Correspondence

machinery such as the UK Pharmaceutical Price Regulation Scheme, and we believe that health au­thorities and practitioners should concentrate on their key task of delivering care as effectively and efficiently as possible, and leave governments to deal with macroeconomic implications for the in­dustry.

Mark Campbell D. Nicholas Bateman

Anne Lee James M. Smith

NHS Northern and Yorkshire Regional Drug and Therapeutics Centre

Wolfson Unit Newcastle-upon-Tyne

England

References

Alison Beaney Department of Pharmacy

Freeman Hospital Newcastle-upon-Tyne

England

1. Walker R. Generic medicines: reducing cost at the expense of quality? PharmacoEconomics 1995; 7 (5): 375-7

2. UK Department of Health. Improving prescribing: the imple­mentation of the GP indicative prescribing scheme. London: Her Majesty's Stationery Office, 1990

3. UK Medicines Control Agency Defective Medicines Report Centre. Drug alerts 1989-94

4. Shaw RJS. Pharmaceutical manufacturers' responses to defec­tive product reports by East Anglian hospitals. Pharm J 1995; 254: 810-3

5. Young JD. Prescribing generic drugs. Br J Gen Pract 1994; 44: 139-40

The author replies: The letter by Campbell and colleagues reflects

an overzealous support for generic medicines and contains some well-intentioned, thoughtful, but polarised rhetoric. There is, of course, a definite niche for generic medicines in the UK health sys­tem. There was no attempt to dispute this in my original article.[11 Exception appears to have been taken because the benefits of generic medicines were not overstated.

© Adis Interna~onal Limited. All rights reserved.

363

With respect to the quality of generic medicines, the about-tum of the General Medical Council, who dropped 11 years of opposition to generic pre­scribing, was clearly cited in the article. This deci­sion, I am sure, was influenced by the quality pro­file of the 4 multinational companies responsible for producing 80% of UK generic sales. That there is no clear evidence of benefit or harm associated with prescribing generic medicines was also indi­cated in the textPl To quote the findings of the Med­icines Control Agency defect reporting scheme[21 certainly does not strengthen the argument for us­ing a generic medicine. It has long been known that few prescribers or pharmacists ever bother to report

. defects pI I do believe it is relevant to speculate on the

impact of generic prescribing on the quality of healthcare. All things being equal, when a decision to prescribe a given drug has been reached, there is little argument that the generic equivalent will be appropriate and there may well be a neutral im­pact on healthcare. However, it is not inconceiv­able that the pressure on practitioners to prescribe generic medicines may distract them from prescrib­ing a more expensive, but more appropriate and possibly more cost-effective, nongeneric alterna­tive. A negative impact on healthcare could be the outcome.

Most of us in education recognise the value of using generic names. Perhaps the more important issue in UK universities is the relatively poor po­sition, in terms of current and future priorities in medical undergraduate education, that prescribing research would appear to have}41

To raise the spectre of the Pharmaceutical Price Regulation Scheme (PPRS) is not entirely relevant to the original article}ll The PPRS indirectly con­trols the prices of most branded medicines sold to the UK National Health Service. The prices are based on profit targets negotiated with each com­pany. It could, therefore, be argued that incentives to promote generic prescribing are operating at the margins when the government has largely determined the profit of a given company in any fiscal year. Nevertheless, whether it be in Gwent

PharmacoEconomics 8 (4) 1995

364

or other parts of the UK, successful prescribing incentive schemes have operated, and general practitioners have been able to reinvest in their prac­tice a percentage of the savings made from monies allocated to cover prescribing costs.

As Campbell and colleagues state, health author­ities should concentrate on the task of delivering effective and efficient healthcare. In Gwent, a pol­icy of rational and cost-effective prescribing is pursued as part of promoting appropriate, evidence­led clinical management. Gwent is one of 8 coun­ties in Wales and has achieved a prescribing profile in primary care that is arguably second to none. This is not bad going if, as Campbell et al. would have you believe, those in that county responsible

Erratum

Correspondence

for policy and direction adopt a questionable ap­proach.

References

Roger Walker Gwent Health Commission

Pontypool, Wales

1. Walker R. Generic medicines: reducing cost at the expense of quality? PharmacoEconomics 1995; 7 (5): 375-7

2. UK Medicines Control Agency Defective Medicines Report Centre. Drug alerts 1989-94

3. Generic prescribing. MeReC Bull 1991; 2: 21-3 4. Walley T, Bligh M, Orme M, et al. Clinical pharmacology and

therapeutics in undergraduate medical education in the UK: current status. Br J Clin Pharmacol1994; 37: 129-35

Vol. 8, No.1, page 46: In the summary, the first sentence should read: 'A spreadsheet simulation model of hepatitis A disease was developed to evaluate the cost effectiveness of an inactivated hepatitis A vaccine ... '

[Severo CA. Fagnani F, Lafuma A. Cost effectiveness ojhepatitis A prevention in France. PharmacoEconomics 1995 lui; 8 (1): 46-61]

© Adis Interna~onal Limited. All rights reserved. PharmacoEconomlcs 6 (4) 1995