The Observer (Kampala)

26 February 2013

Uganda: Cheap Drugs Are Not Necessarily Inefficient

For some time now, NTV, perhaps other media outlets too, has carried an advert citing the advantage new Panadol with Optizorb has over other painkillers. It does not "just sit in your stomach" letting the pain rack the user. Instead, it disintegrates fast, quickly relieving the user of pain, according to the advert.

Before this advert, some of us thought that all Paracetamol worked the same. Perhaps some of us still think that one medicine, if they are in the same class, is as efficient as the other. But they aren't. Individuals who have taken Paracetamol (Panadol) from the UK say it relieves pain much faster than Paracetamol from Uganda.

Some say that the UK's Paracetamol relieves pain much more efficiently than strong painkillers, like Tramadol, on the Ugandan market. Because of such testimonies, one may be led to think that drugs from more developed nations (mostly branded drugs) are efficacious while those from less developed nations (generic drugs), which form the big bulk of drugs on the Ugandan market, are less efficacious.

Would this be a true assumption?

Various pharmacists say all drugs on the Ugandan market, as long as they are from a licensed pharmacy, are efficient.

"Drugs [of a similar class] have the same active ingredient [a compound of the drug with the therapeutic action]," Gathii Karuiki, a pharmacist, says. He explains that one drug may work faster than the other because of a difference in the type of additive used.

"One manufacturer may say, 'I want my Paracetamol to work in five minutes' and so he will use a more expensive additive [disintegrant], which works much faster".

Does this mean that more expensive drugs are always more efficient than their cheaper counterparts?

They aren't, both Karuiki and Hellen Nbagije of National Drug Authority firmly say.

"More expensive drugs are reflective of the cost of production of the countries in which they were produced," Karuiki says.

"When you couple cost of production with transport and logistical costs, you will find one drug, say from Europe, being more expensive than one from Uganda."

They are also sometimes reflective of the original manufacturer's cost. Brand name drugs (originally from researchers) are usually more expensive than generics (reproduced with permission from original researcher/producer) because manufacturers have to recover research, development, marketing and promotion costs of the drug.

Still, various pharmacists interviewed for this article say it is best to take the brand name drugs (original) as opposed to the generics.

"With the original, you are 100% sure," Karuiki says. "This might not be the case with generics as subsequent manufacturers may tweak around with the original formula, rendering a drug less efficient".

Pharmacists say that even where drugs have the same active ingredient but different additives, they may have varying levels of efficiency. This is because additives may tamper with the efficacy level of the active ingredient.

"You are better off taking the original," is the refrain, "but, where you cannot afford it, the generic works fine".

In some instances, generics are made by brand name companies. The US' Food and Drug Administration estimates that 50% generics are made by brand name companies. According to www.medicinenet.com, generics are not slower at working as has sometimes been said.

A generic is simply a copy of an original/brand name drug. They are comparable to the "original" drug in dosage form, strength, route of administration, quality and performance, and intended use. Karuiki advises customers/patients to seek a pharmacist's or dispenser's advice. "They will guide the customer on what medicines are best".

Common drug use around the household

"Using Paracetamol to clean hot flat irons is highly discouraged. The fumes produced are toxic. They could be carcinogenic".

As for people who will not take Indocid because "it kills rats and so it can kill me too", Karuiki says that the human structure is more sophisticated than a rat's; so, medicine that harms a rat may not harm a human being.

"Indocid kills a rat through interfering with blood clotting so that its blood vessels burst. This won't happen with a human being because our blood vessels are stronger". It is for this reason that individuals with peptic ulcers are advised to refrain from using Indocid.

"It may cause bleeding," Karuiki says.

On how to beat counterfeit drugs, which Nbagije says are persistently present on the market because of Uganda's porous borders, customers are advised to buy drugs from licensed pharmacies only.

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