Regulating patient-physician trust

When a person is sick, he sees a physician, not a mechanic or lawyer or congressman. The patient puts his trust on the physician, otherwise he would not see the latter. The physician listens to the patient’s feelings, the symptoms, his other sickness if any (is he asthmatic, diabetic, with hypertension, has allergies, etc.). From a list of several dozen potential medicines on that particular disease, plus consideration of the patient’s condition, the physician chooses one and gives a prescription to the patient, including dosage and frequency of taking the medicine.

One factor that the physician considers in recommending a particular medicine, say brand C, is its proven effectiveness to other patients who have similar disease. Or he used to prescribe medicine brands A and B before, but they proved ineffective to his other patients; then he suspects the quality of brands D, E and F. So this time, he is prescribing brand C.

Can the state regulate this trust by the patient to his physician? Obviously it can, because the state has already regulated many other aspects of our lives. But should the state do it again in this case? And should the state regulate the physician’s trust on particular medicines made by particular medicine innovators?

Patient-physician trust is a matter of personal relationship. It can even be a matter of life and death for some cases. The same way, the physician-pharmaceutical manufacturer trust is a matter of personal relationship too. When the state will try to intervene and dictate the physician that he can only prescribe a generic formulation, and that he should not prescribe to his patients brand C or F or Y or AB, especially those manufactured by multinational pharmaceutical companies, that is going overboard and breaking the patient-physician trust.

In the House version of “cheaper medicines bill”, the Congressmen are proposing to criminalize the physicians who will prescribe certain brands to their patients. Physicians should only prescribe generics formulation, then patients will ask the non-physicians, could even be non-pharmacists, in the drug stores, or super-markets or convenience stores or variety (“sari-sari”) stores that sell medicines, which of several drugs in the same generic category is the cheapest, so that the patient can buy “cheaper/cheapest medicine”.

It looks cute, except that it could be risky for the patients. Physicians and pharmacists observe that different brands under one generic category are capable of causing different effects, delayed effects, or allergic reactions to different patients. That is why doctors always ask the symptoms and feelings of the patients, previous history of contracting that disease, any allergies or related diseases, before prescribing a particular brand.

One reason given by the Congressmen why they resort to such “brands disallowed, generics only” intervention, is because they suspect that physicians are under the influence of big multinational pharmaceutical companies. This wholesale suspicion and distrust of physicians is unfair if not dangerous, and the danger will be transmitted to the patients.

Medicine innovation is a must that should be undertaken by pharmaceutical companies if they want to remain relevant to the public, the physicians and patients in particular. Diseases evolve, so must be the medicines to eliminate or neutralize those diseases. Even pests and insects in rice and other crops evolve, that is why pesticide companies or organic farming practitioners also innovate on new formulations or practices to neutralize those pests that can possibly wipe out a farmers’ potential harvest. Even cellphone manufacturers never cease to innovate new models, discovering new uses to previously underutilized features of other cellphone models.

Physicians understand and appreciate the efforts made by medicine innovators, aka pharmaceutical companies. That is why physicians who truly care for their patients tend to choose those brands that they think truly innovate and innovate continuously, unceasingly.

Unfortunately, there is a big cost to innovation. In addition, government taxes and fees, plus other government health regulations and inspections, add to the already high cost of innovation, clinical trials and product development. This aspect of high and multiple government taxation of medicines and medicine innovators, unfortunately, has escaped the minds of legislators.