Friday, August 10, 2012

Why do doctors prescribe expensive branded drugs ?

We all know that there are generic drugs available , which cost a fraction of what the expensive branded drugs do, but are as effective as them. Even though a considerable amount of money would be saved if doctors prescribed only generics, why do doctors continue to prescribe the expensive branded drugs ?

It’s not fair to say that doctors are on the take – and do this because pharmaceutical companies bribe them to prescribe their drugs . In reality , the matter is far more complex. Most doctors , like most humans, have habits which they follow mindlessly. This means that when you're used to prescribing a particular brand name , you tend to continue doing so if it gives good results , and it's very hard to change these habits, especially as you get a older.

Pharmaceutical companies are extremely aware of this , which is why they spend so much money on brainwashing doctors and trying to embed the brand names of their particular drugs in the brains of doctors when they start practice . They know that most doctors will continue to prescribe just that particular brand name – and this is why the major reason doctors do this is out of inertia.

Secondly, pharmaceutical companies have mastered the art of marketing to doctors, and spend a lot of time and money on making sure that doctors remember their particular brand name. We all know that what is on top of the doctor’s mind is usually what will get prescribed ! It’s very uncommon for a doctor to think consciously when writing a prescription for a common problem – this is something he does reflexively , thanks to intellectual inertia ! Most doctors will not think when writing a prescription – these  are the four different brands and these are the comparable generics - which one should I use ? Since they write so many prescriptions daily, it become a reflex action , and they automatically write the first brand name which pops into their mind ! This is often the one which they have used over a long period of time , and it becomes harder to change long established habits – it’s hard to get neurons to change their synaptic pathways !

Companies which manufacture the less expensive generics don't have as much money to spend on marketing or advertising , as a result of which it's much harder for them to get mind share of the doctor's brain , which an extremely expensive piece of biological estate, because hundreds of drug manufacturers vie for it daily.

One solution would be to insist that doctors are allowed to only prescribe generics . While this would take some problems away, it would create a whole set of new problems instead , and many doctors will protest strongly against this encroachment on their autonomy ! A better choice is to educate patients , so that they learn to ask for inexpensive generic alternatives. I think this is extremely doable – and patients be encouraged to ask their doctors when they write a particular brand , as to whether an inexpensive generic is available instead . And even if doctors don't have the time or the inclination to do so, patients can always ask the chemist !

Let’s not forget that it’s sometimes patients who demand the more expensive branded medicines ! Many believe that the more expensive drugs are better and more effective than their cheaper versions – just like they believe that expensive branded jeans are better than unbranded ones !  This is why we need to spend a lot of time and energy in educating and empowering our patients, rather than focusing only on doctors. This will provide a win-win situation where everyone stands to benefit.

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  1. What about having Doctor write generic name along with his preferred brand name and let patients decide( at least who can decide) The power of pharma is huge and let there be a system which is fair to both doctors and consumers.

  2. Jason9:19 PM

    It's riduculous to justify the practice of prescribing overly expensive drugs by saying the doctors are prescribing these expensive drugs out of habit. The doctors need to recognize that this is a bad habit and take steps to correct it. Every other profession out there strives to bring value to their customers. Why should the medical profession be any different?

  3. Dear Jason,

    Excellent point. This is not a justification - just an acknowledgment of the fact that doctors are human, and are often creatures of habit ( including many bad habits !)


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