Conspiracy Theory

Yes. Another ST Forum letter to make angry doc angry. And on a weekend too!

May 27, 2006
Some patients have no choice but to buy cheaper medicines across the Causeway

I appreciate the advice to be aware of the risks of taking counterfeit medicines from Jason Humphries, President of the Singapore Association of Pharmaceutical Industries, 'Beware, fake drugs can cause serious problems', and Dr Raymond Chua, Honorary Secretary of the Singapore Medical Association, 'Buy drugs only from well-known pharmacies' (ST Forum, May 20).

But I understand that those who seek cheaper medicines across the Causeway want to stretch their dollar.

There are three reasons why Singaporeans buy medicines from Malaysia or overseas. These patients have no choice in their own country.

Firstly, the prices of branded drugs are tightly controlled by the manufacturers or importers, with high profit margins, because patients are denied the free choice to purchase the equivalent or good generics from open competitive markets like in the US or Europe.

Doctors in Singapore only prescribe branded medicines to be safe and comfortable. The pharmacists here only follow rules and keep records to sell the prescribed drugs as stated by the doctors and charge you the same prices as instructed.

So does Mr Chan want doctors to NOT be safe and comfortable? Or does he want pharmacists to NOT prescribe the medications 'as prescribed' by doctors?

Secondly, the prices of branded medicines from your doctors and from the few privately owned pharmacies in Singapore are the same. It's a waste of time to ask for prescriptions from doctors. Eg, I pay $4 a tablet each day for Plavix, a 'new and better' blood thinning drug, after my bypass operation 12 years ago, as compared to $1.70 a tablet of Ticlid and 5 cents a piece of Cardiprin. Is Plavix so good that it can displace the time-proven Cardiprin?

Plavix is not Ticlid is not Cardiprin. The difference between them is not that of branded and generic. They are different drugs, and have subtly different indications. Some patients cannot take Cardiprin or Ticlid because of side effects or allergy or risk factors, some doctors prescribe Plavix because they are proven to be better for the patient's condition.

Health Minister Khaw Boon Wan has said that if the generics costing a fraction can do the job, why pay for the branded?

Because some drugs do not yet have a generic form. Unfortunately new drugs are covered by the same concept of Intellectual Property as movies and computer software, and to manufacture and sell them before their patent run out is to commit a sort of drug piracy.

Thirdly, due to controlled high margins of profits in branded medicines, both doctors and branded medicine suppliers would refrain from prescribing and importing good generics to protect their interests.

Now that's a bold accusation. Against doctors, that is. Not all doctors prescribe branded drugs, and not all doctors have 'interests' in prescribing branded drugs. As Oz Bloke has mentioned before the margins on generic drugs are actually higher than on some branded drugs, and of course they cost less to stock. A doctor who wants to make a quick buck may in fact stock cheap, popular generics, mark them up by a high margin but still keep the selling price 'affordable', and aim for high turn-over.

If indeed doctors and medicine suppliers controlled the import market, wouldn't we simply import cheap generics and not branded drugs at all, but sell the generics at the price of the branded drugs instead?

The multi-million-dollar pharmaceutical industry has virtually controlled the market for more than five decades. It is high time that shackles be liberated. We need prompt and effective action with mandatory recommended prescriptions for patients to purchase medicines of their choice - either branded or generic.

Shackles? That's a bit dramatic. And it's multi-billion-dollar industry, actually. Like I said some drugs are simply not yet available in generic form. And even if they are, not all generics are the same as the original drugs (especially those with a patented 'delivery system').

I urge the Government to pass legislation for separate consultation and dispensing so that patients can choose the cheapest source for their medicines.

Paul Chan Poh Hoi

I have nothing against separating consultation and dispensing, but as others have noted on this blog before this may not necessarily lead to lower costs for the patients.

If the problem is that the medicine importers control the import and the prices, how would preventing doctors from prescribing lower costs when the seller can still maintain a high price?

Are the prices of drugs high? Yes, for some drugs. But are they too high? Well, that depends on what criteria you judge it from. But I take issue with Mr Chan's potrayal of doctors as people involved in a conspiracy to keep drug costs high for their own interests.

God knows I never benefit directly from prescribing branded drugs...