I agree. I am a physician myself and I have quit my job in several corporate style hospitals because they would refuse to keep the cheaper brands available in pharmacies. In actual fact, I have learnt that the same company manufactures the same drug with the same quality in two different packagings. For example, an injectable antibiotic might be supplied at Rs. 100/- as a simple vial with the same strength and purity and it might also be supplied at Rs. 400/- with a fancy packaging and accompanied by a syringe with the same standards of manufacture. The second one is the one supplied to the corporate hospitals directly even from reputed companies. The corporate hospital managements insist that the second one only be available in their pharmacies and they also insist that their patient buy from their own pharmacies and that their employed doctors write that particular brand. The brand name will be different for both the packages. Unlike what the common man believes, the doctors do not have any say in the matter. Doctors working in corporate hospitals have no authority to insist that such and such branch be made available in the hospital pharmacy because it is cheaper and of the same quality. Similarly, the Medical Council of India has authority over investigation and suspension of individual doctors' licenses but has no authority over quacks or corporate hospitals or pharmacies. Thirdly, even though many non-medical intellectuals keep hyping the fact that doctors should write generic drug names and let the patient choose which brand is good for them, practically it is not good for the patient. The reasons are many but I will point out two basic facts. Most pharmacies are run by unqualified people. Most pharmacies also get a cut from the pharmaceutical companies. In fact, in many places, they use the higher margins they get to violate the prescriptions of the doctors and also treat the patients on their own. When pharmacists are unqualified (usually not the brightest of the lot and mostly businessmen with 10th standard qualification), they remember only the brand names that they have in store and never know the generic drug name. Finally, given the option to choose between different brands, most patients are illiterate and are not aware of the differences between the brands. There might be two different reputed companies manufacturing the same drug but one might be manufacturing the drug in an SEZ with the same quality and hence, its price might be slightly lower. That does not make it an inferior drugs. Also, for your kind information, many SEZs have unknown or unqualified pharmaceutical companies set up in them availing tax benefits but running chemical or pesticide factories on the same factory floor. These are the companies which actually bribe pharmacists or doctors to push their drugs and in fact, many of their brand drugs are priced higher than well reputed companies. As far as doctor's incentives are concerned, I know for a fact that reputed companies such as Dr. Reddy, Cipla etc have stopped giving even pens and notepads to doctors as gifts. Even medical textbooks or journal subscriptions are not entertained even though they are absolutely required for updating doctor's knowledge. Considering the low amount of doctors fees charged in India, no Indian doctor can actually afford to buy a journal subscription. For example, my consultation fees is Rs.250/- for 10 days and I get only a few patients a day. The annual subscription fees for the highest rated medical journal i.e NEW ENGLAND JOURNAL OF MEDICINE, in rupee terms is anywhere between Rs. 50,000/- to 75, 000/- depending on exhange rates even if it is online subscription only. The layman may make his own calculations to decide whether it is economically feasible and can visit the websites of any number of reputed medical journals to check the subscription prices themselves.
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