To be as generic as can be

Medicines are becoming more bitter than ever before, moneywise. Why is it, then, that generic medicines are not more broadly utilised by those who have to buy their own?

They are cheaper than branded counterparts and offer scope for substantial savings, particularly to those who are on regular intake. One reason could relate to perception and attitude.

Use of generics, however much one wishes to keep the national and personal cost of medicine bills down, depends on faith in them, as much as on availability.

That is generally true insofar as the private user is concerned. To an extent it also applies to users entitled to free medicines.

The government tries to ensure as far as can be that the medicines it purchases for use in state hospitals and health centres, or to be dispensed to those entitled to receive them for free are of the generic type.

If one, despite being entitled to free drugs, is uncertain about the probable effectiveness of a generic relative to the branded alternative, and can afford or strain to do so without breaking, one would probably pay to buy one's requirement branded.

That happens whether because of advice received or through personal conclusion, notwithstanding that generics produced by reputable companies should be no different from their branded counterpart.

There is a clear need for more widespread dissemination of information in this regard, if medicine requirements are to be bought as economically as can be.

It should not be difficult to quote authoritative sources on the type and quality of generics that could and should be available. Professionals in the pharmaceutical field will tell you that, by definition, a generic is a clone.

So it cannot be any more or less effective than the branded counterpart - as long as the manufacturing is up to the same standards, which definitely - say the professionals - should not a problem with the top rank manufacturers.

Good quality generics are available only for drugs that are off patent. The serious generic manufacturers would not even dream of infringing patent rights.

One does come across suggestions that some doctors and pharmicsts nudge the patient towards branded products even when perfectly acceptable generic substitutes are available.

The point regarding cost, however, is not the exception, or what advice is given to patients. Generics - professionals in the pharmaceutical sector insist - can reduce the cost of medicines and there are enough high-quality manufacturers around to ensure that efficacy and safety are not compromised. The effect of more use of generics due in large part to their lower costs would extend beyond the impact on the pocket of the those who choose to buy them. Availability and use of a generic will prod the manufacture of the branded substitute into a reaction.

Big producers of branded medicines are well versed in protecting their turf. They plead high research costs and resort to considerable shenanigans when they set the prices for their branded products.

They attempt to make sure that they recover their research and development expenses as quickly as possible, irrespective of the burden on the end user.

They do not take lying down the rising threat to sales to revenue and profits offered by competing generics.

The first reaction to a good generic by the large producers would probably be not to lower their own prices, but to offer discounts to pharmacists and incentives to doctors.

Some hold that these are standard practices everywhere, even in highly regulated countries. So why should Malta be different? I was asked.

Discounts and incentives are preferred to price cuts by branded producers because they are reversible. Therefore, any measures to promote generics would need to address that issue as well.

A point emphasised to this columnist was that it would be a mistake to think that the medical and pharmaceutical professions can regulate themselves: "Experience worldwide has shown that they cannot," I was told.

In Switzerland, whose pharmaceuticals industry is a world leader, and where health insurance is contributory, there is currently an active campaign to promote generics going on.

Doctors are being asked to prescribe them and pharmacists are encouraged to recommend its generic alternative when presented with a prescription for a branded product. The campaign does not stop there. Significantly, as part of the push to generics education and exhortation are backed with monetary measures.

For instance, patients who switch to generics have their franchise cut by half, from 20 per cent to 10 ten per cent. (Franchise, in this context, is one Swiss way of describing the amount of money the medically insured has to pay himself before the insurance company starts picking up the bills - an excess provision, in more common insurance parlance.)

The broader discussion of health care costs has to carry an important proviso. The major component of the national outlay on health care is not the cost of medicines. It is the public expenditure that goes on hospital and institutional care.

That is an even more intractable problem, as Malta's health expenditure votes demonstrate in the government accounts demonstrate, and as will become more apparent when Mater Dei Hospital comes fully on stream.

That only serves to emphasise how important it is to order and import medicines as efficiently as possible, in terms of type, quality and price.

In the still restricted discussion on the rising cost of medicines, emphasis is now being placed on higher compliance costs because of registration procedures as a result of Malta being part of the European Union.

The point was evident around three years back, and certainly as soon as accession became a reality.

In this regard, apart from the possibility, assuming it is there, of negotiating better arrangements with the EU, a little more common sense would go a long way. A not untypical experience of a smallish importer illustrates the point.

The importer had to translate two documents. One was meant for health care professionals, and one for lay people. The technical terms used in the document are beyond the reach of the usual type of translator, competent though s/he might be. The importer commissioned a medical person to do the job, which was completed well and in good time.

The translator welcomed the handsome fee, but was somewhat bemused. He remarked as follows: given that (a) Maltese health care professionals may safely be assumed to have a good knowledge of English, and (b) English is an official language in Malta, why does such a professional document need to be translated at all?

The question why? does not tend to have automatic answers, self-evident though they might be. End-users who pay for their own medicines and taxpayers, who shoulder the collective public bill, may do worse than asking it repeatedly: of themselves as well as of the authorities.

Translation costs have been brought up in discussions by medicine importers and pharmacists with the government. I am not aware that a detailed answer has been given, certainly not one that impressed with its clarity and persuasiveness.

Aside from EU requirements, which other smallish countries have managed to keep less burdensome in implementation than has been the case in Malta, there is the related issue of the Maltese language.

When the negotiations on EU membership were going on there was huge political play on whether Maltese would become an official language in the European Union. Those against membership charged that it would not. The government vowed that it would be. And that was how it came to pass.

There is certainly a great need to promote good use of Maltese within the Maltese Islands. It may not have much utility when it comes to transacting business with the rest of the world. And tourists and hedge funds and captive insurers and ITC companies do not come to Malta because of our language.

Yet our language is part of our identity, a distinguishing feature. It permits us to have our own literature. I find it remarkable that there are parents who argue as strongly as can be that an O-level pass in Maltese should not be obligatory to join a Malta University course.

Foreigners can join without having such a pass - why not our children too? I was asked very recently by a clutch of parents. Worse than that is the way the Maltese language continues to be butchered, in pathetic private conversation and also with flagrant disregard for propriety over our radio and television stations.

Taking a stubborn political stance over its inclusion as an official language of the EU was not the medicine required for this national linguistic malady. Imposing translation costs on importers and distributors of medicines, rather than insisting that accompany documentation should be in English, makes little sense.

There is too much around that does not make sense, not least in the discussion on the prices of medicines, and the desirability to promote more resort to good quality generics.

A focused education programme is required. The Swiss model cannot also be applied. We operate on a completely different system, and that too has become a political commandment, though I would not be surprised if it were broken in the not too distant future.

That is not to say that other effective ways could not be found to encourage the use of generics, where that is possible. Individual preference will always weigh heavily on individual decisions. Rising prices carry their own weight as well.

The discussion needs to be expanded. Users may be more inclined to opt for generic medicine if promotion stressed authoritative opinion on quality and effectiveness, rather than price.