by Dr. Iain Corness
Getting “real” medicines!
The stimulus for this week’s article
came from poor old Ms. Hillary who had received a letter on the subject of
pharmaceutical costs. The subject matter did not fit her column, so it was
passed on to me.
The price of medicines is always a contentious subject - and not just in
Thailand. In Australia “brand name” drugs are more expensive than “copy”
(generic) drugs. However, there is a good reason for the brand name being
more expensive than the generic. The pharmaceutical companies spend millions
of dollars to develop, test and get licensing for new drugs, costs not borne
by the makers of the generics, after the patents expire. But some
manufacturers do not wait for the patents to expire and the ‘copy’ drug will
also be cheaper.
In Thailand, many drugs can be bought over the counter (OTC), which may or
may not be a good thing. Self diagnosis and self prescribing can be
dangerous. That is why I believe that doctors should be prescribing, and
pharmacists should be checking and supplying. If most drugs are only
available through pharmacies world-wide, on the prescription of a doctor, is
it safe to just buy OTC, without any doctor’s advice?
I believe it is not safe. As the American Food and Drug Administration (FDA)
reports in its website, “Patients who buy prescription drugs from websites
operating outside the law (or OTC as in Thailand) are at increased risk of
suffering life-threatening adverse events, such as side effects from
inappropriately prescribed medications, dangerous drug interactions,
contaminated drugs, and impure or unknown ingredients found in unapproved
The FDA goes on to warn “… certain drugs be dispensed only with a valid
prescription because they are not safe for use without the supervision of a
licensed health care practitioner. Generally, before the practitioner issues
a prescription for a drug the patient has never taken before, he or she must
first examine the patient to determine the appropriate treatment.
Subsequently, the patient receives the drug from a registered pharmacist
working in a licensed pharmacy that meets state practice standards.”
Now returning to the local situation and the plethora of pharmacies on every
major road (there are three within 50 meters of my home for example), how
many of them are “legal”? How many are actually staffed by registered
With so many, and competing against hospital pharmacies on price alone, the
only way they can make a good profit is to buy cheaper copies of brand names
and sell them OTC. There is also the situation where the local pharmacies
will sell the restricted (some prescription only, and others hospital only)
drugs. Prime examples of this are the ‘blue diamonds’, which are supposedly
only available on prescription from a licensed physician. In the letter that
Hillary passed on, the writer received Prednisolone tablets from his local
pharmacy. Prednisolone is a hospital only restricted drug in Thailand. The
law was again thwarted.
According to the World Health Organization, WHO has been fighting drug
counterfeiting since it became a major threat in the 1980s. The problem was
first noticed by the pharmaceutical industry. They saw that their own
products were being copied, and it went on from there.
In fact, the WHO estimates that 25 percent of medications bought in street
markets in developing countries are fake. My own experience in some of the
poorer SE Asian countries has been that another 50 percent are real but out
of date, leaving around 25 percent genuine manufacturer’s stock.
Some authors say that the figures are even worse than that. An international
study published in Tropical Medicine and International Health in 2004 found
that 53 percent of Artesunate tablet packs sold in the region did not
contain Artesunate, a vital antimalarial drug. You can see the danger.
According to WHO, drugs commonly counterfeited include antibiotics,
antimalarials, hormones and steroids. Increasingly, anticancer and antiviral
drugs are also faked. And you can add to that, the ‘blue diamonds’. Never
forget the phrase “Caveat emptor” (Let the buyer beware).
You have been warned. Get your medications on prescription from a hospital
or large registered pharmacy you can trust.
Like all things in life, you get what you pay for.