Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Reviews
Year : 2009 | Month : June | Volume : 3 | Issue : 3 | Page : 1596 - 1600

Generic Medicines As A Way To Improve Access And Affordability: A Proposed Framework For Pakistan

JAMSHED S *, BABAR Z U D ** , IBRAHIM M I M***, HASSALI M A A ****

*PhD Scholar, Department of Social and Administrative Pharmacy,Universiti Sains (Malaysia),**Lecturer,Pharmacy Practice ,University of Auckland,(New Zealand),*** Professor,****Lecturer, [Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains (Malaysia)]

Correspondence Address :
Shazia Qasim Jamshed
E.mail:pharmacist1992@live.com

Abstract

Medicines play an important role in health systems throughout the globe; however one third of the world population does not have access to essential medicines. Generic drugs have been instrumental in reducing cost and improving affordability. Generic penetration varies in the developing world and the sale of generics are growing in all the major markets, but the proper domestic availability of generics and their quality use is still a question mark. With the increasing population and shrinking resources, generics could be a recipe for improving the access to and affordability of medicines in Pakistan. However, to gain a wider health professionals’ support, it is vital to understand the issues surrounding generic medicines.
This proposed strategy will document the relative importance of the acceptance of generics in Pakistan. This attempt will ameliorate the perception and credibility of generic drugs among providers, prescribers, and consumers. Moreover, this effort will provide the baseline data to assist policy makers to promote the quality use of generic drugs.

Keywords

Generic Medicines, Pakistan, Drug Policy, Pharmaceutical Industry

How to cite this article :

JAMSHED S , BABAR Z U D , IBRAHIM M I M , HASSALI M A A . GENERIC MEDICINES AS A WAY TO IMPROVE ACCESS AND AFFORDABILITY: A PROPOSED FRAMEWORK FOR PAKISTAN. Journal of Clinical and Diagnostic Research [serial online] 2009 June [cited: 2019 Aug 26 ]; 3:1596-1600. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2009&month=June&volume=3&issue=3&page=1596-1600&id=510

Introduction
Developing countries possess inefficient and inequitable healthcare systems characterized by bare resources, economic instability and disparity and meager infrastructure. These are the major obstacles in providing access and affordability to quality healthcare. Access to and affordability of medicines is a vital issue in any Asian region and Pakistan, whose healthcare systems being encrusted with multitudinous challenges along with accelerating healthcare cost, is not an exception in terms of access and affordability. As 77% of medical expenditure in Pakistan is out of pocket1, the issues of access and affordability need to be addressed by the induction and practice of generic medicines, a major cost containment strategy worldwide.

Generic Medicines And Innovator Brands
The term ‘generic product’ is used in different ways. It can be a product that is marketed under the drug’s non-proprietary approved name, or it can be a product that is marketed under a different brand (proprietary) name. It is sometimes used to refer to any product from a company other than the innovator (research-based) manufacturer (2).

A common use of the term that used by the World Health Organization WHO (3), is for a pharmaceutical product that is intended to be interchangeable with the innovator product in an individual patient, which is usually manufactured without a license from the innovator company, and marketed after the expiry of the patent or other exclusivity rights.

An innovator product is a medicinal product that is authorized and marketed on the basis of a full dossier i.e. which receives the marketing authorization first and which is usually the patented version of the medicine. Three determinants of quality, safety, and efficacy apply to generics similarly, as in case of an innovator product.

Thus, a brand-name drug and its generic counterpart are chemically the same and generic drugs are also regulated by the FDA, requiring the same guidelines as their brand-name counterparts. Thus, the incorporation of generics which is one of the major cost containment strategies4, is in need of time.

Perception Of Generic Drugs
According to the WHO, 30% of the world’s population still does not have regular access to essential medicines. 74% of AIDS medicines are still under monopoly (under patents). 77% of Africans still have no access to AIDS treatment. The access to medicines in developing countries relies primarily on affordable generic versions of patented medicines (5).

Several studies have been conducted so far in Western countries regarding the perception and acceptance of generic drug use in health professionals. A study conducted in France shows that prescribing by INN is generally favourably accepted by those in the health area, with a concern for adverse effects (6), (7). Likewise, in Brazil, the generic drugs are known by many, but used by only a few8. In Slovenia, general practitioners, being concerned about the cost of prescribed drugs, showed willingness to increase generic drug use (9). Currently, in countries like Australia, the utilization of generic medicines is a tool for lowering the cost of health care. Generic prescribing, generic dispensing and generic substitution are being strongly supported by health authorities in many countries including Australia (10).

A considerable body of evidence suggests different policy tools to promote the use of generic medicines in industrialized countries like Canada, Denmark, Germany, the Netherlands, the United Kingdom, and the United States. Policy manifestations from these countries encompass both the supply-side and demand-side measures that are of essence for generic promotion and generic use (11).

India is one of the leading exporters of generic medicines, with 67% exports going to developing countries. This reflects a buoyant future for generics worldwide (12). About 60% of all people currently receiving antiretroviral (ARV) treatment in developing countries rely on India’s generic medications.

Pharmaceutical Scenario In Pakistan
The Islamic Republic of Pakistan has an approximate population of 158 million (13) with a population growth rate of 2% per annum (14). As far as the demographic potpourri is concerned, the population is an amalgam of native people with rich cultural and linguistic diversity. With its four administrative provinces, Sind, Punjab, Balochistan and N.W. F. P., the population is clearly depicting an uneven appearance in distribution. In the eastern provinces of Punjab and Sind, there is an estimated population of 78.6%, while Balochistan, though occupying 44% of the total land area of the country has only 5% of its population. In terms of socioeconomic development, Pakistan is overall towards the lower side, but in the past few years, the country has tasted rich economic growth with a GDP growth of 8.4% in 2005 (15).

The pharmaceutical industry in Pakistan is worth around US $1.18 billion, depicting a yearly development of 9.4%. In a number of over 400 registered pharmaceutical companies in Pakistan, there are about 30 multinationals enjoying over 53.3 % of market share, while the rest (46.7%) is in the hands of national pharmaceutical units (16),(17).

With strong influence on the health sector as well as being a key generator of foreign exchange, the pharmaceutical sector of Pakistan has full potential to hike exports to more than $600 million by 2010 (18), but still the sweeping performance of the pharmaceutical industry and the miserable health indicators of Pakistan appear to have a frail liaison with each other. Although the market of pharmaceutical industry is expanding at the rate of 20 per cent annually, about half of the population so far, has no access to modern medicines (19).

Access And Affordability In The Light Of Generic Drugs In Pakistan
In an Asian region which enjoys the largest share of the world’s population, access to and affordability of medicines is a critical issue. The phenomenon of globalization has exercised a strong influence on health care. An upsurge in any nation’s health care costs is not a matter of a single entity. This is related not only to ageing population but also to interchangeability of prior cheaper molecules into newer ones. In connection to the rising cost of drugs in Pakistan, access and affordability is a debatable issue. The National Drug Policy of Pakistan outlined the availability and accessibility of essential drugs to all strata of society, but what remains the cardinal challenge, is the lack of implementation.

Although around one-third of the pharmaceuticals for Pakistan's total consumption are imported, the manufacturing and marketing of cheaper new generic drugs by national companies are the external economic drivers (16),(17). Recently, the Government of Pakistan has highlighted the importance of generic drugs in context with the marketing and sale of medicines under their generic names to check the prices of drugs (20),(21). This raises important questions regarding the hesitancy of the use of generic drugs in the prescription, their lack of substitution by the druggist or the pharmacist and the irresolute behaviour of the consumer towards generics.

Dated back to history, there was a failure of legislation which accounted for mandatory generic prescription. This act of the Government was transformed into sound defeat by intentionally creating doubts regarding the quality and efficacy of generic drugs (22). Although standard drug testing lab is the need of time, a study conducted at the University of Karachi in 2004 suggests that all generics were found analogous with respect to pharmacokinetic behaviour, in-spite of having different excipients, concentration of excipients, sources of raw materials, manufacturing processes, machinery, resources, and also inter individual variations of the study. Results of the study also undoubtedly advocate that generics manufactured in different manufacturing units of Pakistan are near to the standard formulation and produce comparable results (23), but in spite of this, the availability of generic equivalents in the retail pharmacies of Pakistan raises questions. In a report compiled by the “Network for Consumer Protection”, the availability of brand products are much more rampant in retail pharmacies than generic equivalents in Pakistan. Not only is this trend of brand product dominance in retail pharmacies observed, but frequently, a large gap exists between brand and lowest price generic availability. As per reports, several contributory components may account for this disparity. Whether this may be necessitated by the patient or postulated as the prescribing and dispensing habits of doctors and pharmacists, it is a cause of grave concern. These stakeholders preferably opt for innovator brands, presumably related to the local marketing practices of manufacturers. Moreover, false intuitions and beliefs regarding the quality of generics and ignorance or deficient know-how about generics may be some other contributory factors (24). As pointed out by DFID, there is no ordinance or authoritative rule in terms of generic prescribing or substitution, both in the public or private sector and thus, generic prescribing or substitution is solely on the discretion of the prescriber or dispenser. There is not only the absence of financial incentives for the prescriber and the dispenser, but there is no rebate both for the innovator or generics in either the public or the private sectors (25).

In a nutshell, generic medicines will serve as an important tool to promote access to and the affordability of medicines in Pakistan and the practice and utilization of nonproprietary nomenclature should be highlighted and promoted, not only to arrest unnecessary costs, but to abbreviate the conceivable prescribing errors as well. Thus, to construct a magnanimous generic market in Pakistan, a combination of strategies such as generic-backed legislation and regulation with dependable quality assurance, as well as professional and public acceptance along with economic incentives will be sought.

TRIPS and Pakistan
In fact, the TRIPS agreement obliges all WTO member countries to accord patents on medicines, but still there is flexibility in this regard. As per the TRIPS agreement, each member country reserves the right to have its own specific format on patents. In fact, the Doha Declaration on TRIPS and Public Health clearly penned down that the TRIPS agreement can and should be represented and enforced according to the WTO Member’s right to safeguard public health and specifically to promote easy access to all (26). Pakistan is a part of the TRIPS agreement, and since 2000, the Intellectual Property Legislation is duly positioned.

Thus, developing countries are not bound in any way and have the full right to carve and implement their patent laws, taking full consideration of their respective public health needs. But still what remains the cardinal challenge, is the lack of implementation of the flexibilities of TRIPS with regard to the access of medicines.

Recommendations
The accessibility and utilization of generic medicines will gain momentum through a systematic plan of action. The said strategy is likely to perform
• The evaluation and identification of latent factors and circumstances for the physicians and pharmacists in prescribing and dispensing generic medicines
• The advocating of the generic prescribing and dispensing in relation to price and affordability
• sensitization of the consumer in relation to the accessibility and satisfactoriness
• educational outreach to consumers, future practitioners and pharmacists
• Contouring and streamlining the registration process for pharmaceuticals to ensure high-quality standards for generics.

As shown in (Table/Fig 1) a plan for generic medicine policy is recommended, which will later develop into a full generic medicine policy, leading to policy implementation and evaluation.

Acknowledgement

We express our thanks to Dr Vijay Thawani Moderator, Netrum-Network for Rational Use of Medicines for conducting E-discussions on Generic Medicine issues in developing countries.

References

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. The World Medicines Situation (2004). World Health Organization, WHO/EDM/PAR/2004.5
2.
. Birkett DJ. Generics Equal or not? Australian Prescriber. 2003; 26, 85-87.
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. World Health Organization. Globalization, Trade and Health, http://www.who.int/trade/glossary/story034/en/index.html, Accessed 10th November 2007.
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. Center for Drug Evaluation and Research. 2004. Report to the Nation 2003. Rockville, MD: FDA
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. WHO Medicines Strategy Countries at the Core 2004-2007, http://whqlibdoc.who.int/hq/2004/WHO_EDM_2004.2.pdf, Accessed 25th November 2007.
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. Biga J, Taboulet F, Lapeyre-Mestre M, Duguet, A.M., Vincent, S., Montastruc, J. L. Prescribing drugs by international non-proprietary name: the perception of health and non-health professionals. Therapie.2005; 60: 401-7.
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. Lagarce L, Lusson-Brisset C, Bruhat C, Diquet, B., Lainé-Cessac, P. How practitioners view generic drugs: an opinion study from general practitioners in Maine-et-Loire (France). Therapie. 2005; 60: 67-74
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. Bertoldi AD, Barros AJ, Hallal PC Generic drugs in Brazil: known by many, used by few. Cad Saude publica. 2005; 21: 1808-15.
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. Kersnik J. Peklar J. Attitudes of Slovene general practitioners towards generic drug prescribing and comparison with international studies. J Clin Pharm Ther. 2006; 31: 577-83.
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. Hassali MA., Kong DCM. Stewart, K. Utilisation of generic medicines in the Australian healthcare system. Journal of Generic Medicines. 2004; 2: 42-52.
11.
. King DR & Kanavos P. Encouraging the Use of Generic Medicines: Implications for Transition Economies. CMJ.2002; 43: 462-69.
12.
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Tables and Figures
[Table / Fig - 1]
JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com