A new sobriquet for SMS service-Substituted Medicine Service

B Sriram

A recent article in a leading newspaper talked about a novel method of how technology can be leveraged to get the “best price” for the medicines prescribed by your doctor. Interesting.

Apparently, come August 2012, if you have been prescribed a particular brand of a drug by your doctor/physician, you can send an SMS to a predestinated number from your mobile and you will receive two to three options of the same medicine, along with the price differential. Sources said that all responses would come with a caution: ie. Consult the doctor before consuming the alternative medicine. The first question which comes to mind is, who drives this Rs 54,000 crore market and who are the decision makers? Is it the doctors, pharmaceutical companies, distributors or patients?

As per Drugs and Cosmetics (2nd amendment) Rules 2006, all drugs sold under the purview of schedule H need a doctor’s prescription. It would thus be fair to state that the doctor is the decision maker.

If one visits the site www.drugscontrol.org/ Schedule_H.pdf, there are 536 schedule H drugs listed. Imagine if for every drug prescribed by a doctor, two or three alternatives are provided as per the claimed SMS service, we are talking of around 1500 alternatives at the very least!

There are always two sides to a coin. Let’s analyse the pros and cons if an SMS-based system as above comes into effect

Pros

1. You are no more obligated to purchase your medicines as per doctor’s prescription. You can decide on a suitable alternate to the brand prescribed; recheck with your doctor and save valuable money.
2. In case the brand prescribed is not available at your nearby chemist, this system will allow you to choose an alternative thus ensuring compliance of medication. You need not feel stressed and waste valuable time hopping from one medical shop to another enquiring about availability of the brand prescribed by your doctor.
3. The pharmacist begins to play a bigger role since you as a customer are open to “substituting” the prescribed medicine and he could suggest some more cheaper options beyond those received through the SMS system.
4. Many corporate hospitals which insist that medicines be purchased only from their pharmacy might have to keep a bigger range of alternatives in order to cater to patients’ demand, else they might lose patients who are likely to shift to another hospital which stocks a wider range.
5. The system offers an excellent platform for engaging you in valuable direct marketing initiative. An extended service could be that the system provides you value added information about the product you are taking, such as side effects, contraindications, drug interactions which your doctor may not explain to you. A logical counter point could be why the doctor doesn’t always inform all about the above? Maybe it takes a lot of a doctor’s time in explaining and he/ she would much rather use that time to see a few more patients and keep the coffers ringing.
6. Targeted marketing: The database that will be created across India through this service is estimated to be huge. If you are suffering from a serious ailment and are looking for similar patient support group for seeking opinion and emotional support, the system could put you through a similar group with whom you can exchange notes and receive inputs and comfort.(like the successful cancer patient group)

Cons

1. The newspaper article mentions that all responses would come with a caution: to consult the doctor before consuming the alternate medicine. Imagine the time you and the doctor would have to invest in clarifying doubts. Will your busy doctor have the time and inclination to attend to all such calls? Doubtful.
2. Who will guarantee the quality of the cheaper alternative which you will be consuming?
3. If you suffer from any adverse reaction which could be attributable to the substituted medicine you consumed, the next time around would you be able to go back to the same doctor who wrote his brand of choice in the prescription for you. Probably not. Which means every time you buy a cheaper alternative to the brand prescribed by your doctor, it would be time to find a new doctor as some trust deficit might have developed between the doctor and you .
4. The doctor community as also health insurance policies might start to incorporate disclaimers in their prescriptions and forms respectively against substitution.
5. Most people with chronic ailments require multidrug treatment. Let us take a situation (quite common in India) where a person is suffering from hypertension, high cholesterol, arthritis, diabetes and hypothyroidism. If the SMS service provides three alternates for each of the medication prescribed, it can be a tough task for patients to decide on the best alternative for each ailment. Given that any single SMS can have 160 characters, it will have to be multiple messages. It is also not clear as to who pays for the SMS and the price thereof for each SMS.
6. If it is established that death occurred due to the medicines consumed (as per the SMS service), what would be the legal process? How will the next of kin be compensated and by whom?
7. Given the extent of corruption in India, it is quite possible for a local pharma company to influence the system in incorporating their brands in the system. How does one prevent this scam?

There is no doubt that the medical professionals will continue to play an integral part of this multi-billion dollar industry, it may be counterproductive to introduce this system, but then again no harm in seeking another opinion…SMS-based maybe !!

The views expressed in this article are personal. The author can be contacted at [email protected]