E-drug: Reply to Dr. Srinivas from Dr. Attaran (cont'd)
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Amir,
I am encouraged by this discussion. There are too few actual debates
that happen in the group, and a debate such as the one you have
sparked are far more educational (IMHO) than multiple postings
about this or that meeting - it causes people to examine their own
positions and perhaps even chime in.
To continue the discussion however, of course you are right, patents
are not solely responsible for poor prescribing practices. However it is
naive to suggest that just because they are not solely responsible,
that the issues around patents cannot have any role. Poor prescribing
practices arise from a multiplicity of causes, all of which interact.
Rather than attempting to refute the impact of a single contributing
factor we might be better engaged in trying to determine the nature of
the role that patents might play in affecting prescribing practices, and
what the interactions are with the other factors that may be amenable
to improvement. The issues that surround the incorrect use of
Chloroquine in a rural setting are somewhat different from those that
surround the incorrect use of newly patented drugs in an urban,
private practice, and I don't think that your comparison is helpful. It is
also important to not confuse the use of OTC or socially marketed
drugs with prescription medications.
Overall I believe that there is a disproportionate focus on simple
logistics (how to get medications from point A to point B), and too little
attention paid to rational prescribing or rational drug use (how to get
the right drug to the right person for the right reasons at the right
time). None of this takes away the absurdity of issuing a patent for a
medication that has no demonstrable difference from its
predecessors beyond a chemical substitution that does not affect its
action on the body. Neither does it change the obvious fact that if you
use a reputable mechanism (the patent) to carry out a (seeming)
deception, then you will devalue the patent mechanism, and
contribute to compromised decision-making.
Cheers,
Malcolm Bryant MD. MPH
Medical Director
SATELLIFE
30 California Street
Watertown MA 02742, USA
tel: +1-617-926-9400
www.healthnet.org
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