E-drug: Reply to Dr. Srinivas from Dr. Attaran (cont'd)
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Dear e-druggers,
I think the many replies to my letter since last week (sorry for the
delay in answering) are getting closer to the truth of this matter.
Yes, there absolutely IS a problem with irrational prescribing in
developing countries -- that is certainly and lamentably true, and
hopefully everyone recognizes that exposing it as an underlying
assumption in Dr. Srinivas' reasoning is not the same thing as
denying that it's true. But as I made clear, it does not follow from even
many observations of irrational prescribing that patents are causal of
this; and what I object to is the sloppy reasoning which seeks to make
this linkage.
In fact, irrational prescribing happens no matter whether medicines
are patented or not: think of the truckloads of irrationally prescribed
chloroquine or SP, off patent for years or decades, that still clog
dispensaries the developing world. Moreover, pharmaceutical
marketing is not confined to patented products: think of the many
advertisements we've seen for those same antimalarials painted on
signs and sides of buildings throughout Africa.
And even leaving that aside, in the subset of cases where
pharmaceutical marketing is pitching the latest, possibly patented
medicines, it is a deep and case-specific inquiry, not to be made light
of in generalizations, whether that marketing is: (a) affecting
prescribing practices contrary to other influences such as essential
medicines lists, and; (b) resulting in patient outcomes that are
irrational, in an economic and/or medical sense.
I'm grateful for the studies that others have cited, but let's face up to
the fact that they fall rather short of establishing the proposition that
patents generally affect prescribing practices, and further, that they
do so irrationally. For those who may feel a pressing need to lay
blame on the patent system, there are a number of indictments that I
or others can accurately and meaningfully levy at it. This isn't one of
them.
Dr. Amir Attaran
e-mail: amir_attaran@harvard.edu
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