Tuesday, May 13, 2008

I’ve puzzled over what to call this blog entry. “Could Anyone Explain This, Please?”, “What’s WRONG With These People?” and “WTF” (short, to the point and my current favourite) were all candidates.

But I’ll just tell the story as I see it and let you figure it out.

This morning I faced a situation that I’ve dealt with hundreds of time here in Burkina Faso. A Burkinabé of modest means came to me for help buying a medication prescribed after a recent medical visit. S. is pregnant with her third child (she has two girls, but her husband wants a boy. Don’t even get me started on that one). She is following her well-baby visits and has been taking her iron/folic acid supplement regularly. A month’s worth of generic tablets costs a little over one US dollar. It’s affordable (barely) for someone like S. that works at odd jobs and makes about 16 dollars in cash each month, on average.

But the doctor at the clinic recently gave S. a new prescription to replace her generic iron tablets. It was for a brand-name iron supplement made by a big pharmaceutical company. S. was quite worried as she spoke to me and asked if I knew any way to get her this important medication that the had doctor said she needed. She’d just been to the pharmacy and seen how expensive it is- over TEN times the price of her current iron pills! And it’s just that. Iron. Nothing fancy. No secret ingredient. It’s just iron like she’s already taking. But it’s super-expensive iron in a pretty box.

Sadly- frustratingly- crazy-makingly, this is not a rare situation here in Burkina. Doctors working in clinics that serve poor people here in the second poorest country in the entire world frequently prescribe expensive brand-name medications rather than affordable generics. And most patients haven’t the knowledge to question this. They think that the doctor has their best interest at heart and the families scramble to find the money, borrowing, if they can, or quite simply doing without other things like food or clean water.

I was recently talking with a pharmacist here in our neighbourhood, trying to figure out what the hell these doctors are thinking. (I did, about five years back, try to talk to a Burkinabé doctor about this issue, which was a big mistake. I’d asked my question in the politest possible terms, but he still took it as an unforgivable presumption on my part in questioning the Doctor-God.)
This pharmacist, though, is a lovely person and just as mystified and frustrated as I am. He pointed out that people often won’t even listen to him when he suggests that they substitute a generic for a name-brand. (I run into this, too. But as I’m not a health-care professional, it makes more sense that people might discount my input) He sees very poor families that have obviously scraped up their last few resources to buy, for example, the frequently prescribed effervescent medication called Efferalgan. All it is is a fancy delivery system for paracetamol, which can be bought for a few cents in generic form. But most people just ignore his kindly meant advice with polite smiles and trust their doctor. They pay for the over-priced brand-name product and then often don’t have enough left to buy any of the other medications on the prescription. So, they go home with a pain killer/fever reducer but don’t have the antibiotic to treat the infection or the chloroquinine to treat the malaria, or whatever… This is not a trivial problem- these doctors are indirectly causing many needless deaths.

Why are doctors doing this? Are they really that addicted to the gifts and incentives of the pharmaceutical companies. I just don’t understand.

1 comment:

babzee said...

I've never run into a US doctor who was this abusive (altho' I've heard several stories). I don't know if local Burkinabe docs are contemptuous of their patients or if they are truly ignorant of the consequences (and alternatives?). BigPharma has a stranglehold on the US: I still can't get generic triptans for migraines without ordering from overseas, although they've been available generically for 25 years in Europe. Every time the patent expires they reformulate it under a new patent. Brand-name Imitrex now costs about $40 per pill, so it's usually cheaper to miss a day of your life than fight the migraine.

But being this abusive of a healthy pregnant woman should be a crime. There shouldn't be an expectant mother on this planet who isn't provided with prenatal vitamins and minerals for free.