What’s in a name?

Names are important where drugs or medicines are concerned. It was reported not too long ago that two entirely different medicines – one used to treat seizures and the other to control high blood pressure – were being marketed under an identical brand name in Pakistan. It is a chilling thought that many unfortunate patients may have suffered serious consequences, possibly even death, because of this.

Each drug or medicine has a distinct single non-proprietary name, which is popularly referred to as the ‘generic name’. These International Non-proprietary Names (INN) are recognised across the world and used in medical literature and textbooks. A trade or brand name is conceived by and allotted to a medicine by the patent-holding manufacturer when it is first marketed. As a result, the cholesterol-lowering medicine which has the generic name of Simvastatin also has a single brand name, Zocor – as marketed by its original manufacturer, Merck & Co Inc.

In developing countries such as Pakistan, patent rights to most drugs either do not apply or are not strictly enforced. Many companies therefore start manufacturing and marketing drugs much before the patent rights to them expire in the Western world.

The problem with drug marketing in Pakistan is that different manufacturers market the same drug using their own brand names instead of their generic names. These names are assigned arbitrarily without a defined system. The generic names are used very infrequently, if at all, in prescriptions written in a majority of office or hospital settings. This opens up Pandora’s box.

According to www.druginfosys.com, Omeprazole, a medicine used to treat stomach ulcers and inflammation, is marketed in Pakistan under 68 different brand names. Similarly Amoxicillin, a commonly prescribed antibiotic, is available under as many as 63 different brand names. Simvastatin, available in the US under a single brand and generic name, is registered in Pakistan by no less than 70 arbitrary brand names. The retail prices for these different brands of the same medicines vary significantly.

Drug-dispensing errors are a huge concern when medicines are marketed under different brand names. It is virtually impossible to remember every single brand name of a particular medicine. How is one expected to remember more than 60 brand names for Amoxicillin? It would make more sense if the medicine was marketed and prescribed solely by its generic name. Medical workers in any corner of the world would readily recognise Amoxicillin rather than scratching their heads trying to find the medicine sold under fancy brand names, such as ‘Lomoxy’, ‘Zekatac’ or ‘Abac’.

There are frequent instances when doctors make inadvertent errors because the brand names of medicines have been confused. These may have dire consequences.

A friend’s wife recently had serious side-effects from the use of a certain cholesterol-lowering medicine. She consulted a professor of medicine, who discontinued the medicine and prescribed an alternative drug. Interestingly, the medicine was discontinued and the alternative which was prescribed was only a different brand name for the same drug. With a not-so-informed patient population and virtually no system of secondary checks from pharmacies, errors like these are recipes for disasters.

While many may not like saying it, corruption is rampant in our healthcare system. With the same drug marketed under different brand names at different prices, the avenues for corrupt practices remain wide. It is not uncommon that pharmaceutical companies give underhand incentives or kickbacks to doctors for prescribing their brand names.

Some unscrupulous doctors often deceive patients by changing just the brand names on prescriptions. Patients assume that the treatment plan has been changed when, in fact, nothing but the brand name has. For example, Doctor A may prescribe a particular brand name of a commonly used heart medicine, Metoprolol. When the patient goes to Doctor B, the latter might just ask the patient to opt for a different brand name of the same medicine. The patient is unnecessarily burdened while no health benefits are gained. Relationships with pharmaceutical companies are usually the incentive for such unethical practices.

Those who defend this system of assigning arbitrary brand names to medicines often present the argument of the ‘quality’ and ‘trustworthiness’ of different manufacturers. This is not a sound argument. It is the job of the regulators to hold all manufacturers to strict quality control standards. Bioequivalence tests should be made mandatory. Any deviation should call for strict punitive actions, including – but not limited – to the cancellation of licenses.

Medicines are not fashion accessories. The same products cannot be sold under different packaging, brand labels and prices. They are not a luxury but a necessity for those who are suffering from a disease. Prescribing practices must be kept as simple and uniform as possible. Drug errors and dishonest practices cost patients heavily in monetary terms and also jeopardise their health and life.

Pakistan has previously flirted with the idea of single generic names for medicines during Zulfikar Ali Bhutto’s government in the 1970s – but only very briefly. The plan was scrapped because of immense pressure from the pharmaceutical industry. The pharmaceutical industry is a multibillion-rupee enterprise that will surely resist any such idea again as well. This resistance must be ignored and overcome if relief is to be provided to the people.

It is time to completely rethink the drug nomenclature and marketing systems in Pakistan. There is no legitimate or logical reason for marketing the same generic medication under a multitude of brand names. The only thing this system does is open up a whole range of opportunities for corruption and profiteering. This usually comes at the cost of serious consequences for the user.

In order to protect patients, reduce drug errors and limit avenues for corruption in the healthcare system, medicines should be marketed under single generic names only. The system of registering nonsensical and arbitrary brand names should also be abolished. Regulatory authorities should fix a single price for the same generic medicine for all manufacturers. The only exceptions could be to introduce brand name and patent right protection for the original manufacturers of a drug.

“That which we call a rose/By any other name would smell as sweet”

– Romeo and Juliet (2.2.43–44).

The writer is a former president
of the Association of Pakistani
Cardiologists of North America (APCNA).

He tweets @spaelaney