Not all Neurofen is the same - oh, yes it is

[p3t3r]

I assume you have proof to back that up as that is a very serious allegation.

 

Proof? Try this:

http://bma.org.uk/wall/AA7E0E0B32C3F574802568F50054324C?OpenDocument

 

Further proof? Try this:

http://www.dailymail.co.uk/health/article-1263805/Is-pharmacist-fobbing-cheap-copies-branded-drugs.html

Above link is an article showing this and detailing one patient had trouble with her epilepsy drugs (something which I advised of earlier with generic drug due to absorption rates)

 

Want more? Try this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949903/

Above link is extensive article in relation to the proof you require to back up my 'very serious allegation'

 

If you want more proof, then I assume you can use google? http://bit.ly/19jlHUx

 

 

 

I hope the above is enough proof for you Ploddertom. Can I therefore respectfully ask you to prove your serious allegations against me in other threads in which you stated that I am: Judging the poster? (I was clearly not) as well as your other allegations within the EC / ECHR thread? Thank you

[ploddertom]

The first link is dead. The rest are generally accepted as to what goes on and not attributed to a money making scheme. Most prescriptions dispensed can see different manufacturers being used on a month to month basis. If there was a concerted effort at fraud or if it was found a manufacturer was cheating then their licence & drugs would be removed. There is always the chance of some people being adversly affected and these are generally rooted out during trials.

 

As for you last link then if you want to play childish games then you should go elsewhere.

[p3t3r]

hello again..

The first link is dead. The first link works for me. I recently looked for the article for your proof.

 

The rest are generally accepted as to what goes on and not attributed to a money making scheme.

The rest are further proof you require, showing how pharmacists can substitute the branded drug for a generic drug. I made no reference to a money making scheme.

 

Most prescriptions dispensed can see different manufacturers being used on a month to month basis. If there was a concerted effort at fraud Fraud? I am not speaking about fraud! However, substituting one drug for its equivalent is not fraud. or if it was found a manufacturer was cheating then their licence & drugs would be removed. There is always the chance of some people being adversly affected and these are generally rooted out during trials.

No. Not necessarily. Around 75% of doctors were opposed to the idea of substituting branded drugs with generic drugs, the main reason being that not enough research and trials were conducted. Feedback from patients has shown that some generic drugs can be a danger in the instances that i have listed above. As well as the article linked above in relation to a patients drug being substituted with a generic drug which caused complications.

As for you last link then if you want to play childish games then you should go elsewhere.

As for my last link it just linked to a google search for you since you require proof of my 'serious allegations' lots of links for you to choose from for your required proof.

 

I do not play childish games.... But my response to your latest accusation is that it is not myself accusing you of judging other people, being without merit, going round in circles - which can all be seen in other threads where you have accused me.

[doggone it]

 

To substitute a drug to save money.

 

 

"I made no reference to a money making scheme. "

 

Seems you contradict yourself

[p3t3r]

I assume you have proof to back that up as that is a very serious allegation.

 

Since you imply that my links providing you with the proof is infact not proof, then I hope below will suffice.

 

Generic substitution will be introduced in the UK in January 2010. Its primary aim is to reduce costs. The government predict an annual saving of £million by 2013. It was negotiated as part of the PPRS agreement, the government negotiated generic substitution and the manufacturers will receive government help in encouraging the uptake of new medications.

Generic substitution is different to generic prescribing. It means that a pharmacist could substitute a generic drug on a prescription of a brand without consultation with the patient or the doctor who wrote the prescription, unless a doctor ticks a box to insist on the branded drug.

Above quoted from:

http://www.kidney.org.uk/help-and-information/medical-information-from-the-nkf-/medical-info-main-switch-meds-/main-switch-meds-dda-generic-subs

 

If the doctor required the pharmacist to dispense the branded drug and not a generic drug, the doctor would have to write 'no substitution' on the prescription.

[p3t3r]

"I made no reference to a money making scheme. "

 

Seems you contradict yourself

 

To save money for the NHS, certainly not a money making 'scheme'.

[doggone it]

Having seen some of your other posts you do seem to suffer from foot in mouth. Phones4U for instance.

[p3t3r]

Having seen some of your other posts you do seem to suffer from foot in mouth. Phones4U for instance.

With all respect, I do not care about your opinion of me

 

If you have something to say about Phones4U thread, then I suggest you post it there. http://www.consumeractiongroup.co.uk/forum/showthread.php?443340-phones4u-OR-vodafone-%282-Viewing%29-nbsp

 

It is certainly off topic for this thread.

[SabreSheep]

 

I hope the above is enough proof for you Ploddertom. Can I therefore respectfully ask you to prove your serious allegations against me in other threads in which you stated that I am: Judging the poster? (I was clearly not) as well as your other allegations within the EC / ECHR thread? Thank you

 

 

With all respect, I do not care about your opinion of me

 

If you have something to say about Phones4U thread, then I suggest you post it there. http://www.consumeractiongroup.co.uk/forum/showthread.php?443340-phones4u-OR-vodafone-%282-Viewing%29-nbsp

 

It is certainly off topic for this thread.

 

I would like to remind everyone to remain on topic and play nicely

[tobyjugg2]

I assume you have proof to back that up as that is a very serious allegation.

 

I have seen it as quite common for a dispensing chemist to offer a cheaper alternative to a prescription item.

This is not substitution as such as the prescription is then discarded and the item bought and used as prescribed.

 

For example

Although getting neurophen on prescription is fine for those who get free prescriptions, the chemist offering a generic ibuprofen at under a pound is a great boon for those of us who pay for prescriptions who would otherwise pay over £7 for the item.

[BazzaS]

Since you imply that my links providing you with the proof is infact not proof, then I hope below will suffice.

 

Above quoted from:

http://www.kidney.org.uk/help-and-information/medical-information-from-the-nkf-/medical-info-main-switch-meds-/main-switch-meds-dda-generic-subs

 

If the doctor required the pharmacist to dispense the branded drug and not a generic drug, the doctor would have to write 'no substitution' on the prescription.

 

Replacement of branded with generics is perfectly acceptable, except for circumstances including:

a) where the different appearance of the generic might confuse the patient

i) for example, the 'mildly confused' patient, or

ii) where "Patient familiarity with the same brand is important",

 

b) Different formulations of a modified release preparation have different release characteristics (differing levels over time), such as for diltiazem modified release, or

 

c) different formulations of the same drug have different biaovailability (the usual example being lithium preparations for treating bipolar disease, where the same 'strength' of preparation can have such vastly different availability that a change in preparation is handled the same as starting treatment anew .....

 

http://psnc.org.uk/walsall-lpc/wp-content/uploads/sites/56/2014/02/Drugs-to-consider-prescribing-by-brand-name-or-where-brands-should-not-be-switched.pdf

 

The drugs where it is perfectly acceptable to use generics in place of branded far outnumber those where it isn't.

 

However, that is COMPLETELY different to "Drug companies pay doctors £40m for travel and expenses"

 

http://www.theguardian.com/society/2013/apr/05/drug-companies-pay-doctors-40m

 

which cites "A total of £563,000 including expenses was paid out to 93 individuals, giving an average of £6,053.76. However, the 93 people were involved in 304 activities, which gave them an average fee, including expenses, of £1,851.97."

 

Many doctors can only go to conferences using sponsorship (since the study leave budgets have taken a hammering .......).

There has to be a balance : the positive effect on doctors going to conferences against the negative effect of "feeling an obligation" to one's sponsors and the more insidious "only going to a conference where only one point of view is available".

 

The days of "here, we'll pay for you to go to this conference, in the Caribbean. There is only 1 set of flights available, so we'll have to put you up there for 2 weeks ...." (so, it is in fact an all expenses paid holiday for 2 weeks, and only 1 company's products got mentioned) .... are long gone.

 

It is easy to say "so ban company sponsorship" .... but much research is funded by drug companies.

Let us take one expert, whose area of expertise is in treating fungal disease in the immunocompromised (often as a result of treament for cancer).

 

He lists a "disclosure" when speaking at conferences, so people can gauge how likely he is to be influenced by financial concerns.

 

Dr. D******* holds founder shares in *** Ltd., a University of****** spin-out company, and has received grant support from *** as well as the Fungal Research Trust, the Wellcome Trust, the Moulton Trust, The Medical Research Council, The Chronic Granulomatous Disease Research Trust, the National Institute of Allergy and Infectious Diseases, National Institute of Health Research and the European Union, and AstraZeneca. He acts as an adviser/consultant to **** and Myconostica (now part of Lab21 group) as well as other companies over the past 5 years, including Pfizer, Schering Plough (now Merck), Nektar, Astellas, and Gilead. He has been paid for talks on behalf of Merck, Astellas, Novartis, Merck, Dainippon, and Pfizer.

 

So, he has helped his University develop a company to capitalise on their research.

He has taken money from almost every 'player' drug company in his field : to my mind this means he isnt likely to be biased, as if any company said "here is some pressure to recommend our product when it isn't best" - he can just say "get stuffed, I'll just carry on co-operating with your competitors, not you".

 

However, if he was banned from ever taking any money from drug companies, result: less research.

 

So, I doubt the experts can be significantly influenced over and above the effect limited by their disclosures.

 

Can an individual GP be influenced in their prescribing?

Possibly subtly, by seeing a brand name (and the pens and post-it notes from drug companies will no doubt carry the brand name, rather than the generic name) ; but this is dealt with by generic replacement, as above.

There is also a VERY sophisticated system that looks at the GP's prescribing and monitors where practice deviates from the norm ....

 

Overall, I suspect the effect of "drug company influence' is less than the (none the less factually based) "The Association of the British Pharmaceutical Industry (ABPI) said that most of the 44 biggest companies had now revealed how much they paid doctors to help market their drugs. Its aggregated total of £40m" suggests at first glance, for the reasons I suggest above, summarised as:

 

a) The experts are likely experts to multiple companies, so will be less susceptible to pressure

b) The GP's are only likely to restrict their prescriptions to certain brands in specific justifiable circumstances.

 

It is easy to argue "well, the drug companies wouldn't pay it if they didn't get something for it", and I've seen sponsorship for conferences (and lunchtime meetings) at work. I suspect it isn't as direct as "we'll pay for this and you'll prescribe our product"

It is more likely "this is how we'll increase the chance our product rep will have access to you, and leave you the literature that will convince you where it is better for the patient to use our product".

 

I've met a few doctors who have revealed they only see reps by appointment and respond better to the "relationship method" mentioned above than the "hard sell".

If it is convincing a prescriber that it is better for the patient, provided the claim is true, is that such a bad thing?

[BazzaS]

Proof? Try this:

http://bma.org.uk/wall/AA7E0E0B32C3F574802568F50054324C?OpenDocument

 

Further proof? Try this:

http://www.dailymail.co.uk/health/article-1263805/Is-pharmacist-fobbing-cheap-copies-branded-drugs.html

Above link is an article showing this and detailing one patient had trouble with her epilepsy drugs (something which I advised of earlier with generic drug due to absorption rates)

 

Want more? Try this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949903/

Above link is extensive article in relation to the proof you require to back up my 'very serious allegation'

 

If you want more proof, then I assume you can use google? http://bit.ly/19jlHUx

 

 

I too couldn't get the first link to work

 

I'm familiar with the use / dispensing of generic prescribed drugs, so the next 2 links didn't add much.

 

I'm confused by your lmgtfy link though.

You were talking about generics being substituted for branded, but that link googles "are branded drugs substituted for generic drugs in by British pharmacists?"

 

Are you trying to argue for "branded drugs substituted for generics" or "generic drugs substituted for branded"?

 

Substitution of generic for branded is common (see above), while substitution of branded for generic is less common but still can be entirely reasonable (pharmacy out of stock of generic or "want to shift out some branded stock that has a shorter expiry date than the generic stock"

 

So, I'm not clear which "direction" of substitution you are discussing, and come to think of it your point is unclear : are you saying it is good or bad, and who / what are you criticising?

[p3t3r]

hi Bazza,

 

the links were given to respond to the post below since that poster required proof to back up my 'very serious allegation'

 

I assume you have proof to back that up as that is a very serious allegation.

 

i am not saying it is either good nor bad, some circumstances it would be a good thing since it would save the NHS a lot of money (not a money making scheme), whilst other circumstances it could be a bad thing if substitution occurred for people with bipolar / heart / epilepsy since the absorption rates would be different. 2 sides of a coin!

 

the point i was trying to make (without having to prove my serious allegation) was that branded medicines are often substituted for generic medicines since essentially they are exactly the same. though, whilst saying that, I said it could be dangerous for some groups of people (brain / heart / asthma)

 

your post makes an interesting point about the sponsorship - again, good and bad points

[BazzaS]

hi Bazza,

 

the point i was trying to make (without having to prove my serious allegation) was that branded medicines are often substituted for generic medicines since essentially they are exactly the same. though, whilst saying that, I said it could be dangerous for some groups of people (brain / heart / asthma)

 

your post makes an interesting point about the sponsorship - again, good and bad points

 

I still think you have it the wrong way around.

 

Substituting branded supply for a prescribed generic is rare, (though does happen - see my post above).

 

Substituting generic supply for a branded prescription is much more common, though there are situations where it is unwise (eg differing bioavailability)

 

Where substitution is unwise, a generic shouldn't be prescribed in the first place, and most electronic prescribing systems won't allow it - if a GP prescriber tried to prescribe "lithium carbonate 400mg" their electronic system would prompt "which brand".

They could write out an FP10 (the green prescription slip) manually : but then they'd have to enter a record for it on their system manually anyway ..... So why wouldn't they just use their computer system and get a neatly printed scrip

 

Within hospital, if still using paper charts (rather than electronic prescribing), the prescriber would likely invite the "green pen's wrath" ...... As the ward pharmacist asked "which preparation?"

 

If a generic was prescribed where substitution is unwise (e.g lithium carbonate, where it is wise to stipulate a brand / preparation), if it got as far as the dispensary (paper scrip in hospital, or handwritten FP10 from a home visit by a GP?), the dispensing pharmacist would likely offer another bite at the cherry to avoid an error, and clarify with the prescriber which brand was appropriate.

[determindator]

Lithium carbonate http://www.nhs.uk/Medicine-Guides/Pages/MedicineOverview.aspx?condition=Depression&medicine=Lithium%20Carbonate

 

An outline of the drug you chose as an example Bazza S

[citizenB]

http://www.bbc.co.uk/news/business-35090087

 

Well it seems an Australian Court has ordered this product off the shelf - but the ruling doesn't effect UK sales..

 

The Producers defend the use of the packaging claiming it helps people to purchase something specific, despite it being proved that all the contents are the same !!

 

 

 

The Federal Court of Australia said the products must be taken off Australian shelves within three months.

[MaxxPower]

UK Advertising Standards Agency to investigate Neurofen after Australian court case

[unclebulgaria67]

If this is true, then it is bad business practice to fool some customers. They say it was to help customers find a product that was suitable for a condition they were suffering. The info on tbe back of tbe products usually list all of the ailments it was suitable to offer pain relief from.

[tobyjugg2]

I think they are claiming the stuff in the tablets added to the ibuprofen results in the ibuprofen being absorbed quicker or at least differently.

 

This isn't necessarily hogwash, it seems to be a fact that caffeine promotes the properties of paracetamol and why so many cold relief concoctions are paracetamol and caffeine.

Look at dietary advice, adding fiber improves the bodies use of many foods.

 

So I believe this is mainly about the additives rather than whether its a better ibuprofen.

 

http://www.ncbi.nlm.nih.gov/pubmed/10963764

 

and a less technical report

http://www.thelifestyleelf.net/new-review-evidence-shows-caffeine-makes-painkillers-more-effective/

[AndyOrch]

This was covered on Watchdog years ago....and its not just Neurofen...they are all at it.

 

Andy