Mankind Pharma vs. Glaxo
Recently, I went to meet a doctor for a health condition. The doctor suspected some infection and prescribed anti-biotics. Moreover, he wanted me to support Glaxo over Mankind Pharma. Now in case you are wondering. The doctor figured I am a rich guy and so I, should support big drug companies which spend millions of dollars in R and D and take doctors to exotic locations for their paid vacations over drug companies who copy the medicine formulas after the patent expiry. Yes, the doctor prescribed Augmentin 625, the chemical name of which is Amoxycillin-Clavulanic Acid. Each tablet costs about 40 Rs. I was asked to take a course of 10. On the other hand, there is a generic pharma company called Mankind Pharma which manufactures the same drug and calls it Ramaswamy aka MOXIKIND-CV 625 instead of Kuppuswamy aka Augmentin, and interestingly offers the tablet for 15 Rs. It is not as if Moxikind is manufactured by Selvasingh annachi kadai in Medavakkam. Mankind is also a recognized pharma company.
I buy the medicines and came home happy, only to find Thangamani fuming.
She thinks the doc took me for a ride by prescribing a more expensive brand when there are cheaper but as effective options available. Thangamani and her ‘pal’ doctor colleagues always prescribe Ramaswamy (the Mankind pharma brand) and apparently it’s as effective and evidently costs 25 Rs. less per tablet.
Interestingly for the other anti-biotic, the doc prescribes the generic ‘metrodinazole’ when the popular brand is Flagyl. Why? This one costs 7 Rs. for 9 tablets. No wonder he did not care what I bought, my wife says.
How do I know Augmentin is a brand name for Amoxycillin-Clavulanic Acid tablets and the same thing can also be called Ramaswamy by Mankind Pharma and it would cost less?
On hearing this, my mom started how I always paid more to fruit vendors, vegetable vendors, auto drivers, etc. - Somehow they all figured I am one sucker and this doctor is the latest is mom’s theory.
My friends told me I would’ve mentioned something which made the doc feel ‘Oh here’s one more jobless IT guy who had searched endlessly on the net for the symptoms and conditions’ and so charged a 100 bucks more for consultation and a few more on medicines.
All said and done, I have recovered from my condition, and I am happy that I contribute my bit to the economy, keep the medical fraternity in good humour, and support big pharma. More paid vacations to the doctors!
January 13th, 2012 at 2:47 am
Your mom is right. Instead of writing this in a diary and keeping it with you, you pay for hosting, take time to write and all, wasting money. What a sucker
Joseph
January 13th, 2012 at 4:50 am
ippadiyum nadakkumaa?
and right how are we to know?
some people like me might think that the medicine would cost the same across brands…
ennavo ponga!!
doctors mela nambikkaye pochu!!
January 13th, 2012 at 6:23 am
Hi Monu,
Doctors are the end-line Marketing people. They have made a huge investment in the clinics and the only way they can get remunerated is by way of commissions because the fees we pay is enough only for their maintenance cost.
Mankind always makes cheaper Generic Drugs than many companies like Sun, Reddys etc.
Generic drugs are like what Shakespeare says ” What’s in a name? That which we call a rose by any other name would smell as sweet.”
January 13th, 2012 at 9:18 am
Here’s some more info on Mankind Pharma
http://business.outlookindia.com/article.aspx?279322
Even Moxikind CV is featured in this list
January 13th, 2012 at 2:57 pm
Doctors might be getting samples and free gifts from the giant companies. Just to be reciprocative the doctors might be extending the favor by prescribing these costlier medicines. But thoughtful family doctors who are more practical give you names of those generics. I always think healthcare and education sectors in India are wonderful and they are way better than most developed nations. We could let people know these generics by govt ads or on newspapers. But thanks to those good doctors who diagnose u and suggest ways to save money.
January 14th, 2012 at 12:17 am
Prabhu
Let’s forget what the doctors make and what the Big Pharma gives them.
Finally it’s your health.
Kuppusamy and Ramasamy companies ( aka generic no name companies) might make the generic versions of Augumentin or Flagyl. But their quality control strategies and the chemical compositions might not be at par with the Bigger Pharma.
If someone takes a generic Augumentin made by Kuppusamy Pharma and has a serious problem it might not become a big issue. But if you take Augumentin and you end up with trouble…Glaxo …being an International company will be in trouble !
There are dime a dozen Pharma companies all over India…who knows how their products are? Who tests them? Who assures quality? but …bigger companies ( assuming you buy the medicines from a good Pharmacy) can be trusted with good quality medicine.
Would you pay 15 bucks for a generic that doesn’t work or rather 60 bucks for a quality product that would save a life?
I always ( especially in India) - no matter what the doc. writes - always ensure that I buy the same formulation from a well known company..doesn’t matter it costs 2 times.
Out here in the US it’s a different issue. Thanks to Insurance regulations , if a formulation is available generic, they’ll give it generic ( especially in HMO’s).
Recently there was a scare that Nitroglycerin generic made by some Indian company was not good and didn’t work. After reading that, I tell my pharmacy not to give me generics made by that company !
January 14th, 2012 at 6:43 am
NV Sir,
Some questions since I do not know much in this industry.
>>But their quality control strategies and the chemical compositions might not be at par with the Bigger Pharma.
How do we know? Because the other party gives more expensive drug so we presume it is of higher quality? to be fair, I heard this version of the stry as well. One of my wife’s colleagues said the same thing. So opinions are not 100 % one way.
But in a country like India where there is very low Health cover, if a treatment for an infection costs 800 bucks, I am not sure everybody can afford that.
And what do they do? They will go to dubious pharmacies who sell ‘ set maathirai’ which are given to the shops at 5 Rs, per strip while the MRP will be like 5 Rs per tablet.
>>Would you pay 15 bucks for a generic that doesn’t work or rather 60 bucks for a quality product that would save a life?
Moxikind CV is well known. According to that outlook business magazine article, it is their top selling brand. It’s a 1500 crore company. Who knows, even this ‘generics will not work’ might be a marketing ploy planted by the big pharma. Who knows, this guy might even be an outsourcing partner for the big pharma. It’s like HUL selling kwality ice cream which may be manufactured by somebody else. So that somebody else can sell the same ice cream for cheap, and HUL can sell the same ice cream for a higher price as Kwality brand because of perceived better quality.
>> Out here in the US it’s a different issue. Thanks to Insurance regulations , if a formulation is available generic, they’ll give it generic ( especially in HMO’s).
If generics do not work, Is it not wrong to even have them available as an option in the market place? And why does US prefer generics if available? The same is the case in NHS UK FYI.
I respect your position - at least you are consistent,
Here is what me thinks,
If generics do not work, they should not be available, if they do work, the doctor should prescribe the medicine name ( just like the way he did for the 9 tablet for 7 bucks metrodinazole aka flagyl 400) and I should be free to purchase whatever brand I want.
Or if the doc is a Kolgai singam, he should be consistent. Is it okay if I take Metgyl from Jagsonpal pharmaceuticals which I can get 100 tabs for 45 bucks?
A good majority of the folks in India do not understand the intricacies of this trade. So mst of the times they end up asking barbers whether they need a haircut. You know what I mean?
January 14th, 2012 at 7:05 am
Joseph,
Vasthavam!
January 14th, 2012 at 7:06 am
Monu,
it’s not so easy, you will still find good doctors in this country!
January 14th, 2012 at 8:14 am
Prabhu -
Your question about ‘How do we know’ is very valid and has been put to test quite a few times…with spurious drugs etc..especially with ‘BENADRYL’ and meds like that which are big names.
The Answer is - Powerful - FDA ( Is it called FDA in India?). It’s a shame that patients lives are risked here ! Death Sentence for people who involve in spurious medicines must be mandatory IMHO.
–
Generics Why in US - It’s all about Money. but then there is ‘SOME TRUST” here with the FDA that we will never get SPURIOUS drugs. When I read about Nitroglycerin not working I was shocked actually ! It’s a heart Med. used during a Heart Attack !
–
Yes, I do understand the price issues when it comes to affordability by the population. I feel that the Indian govt. should have an extra pair of eyes on all the pharma companies - big and small and ensure the quality.
–
Your final line is funny !! and true…and I do see it happen !
–
India and countries alike where health care is cheap is a good business and a win-win for both sides. With good brains and cheap labor it is a good money maker for the Indian Govt as well.
It would only be wise on the Indian Govt to ensure that the GENERICs made in India are 100% quality !
-
PS - I am glad you are getting better. Take care. FYI - I was also on FLAGYL (generic) last week and stopped it due to severe side effects ! I am not 100% still but..slowly getting there!
January 14th, 2012 at 11:06 am
NV Sir,
My reference to ’set maathirai’ is a case of spurious drugs. Unethical pharmacies sell them to people who bypass the doctors and come to pharmacies for medicines.
your concerns on quality - very valid but I guess there are no easy answers…
I think mistakes can happen - big players or small.
If you remember the ranbaxy fiasco, some of their plants were banned by USFDA… I think things are sorted out now…
God alone knows if some condition goes away as a course of remission or because of the tablet.. Even placebos may give that effect in some situations… That’s why these guys have that ‘control group’
January 15th, 2012 at 3:20 pm
I agree with Narayanan. There is a group called Consumer Reports which chemically tests the quality level and ingredients for Multi vitamins in north america and Europe too I think. It appears that there are certain additives such as coloring agents, binding materials in your pills which should not exceed a certain level. These were regularly violated by the generics.
My point in is your comaprison between Augmentin and Moxikind, we have no way of telling whats in the pills unless a 3rd party does chemical tests. Sadly there is no other way out of this.
January 17th, 2012 at 4:55 pm
You have told that the doctor has written Metronidazole instead of Flagyl, so there could be a reason other than economics for the augmentin prescription
Clavulinic acid was invented by Beecham and Glaxo was the first one to market “Co-Amoxy-Clav” as Augmentin
Since it was the only brand in market for a long long time, the drug is usually referred by this name, just like Walkman, Kleenex, Xerox and Google
It could be possible that the doctor was not aware of the other brands which came much later
//Interestingly for the other anti-biotic, the doc prescribes the generic ‘metrodinazole’ when the popular brand is Flagyl. Why? This one costs 7 Rs. for 9 tablets. No wonder he did not care what I bought, my wife says.//
—–
Other than that,
How are you sure that Mankind Pharma does not sponsor paid holidays . . .
—–
I have heard (no first hand knowledge or experience) that : bigger the pharma company, lesser is the sponsorship
:)
—–
I have heard (no first hand knowledge or experience) because, I do not have a private practice and only prescribe Government of TN does not take me for paid holidays for prescribing drugs from their pharmacy
:)
January 17th, 2012 at 5:00 pm
//ippadiyum nadakkumaa?
and right how are we to know?
some people like me might think that the medicine would cost the same across brands…
ennavo ponga!!
doctors mela nambikkaye pochu!!//
Suppose I ask you what laptop to buy and you say SONY VAIO
And if I compare those specifications across various manufacturers and then decide
That you got a paid holiday from SONY
is that valid
:)
—
Wait wait
I am not denying that few doctors get sponsorship from pharma companies
But NOT every prescription is driven by it
There are many medical reasons other than economics for prescribing a drug manufactured by Parke Davis instead of Company in Avadi
January 17th, 2012 at 8:22 pm
Bruno,
Don’t you think the doctor’s lack of awareness of generics comes at the patients expense?
If mankind pharma can sponsor a paid vacation to the doc, atleast it burns a lesser hole in my pocket.
BTW, Bruno your analogy to monu’s comment was not very relevant. The position of the healthcare providers and that of a laptop salesman or for that matter a car salesman are very different. There is an element of trust in doctors ( that he/she will do only the right thing to cure my disease at the cheapest possible cost ) which is never the case with any sales guy.
I am yet to see a person visit multiple doctors for a throat infection or fever.
Maybe people do when someone is suggested a by-pass surgery.
Why does that Avadi company even operate in this business if their product is not upto standards? Do you expect the public to avoid the avadi company and choose Parke Davis?
As you yourself did not deny, I personally know doctors working in leading hospitals who are indeed taken care by the pharma companies. It’s very naive to think the doctors will not be influenced when they write prescription.
January 17th, 2012 at 8:44 pm
Just FYR apart from augmentin, even Pfizer has a cheaper product. I am sure pfizer is not one of those ‘Avadi’ based companies. If Parke Davis, Pfizer, Glaxo is the way to go, what is the need for generics in this world?
January 17th, 2012 at 11:42 pm
There are some companies that sell generics and also reputed. Cipla, Ranbaxy etc. I would trust those companies, better than Munimma Pharma, Shuklabeedi Pharma etc. :).
January 18th, 2012 at 7:26 am
NV sir,
I understand.
What I do not understand is, as a patient should i go blindly buy what the doctor writes in his prescription or not?
To avoid getting ripped apart, should i check online and see what are the reputed generics available for the same medicine?
some claim medicinal reason, but totally silent on ‘then how come generics is available and recommended’ solution.
I think medicine is not FMCG. when someone will depend on a drug for his or her life i think its not appropriate to go by brand. Should i go by whether i see Augmentin AD in TV? Just like there are ads in the US for lipitor/Nexxium etc?
January 20th, 2012 at 8:28 am
//Bruno,
Don’t you think the doctor’s lack of awareness of generics comes at the patients expense?
//
A doctor cannot be expected to know each and every brand name of each and every drug
He prescribes what he is comfortable with
//If mankind pharma can sponsor a paid vacation to the doc, atleast it burns a lesser hole in my pocket.//
That is fair
//BTW, Bruno your analogy to monu’s comment was not very relevant. The position of the healthcare providers and that of a laptop salesman or for that matter a car salesman are very different.//
I know that
I was just telling you that IT IS WRONG TO BRAND EVERYTHING as one
// There is an element of trust in doctors ( that he/she will do only the right thing to cure my disease at the cheapest possible cost ) which is never the case with any sales guy.//
I was not referring to SALES GUY
I was telling to a advice by a friend
Please read again
—
//I am yet to see a person visit multiple doctors for a throat infection or fever.//
That shows that you have very very less knowledge about this field
:) 
//Maybe people do when someone is suggested a by-pass surgery.//
Why can’t you come to GH one day
I will show you people who visit various departments of the same GH
:)
//Why does that Avadi company even operate in this business if their product is not upto standards?//
The same way Assembled computers operate vs Apple Computers
The same way you get a MP3 Player for 500 rupees in ritchie street vs iPod
// Do you expect the public to avoid the avadi company and choose Parke Davis?//
That is for them to decide !!
//As you yourself did not deny, I personally know doctors working in leading hospitals who are indeed taken care by the pharma companies. It’s very naive to think the doctors will not be influenced when they write prescription.//
It is very naive to think that doctors are always influenced when they write prescription
January 20th, 2012 at 8:37 am
Generic Name is like a specification : This speed processor, this capacity HDD, this size monitor, this number USB ports
Brand name is giving the name of the model ” SONY VAIO, HP Pavilion etc
–
If I recommend VAIO to you and if you decide to buy an assembled system with the same configuration, can you expect the same performance
This is the first difference
There are other differences too
If you really interested in learning them, i will explain
But
Even after that, if you are going to say that “I am not convinced” what is the need for the explanation
January 20th, 2012 at 8:40 am
OK
Answer this question
is the Branded system like VAIO, HP Pavilion, MacBook same as that of a assembled one with similar configuration
Yes
or
No
January 20th, 2012 at 8:45 am
As I have told already, I am not trying to totally oppose your points in toto
I am just pointing out that your view is not 100 % correct
TNMSC gets only generic drugs
But they do work, because those drugs are FROM ESTABLISHED companies with definite QC Norms
Let me give you few links for your side too
http://jama.ama-assn.org/content/300/21/2514.short
http://jama.ama-assn.org/content/301/16/1654.2.extract
In Government Setup, TNMSC model is based on studies like this
That Generic is effective as Branded, when QC Norms are adhered too
There is no issue regarding use of Generic in Government Setup as the purchases are made in bulk and there is a mechanism for testing the drugs
–
But
How are you going to know the QC when you are going to buy Over the counter
This is the main issue
–
Should a doctor test whether the generic drug works on the patient, or should he stick with the time tested branded drug
January 20th, 2012 at 8:48 am
Bottom Line
There are economic reasons ( low cost) to prescribe generic drugs
There are medical reasons ( bio availability, safety) to prescribe branded drugs
–
Both sides have their points
Unless government supplies the drugs (after ensuring QC) , prescription of generic drugs is not advisable
January 20th, 2012 at 11:03 pm
Doesn’t matter if it’s Generic or Not. The Govt. should ensure that the citizens get the best - Price and Quality.
January 21st, 2012 at 8:12 am
Mr. Bruno,
If all a patient needs is a laptop that works, then it’s wrong to ‘prescribe’ them a MacBook Pro, due to real or perceived quality.
There are enough literature available to inform doctors about the various brands and generics available - IDR and the likes is what I hear. So if the doctor is not expected to know, then is the patient expected to know? That’s very realistic and reasonable I say
BTW I am a few hours away from the GH. I am not interested in spending 4 hours in travel alone for treating a normal infection. I am willing to pay a price to the doctor for the convenience of a consultation in my neighborhood. I have no problems in paying his consultation fee. What concerns me is the other perceived or real hidden fees.
The real deal is not many even well educated folks know about the difference between generics and branded drugs. Plus, I do not know if what the doctor writes is a generic or branded.
I never claimed to know a lot about medicine. I am raising something which i believe has significant cost impacts for the patients. It is for the medical community to evolve systems which works for everybody in a transparent way - to avoid abuses and exploitation. Otherwise the poor man will go straight to the nearby pharmacy and get spurious drugs which is a lose lose proposition for any right thinking person.
Of course not all doctors are bathani the same way that not all auto drivers are bad, not every govt. employee is corrupt etc. that just adds very little to the conversation IMHO.
January 21st, 2012 at 8:29 am
To your comment on the ‘main issue’
- any lay man will assume the drugs available in the pharmacy is drugs manufactured by reputed companies with good QC. That’s part of the patient’s mental model. Their world does not involve generics, branded drugs, quality control trade off etc. they think doctors know best, and they are engaging the doc’s consultation for a fee. This trust also comes with its own share of responsibility I think, from the entire medical community. If it means creating an awareness about generics, so be it, just like AIDS awareness. At least I am not able to see much on generics in India. The silence of all concerned in the industry is deafening to say the least.
January 21st, 2012 at 8:35 am
You are free to make up your mind to explain or not. As long as its not personally offending me or any one I will publish it. It is for the people who read to learn somethng from it. By posting here, you are not just explaining me, but also a bunch of folks who read my blog.
I am neither inviting you nor barring you from posting here.
January 21st, 2012 at 8:38 am
Thanks it the link. FYI I did read a few ( not the same URLs ) on the same topic before this post.
On a related note:
http://www.newyorker.com/archive/2004/10/25/041025crat_atlarge?currentPage=all