From Dr P.Mallia

I thank Ms Caruana Galizia for her comments and criticism to the published interview of my reactions to the GRTU “affair”. I hope she understands that interviews almost always tend to be distorted from the tone statements were said in, when summarised. Il tono fa la musica.

I will not prejudice myself in favour of either generic drugs or brands. I use both and both have their disadvantages and advantages. Certainly however not all generics are the same; some have pharmacodynamics and pharmacokinetcs as good as the brand and others not; EU approval notwithstanding.

I commend Ms Caruana Galizia in her attempt for Patient Advocacy and in fact invite her to contact me regarding our new Centre for Bioethics and Patient Advocacy – we need all the help we can get.

But the point here is business and not corruption. Who used corruption did so only cover the fact that they are worried about their own pockets. This makes perfect common sense, as it is in the GRTU’s interest, as a union, to fight for its members. Where it went wrong was trying to blame it on doctors. I certainly did not say that it is banal to think that corruption does not exist. It is banal to associate the two. I apologise if what I said came across in the wrong way. I do not think corruption is as rampant as they are making it out to be – certainly not to an extent to affect our economy, or as a reason why generics sell less. From what I see, generics sell more. The question is why has it been pointed out in connection with this issue. Corruption can come from companies who promote both brands and generics. However, the serious companies, and most brands are serious, have a world-wide name to defend and it is simply not in their interest to corrupt doctors.

Even if freebees exist, and Malta certainly will not be an exception, I think it foolish for a doctor to jeopardise his ethics, let alone his patients, for something of so little value in money, compared to income, reputation and risk put together, as a holiday. Be that as it may, we certainly should not be invoking emotive arguments and one who asserts that corruption exists needs to have some proof or facts. Certainly I do not think that the doctor in the health centre prescribed an antibiotic out of vested or conflict of interest. It is too much of a sweeping statement, even if it makes a good story to know that consultants still bring students around them to have a go at GPs. It may have been bad prescribing, but has nothing, in my humble opinion, to do with what the GRTU is saying. A generic drug could just as well have caused the rash.

I may need to go out more (but only because I have three kids), but I think that Ms Caruana Galizia has been around the block a few times to know that this is not really about gifts or bribes, but about competition. The reality is that only brand names invest the money to promote the drug and support medical education in conferences and the like.

The issue of corruption has therefore nothing to do with the brand/generic argument, and I insist it is unethical to try to associate them, for one’s gain. Why bring it up now, I ask again? What they are saying is that if corruption exists, it is only the brands that corrupt doctors. This is a serious accusation on their own colleagues and if they have the proof it is they who should blow the whistle on them. There are not that many brands around not to be able to launch a thorough investigation.

There is more to the argument of brand vs generic than cost. When the generic comes, the brand would have been around for quite some time. It may take time for the former to prove itself. One generic also militates against another of the same kind. Moreover some generics simply do not work as effectively – ask any asthmatic patient who used to use the generics given free by the health department (although now we have better ones). Forgive me therefore for trying to give my patients what is best and I certainly resent the fact that if a few corrupt do exist, you then put all in one basket. But it is certainly unethical, especially nowadays, when we speak of preventive medicine, when you will know the effect of a drug years later, to prescribe a drug simply because it is cheaper. It is the brand that has undergone the clinically controlled trial and therefore the necessary tests. Generics are simply compared to the brand. One will certainly have to look at the reputation of the company producing them.

Again, doctors who order expensive drugs and tests will most probably notice that it backfires on the amount of patients that will go to them; a doctor know that an important factor to take into consideration is the patient’s pocket. I will certainly take it into my hands to blow the whistle if she gives me enough details. But suppositions and assumptions, emotive as they may be, do not work in front of a judge (who presides the Medical Council). Certainly however if a doctor had no other reason to make a 17 year old spend Lm40 on tests for a simple sore throat, then this is reportable. I do not think that any tests other than perhaps a throat swab should be necessary.

As the title of her article clearly states, some doctors are corrupt. But corruption has nothing to do with the argument at hand and it is naïve to assume that only brand names give out gifts. The only gifts we really get are biros and prescription pads. Sometimes you get a flashing key chain or some stickers for the kids. Both generics companies and brand companies give these away, and if one is to accuse one and not the other, then certainly one needs to have some proof.

I thank again Ms Caruana Galizia for giving me the opportunity for this exchange and hope I have clarified my position. We need strong arguments to attack corruption and not mere sweeping statements or emotive experiences. It is in the Maltese blood to praise all the Saints when maladies heal; but blame the doctor for anything else. It is also a perversion in our blood to attack it-tobba u l-avukati for all the ailments of this country, from tax evasion to the national debt. I think we should all be a little more careful before we attack each other as we are not really solving anything. Popular columnists have a responsibility for rational arguments and not to join those who say min jaf kemm jaqla dak! Or tghid m’ghandux xi kommixin!

As most doctors I will continue prescribing what my conscience tells me is right. This will definitely involve consideration of cost, but not only. If there are people who are corrupt, they exist in all professions. We will not solve any corruption by prescribing more generics than brands. After all, Generics compete with each other as well!!

Pierre Mallia