pharmacy and the pharmacy seller (who has a degree in pharmacology) can and often do propose the generic version of the prescribed drug.

There has been some marketing to present generics as cheap knockoffs of bad quality, leading to many people choosing to pay for the prescribed drug (which will be reimbursed anyway) but it all comes down to the patient's behavior.

> There has been some marketing to present generics as cheap knockoffs of bad quality

The last I've seen drug-related marketing, the message was the exact opposite, with the message being pushed by the Social Security system, since they're the one that would pick up part of the bill if people take the prescribed drug and not the generic.

Actually I haven't been back in France for years, so it may have changed.

Generics might be cheap knockoffs. It's uncertain if the purity, formulation, method of production, and quality control for a generic will yield the same benefits (or any benefits) for a particular drug. There are countless stories about how some people like some brands of generics better than others.

There was some reporting around these parts recently that generics don't really undergo any kind of efficacy studies, they are assumed to just work, and there's really not much oversight whatsoever.

It’s kind of weird. The FDA, and agencies in other countries modelled after it, usually have two jobs:

• for drugs, such agencies verify that new drugs are safe/effective in concept (rather than in any particular manufacturing implementation)

• for food, the agency looks at specific manufacturers and distributors of a food, and—given a particular food they’re claiming to be producing—the agency verifies that their product meets the agency’s own definition of what that named food “should” be (i.e. you can’t sell Cheez Whiz as “cheese” because it doesn’t contain enough [whatever], though you can sell it if you don’t try to call it “cheese”; you can’t sell beef as “beef” if it contains toxic levels of thyroid hormones, though you could sell it as something else, e.g. as a hypothyroidism supplement, since those levels would be expected for that product; etc.)

But, strangely, these agencies don’t have any mandate to to apply the “food”-type rules (checking manufacturers and distributors for their output being within tolerances to a definition) to the drugs—even when those drugs are known to be produced through a process that can leave harmful reagents in them if not cleaned properly.

What’s up with that?

> What’s up with that?

I suspect it's all about who benefits. In the food industry, we've seen the effects, the industry is consolidating and forcing smaller players out.

In the case of generic prescription drugs, those are still very large players. There seems to be a cartel for all but the most common drugs, where manufacturers don't bother competing for market share.

Hmmm, I must confess I don't know the specifics of the laws and controls, but box of medicine have to state the composition: the molecules present and their quantities. Got prescribed 3 mg of TradeMarked(tm) <moleculeXXX>, a generic would be 3mg of NoName <moleculeXXX>. I think labeling a generic incorrectly would result in pretty heavy fines.

Consider magnesium supplements. You can get magnesium in a variety of forms: magnesium oxide, magnesium citrate, magnesium taurate, magnesium glycinate.

Each one of those formulas is going to contain magnesium, but the magnesium is bound to another molecule. One form of magnesium maybe be more effective than another for any given individual or condition. Some products are labeled as just "Magnesium" and it's unclear what form the magnesium is in.

Then there's a consideration of yield and purity. If you're making a compound through a given process, it's going to yield X amount of the desired compound, and Y amount of something else (other compounds or unconverted materials). Some of this is going to make it into the end product.

If two companies are using totally different processes to create the same end compound, everything is going to be different.

> I think labeling a generic incorrectly would result in pretty heavy fines.

Who's watching? I don't recall hearing much about generic manufacturers of prescription medications facing much scrutiny.

In Portugal it's the same way, and I'm glad to say that the countermarketing+regulation is working effectively: more and more people are choosing generics

Can confirm. It is pretty abhorrent how widespread this practice is in India.

IMO, the practice ought to be made unlawful. Medicine is a life-critical sector. As such regulations need to be the tightest around it.

One way or another, it’s widespread everywhere.

The exact degree may vary, but it happens everywhere.

Usually the laws and regulators allow prescribers tons of discretion, which is often subject to abuse that costs time/money/outcomes to somebody else.

You're right about this being an epidemic. However, due to rising awareness in recent times, there is a reverse trend.

I live in an expensive neighbourhood in a TIER 1 city in India and can confirm that many general physicians now prescribe medicines by their generic names.

That being said, it doesn't change the fact that the practice is still widespread. For e.g. I have never been to a dermatologist who will not insist on purchasing a particular often over priced brand, many even have their own pharmacy at their clinic.

I'm often shocked by the leniency of laws subject to doctors in India.

In Germany doctors are not allowed to sell you prescription drugs, or tell you to which pharmacy to go to. The doctors have to select the cheapest of comparable medications and the pharmacy has to replace with the cheapest available medications.

All this just applies for public healthcare. Private healthcare is basically an unregulated Wild West.

What kind of drugs do they prescribe ? Alopathic ? Ayurvedic ? Do they favour one over the other ?

If only a particular doctor can prescribe his own brand of drugs, does it mean he designs and manufactures them or is there a pool of common recipes from which any pharmacist can make the drug and sell it under very different names ?

1 - Allopathic. 2 - No much clarity on that. But think these guys (these = pharma company) sell area wise. Say if they tied up with pharma store A for x medicine. They will not sell the same in any other pharam store in that area. And will tie up with Doctors in that area to sell that medicine.

I will try to get more info on this. Each company has MR (Medical Representatives) they meet docotor every week on one day and present their schemes and offers.

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