The pharmaceutical sector of Bangladesh has achieved quite a success in terms of quality and overseas market penetration. The country exports medicines to over 150 countries with several of the over 250 functional drug manufacturers sending their products even to highly regulated markets like the USA. The local people, however, cannot enjoy the full benefit of the advancement because of the policy constraints that fail to make doctors prescribe medications by their generic names.
The reluctance of doctors to write the generic names of drugs keeps the patients vulnerable to doctors' discretion to prescribe medications by the brand names they wish. This practice raises concerns about affordability, transparency, and accessibility in a country where a significant portion of the population is poor.
Several interrelated factors are responsible for doctors' reluctance to prescribe medications by their generic names with a few of them being pharmaceutical marketing influence, perceived quality concerns, habitual practices, and lack of awareness among patients.
The pharmaceutical industry in Bangladesh is highly competitive, with companies competing with each other to draw doctors' attention. Aggressive marketing campaigns, promotional gifts, sponsored trips, and financial incentives are responsible for prescribing some branded medicines. It is very obvious that the doctors who take benefit from any pharmaceutical brand will feel compelled, consciously or unconsciously, to support them, sidelining the use of generics.
Doctors in Bangladesh always stand against the provision of prescribing drugs by their generic names. They argue that if the doctors are compelled to mention only the generic names of medicines, drugstores will decide which brand they will sell to patients, making users vulnerable to low quality medicines, as most citizens are not educated enough to know the difference. It is a misconception. Generic drugs contain the same active ingredients as their branded counterparts and are subject to rigorous quality control measures, particularly bioequivalence tests. Through bioequivalence, the generic drug's biomass and concentration level in blood plasma are compared to the originally researched drugs, and if the results are found to be similar or the difference is within a permissible limit, it is considered to be a bioequivalent tested drug.
Pharmaceutical companies conduct bioequivalence tests on the drugs they export as the regulatory authorities in most of the destination markets have made such tests mandatory, but they usually do not conduct the test on the medicines they sell in the local market. The country's resource constraints act as a deterrent to bioequivalence tests of drugs. Currently there are only two-three institutions in the country which can conduct such tests and the test of a single drug costs around Tk2.0 million. But why does Bangladesh not begin working on the expansion of the facilities to ensure that the tests are more accessible and affordable for the drug manufacturers?
Medical education in Bangladesh puts little emphasis on generic prescription. The medical curriculum here emphasises branded medications, making doctors accustomed to using brand names during their studies and continuing the practice in their professional lives. A lack of awareness among patients also contributes to promotion of the prescription of brand drugs. Patients often trust doctors to make the best decisions for their health and may not question the prescribed brands. This reduces pressure on doctors to prioritise generic options.
Switching to prescriptions based on generic names is not just a matter of convenience; it is a necessity for building a fair and equitable healthcare system in Bangladesh. Such prescription can significantly lower the cost of medicine for patients, which is critically important for a country where a large segment of the population lives below the poverty line. Branded medications are not available everywhere, particularly in remote or rural areas. Prescription of generics ensures that patients have the flexibility to choose from multiple manufacturers. The practice will eliminate doubts about conflicts of interest between doctors and pharmaceutical companies. It fosters greater trust in the healthcare system by prioritising patients' welfare over corporate profits.
Shifting to prescriptions based on generic names could transform the healthcare landscape in Bangladesh. Almost all developed nations and many developing countries like India have switched to such a prescription method. It is high time for Bangladesh to follow suit.
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