LET’S TALK GENERICS!

Recently there was a spat between Dr Fuad Khan, the Trinidad & Tobago health Minister and Dr Petronella Manning-Alleyne (sister of the former Prime Minister) over the standard of generic medicines in Trinidad.  Dr Manning-Alleyne’s comment as a concerned relative of an ill person, though merely observational should be used as an opportunity to re-examine our regional procedure in terms of the medicines that are used on our patients. Dr Khan’s response which I believe to be correct carried a tinge of politics with it.  I believe there are likely to be other reasons why former Prime Minister Manning was not responding appropriately to the medication and not necessarily that it was of poor quality. That said, the Caribbean region should not be seen as a dumping ground for manufacturers of generic medications that are substandard in anyway. There are many factors responsible for the use of generic medicines the first of which is cost. In a Caribbean survey carried out by L.M. Pinto Pereira et.al in 1998 approximated that 35 – 55% of each country’s requirement is generic substitution and is likely to increase. They further stated that “Standard bioavailability laboratories doing drug testing are not present in the region. The Caribbean Regional Drug Testing Laboratory in Jamaica undertakes analysis for Caribbean countries on government requests and for a fee for private consumers. Production of generic drugs in the English speaking Caribbean is undertaken predominantly in Barbados, Trinidad and Tobago, and Jamaica. Together with the eastern Caribbean countries they are the major buyers of generic products. Certification of the generic equivalent in the country of origin is mandatory. In Trinidad and Tobago the Ministry of Health is drafting a national drug policy which will address evaluation of generic substitutes.” It is time a comprehensive and cohesive decision is made by individual government to ensure that concerns about standards of generic equivalents are urgently addressed. WHO in their 1999 document ‘Operational principles for good pharmaceutical procurement’ identified a number of problems such as inadequate rules, regulations and structures; public sector staff with little experience in responding to market situations; absence of a comprehensive procurement policy;  government funding which is insufficient and/or released irregularly; donor agencies with conflicting procurement regulations; fragmented drug procurement at provincial or district level; lack of unbiased market information; lack of trained procurement staff. They then recommend that governmental agencies should procure the most cost-effective drugs in the right quantities; select reliable suppliers of high-quality products; ensure timely delivery and achieve the lowest possible total cost. As Mr Manning recovers in the USA, I wish him speedy recovery and thank him for bringing to light a very important issue. National governments are encouraged to make effort to harmonise policies taking on board the possible relationship among definitions adopted in different countries, the development of national pharmaceutical markets, and national policies to stimulate competition.