Last week, seven-year-old Mecca came down with a cold and a sore throat. She visited her doctor for examination, and was prescribed a nutritional supplement to help with the symptoms. Her family sent a photo of the prescription to a pharmacy in Zahraa al-Maadi for home delivery, and the drug was delivered around 11:30 pm. After ingesting a 6-ml dose of the drug, however, Mecca “suffered something akin to paralysis,” her mother, Samia, tells Mada Masr. “My daughter was suffering from a simple cold,” says Samia. “But the pharmacist confused the last two letters [of the drug’s name] and dispensed an epilepsy medication instead.” Samia rushed her daughter to the Poison Control Center, which refused to admit Mecca, as did several hospitals afterward, with all of them telling the mother that, since it had been 24 hours since the medication was administered, she needed to go to the intensive care unit at Demerdash Hospital, where the specialized care unit is located. Mecca remained sick for a day and a half, “no longer able to move her hands, legs or eyes,” Samia says. She remained in this condition for four days before eventually recovering. Soon after the life-threatening incident, the family filed a lawsuit against the pharmacy and submitted complaints to the Egyptian Drug Authority — the body responsible for pharmacy inspections — as well as to the Pharmacists Syndicate and the public prosecutor. But professionals working in the pharmacy sector and syndicate officials who spoke to Mada Masr say Mecca’s case is not the first time a patient has faced dangerous consequences as a result of mistakes in interpreting prescriptions. For them, complaints and investigations into each individual incident — while important for establishing liability and holding the responsible party accountable — will fail to address the root cause of the problem or prevent its recurrence, leaving patients exposed to the same danger. They believe the true solution lies in changing prescribing practices: mandating that physicians prescribe medications by their generic, non-proprietary names to reduce the likelihood that pharmacists will confuse the commercial names of popular drugs, a demand that pharmacists have put to the Health Ministry in recent days and which has already been recommended in a 2024 prime ministerial directive. However, doctors have expressed unwillingness to adhere to the recommendation — a stance that several sources who spoke to Mada Masr attribute to the strong financial and professional incentives offered by pharmaceutical companies to doctors, part of marketing arrangements that generate billions in revenue. *** Mistakes in drug dispensation of the kind that endangered Samia’s daughter are easily made when doctors prescribe drugs by their commercial name, according to two pharmacists who spoke to Mada Masr. A Pharmacists Syndicate official, speaking on condition of anonymity, tells Mada Masr that Mecca would not have been endangered had the generic name been used. The confusion originated due to a confusion between the name of the prescribed drug and a different drug with a similar name, he says. “The active ingredient in the first medication, Acetylcysteine, is completely different from the one in the second medication, Risperidone, which is used to treat certain psychiatric and neurological disorders,” he explains. A pharmacy manager notes that by contrast the trade name for the prescribed drug, Respidep, is very similar to Risperdal, the brand name of the antipsychotic that was dispensed. “Similar incidents have occurred many times,” says the pharmacy manager. “One case that stands out in my memory involved a pharmacist who mistakenly dispensed a neurological medication: the difference between the name written on the prescription and the drug actually dispensed was just two letters.” A bare minimum threshold to prevent the recurrence of similar incidents would be to mandate that doctors use generic names, says the manager, who stresses that “there is no active ingredient whose name resembles another active ingredient in the way brand names do.” Brand names, by contrast, are frequently very similar, he says, noting that companies will often exploit the name recognition of existing medication, launching drugs under similar brand names that differ by a couple of letters. There are myriad examples of similar trade names, such as antispasmodic drugs Spasomofin and Spasmomen, or deworming medication Flubvendazole and Metronidazole, an antibiotic. Given that doctors often have illegible handwriting, the similarity of trade names increases the chance of misreading, whether on the part of the physician or the pharmacist. Opting for the name of the active ingredient could reduce the margin for error when reading prescriptions and dispensing medication, says the pharmacy manager. A simple solution would be for the doctor to write the scientific name of the active ingredient alongside the brand name of the specific drug they want, he says. But he anticipates that the widespread adoption of this practice is unlikely. “A doctor might feel embarrassed to do that, as it would make them look like a dealer doing business with [pharma] companies,” he says. With many physicians prescribing drugs by their commercial name rather than their active ingredients, doctors play a major role in the pharmaceutical market and sales. Companies strive to persuade doctors to prescribe their pharmaceutical products over market alternatives, relying on a nationwide network of sales representatives and massive advertising budgets which aim to convince the largest possible number of doctors to prescribe these drugs. This “persuasion” goes beyond scientific arguments claiming one product is superior to its alternative, relying instead on a range of incentives that companies offer to doctors. These range from facilitating participation in scientific conferences — in Egypt and abroad — to, in some instances, direct cash payments in exchange for prescribing specific products, thereby encouraging the doctor’s continued commitment to the practice despite the potential negative impact on patients. *** While the Cairo Pharmacists Syndicate has already requested government action to enforce an existing ministerial directive that says doctors should use generic names, the response from physicians has been lukewarm. After Mecca’s hospitalization, the syndicate said last week that it had sent a formal request to the health minister calling for a mandate that all medical service providers prescribe drugs using generic rather than brand names in accordance with the prime minister’s 2024 directives. They proposed it be implemented as an immediate, specific and binding measure for antibiotics as a first step, to help curb their indiscriminate and excessive use, limit the dangers of antibiotic resistance, and accurately assess and monitor treatment efficacy. This measure would grant patients the freedom to choose between commercial alternatives of the same generic drug, breaking the monopoly that expensive brand names hold and ensuring the availability of alternatives during drug shortages. It would also help patients obtain substitutes quickly, without much back-and-forth between physicians and pharmacies, the syndicate said. The step would “represent a qualitative shift in national pharmaceutical policy,” the syndicate said, “and strengthen state sovereignty in providing safe, effective medicines at fair prices,” requesting that the health minister order a review of the proposal and issue an urgent directive for its adoption. In a separate request to the health minister, the syndicate asked that public and private healthcare facilities be required to issue prescriptions digitally to reduce errors resulting from illegible handwriting or similarities in drug names and dosages. But when Mada Masr asked officials from the Doctors Syndicate whether they would welcome the step, they were unenthusiastic. Doctors are “committed to the patient’s best interest” and to ensuring they receive effective treatment, says Khaled Amin, assistant secretary general and board member at the union. Consequently, they will prescribe the medication they deem most suitable for the patient’s condition, including specific brand names, he says, maintaining that the “patient’s best interest” is not necessarily served by relying solely on generic drugs. Denying that the practice of prescribing specific brands is linked to financial incentives by the pharmaceutical industry, he argues that “no one would jeopardize their reputation just because a company is offering a trip.” On using generic names, he believes it is impossible for a doctor to be certain of the details. “I am a doctor,” he says, “and I cannot memorize all the generic names: there are so many of them.” Gamal Omera, a member of the Doctors Syndicate board, also tells Mada Masr that he believes it would be difficult in practice to mandate that prescriptions are written using generic names. Brand names are often short and easy to use, he says, whereas generic names can consist of multiple syllables, making them long and difficult to write, citing the GSK-made Augmentin as an example, noting that the drug’s generic name is far longer than the well-known brand. Both Doctors Syndicate officials believe a digital prescription system is a long way off, with Amin describing it as “impossible at present.” It would require digital infrastructure connecting all service providers and digital records for every patient, he explains, along with many preparatory steps. Doctors can use printed prescriptions if they wish, he says, though they cannot currently be required to, particularly in medical convoys and rural areas where computers and printers may be less available. *** Mahmoud Fouad, chair of patient advocacy organization Right to Medicine, believes that prescribing by generic name would indeed “reduce the confusion that currently occurs.” But he anticipates that the shared interests of doctors and pharmaceutical companies will prevent such a practice from being widely adopted. Demanding generic drug prescriptions is “like stirring up a hornet’s nest,” he says. “Companies would raise an outcry, and the state would be unable to confront them due to commercial competition, investments and the influence of major corporations — particularly those that do business with doctors.” Ultimately, he concludes, “it is a losing battle for pharmacists.” All the health and pharmacy professionals and experts who spoke to Mada Masr agree that improvements at the pharmacy level are possible. Mahfouz Ramzy, head of the Pharmaceutical Manufacturing Committee of the Pharmacists Syndicate, assures Mada Masr that the complaint filed by Mecca’s father to the syndicate last week has been referred to the Legal Affairs Department, and that an investigative committee, including a representative from the State Council, has been assigned to the case. While it remains unclear whether the pharmacy that dispensed the medication to Mecca’s family made an error beyond misreading the drug’s name, there are various loopholes that could be closed, the sources suggest. Fouad and Amin, for example, both note that many pharmacies operate without a qualified pharmacist present, meaning that even if the prescription uses a generic name, a pharmacy assistant might still be unable to read and dispense the right drug. However, the pharmacy manager suggests that the margin for improvement here is limited as the law mandates a pharmacist be present but does not require that they themselves take exclusive responsibility for dispensing medications. This is consistent with how the Egyptian Drug Authority itself conducts inspections, he explains, with the primary concern often being simply to verify the presence of a licensed pharmacist. Some pharmacy job advertisements explicitly seek a “morning pharmacist for inspection times,” he continues, implying that, in some cases, the pharmacist’s presence is tied more to regulatory compliance than practicing the profession. He says that while any pharmacist can make a dispensing error, “it is certainly a grave mistake.” A more effective corrective measure, he proposes, would be stricter experience requirements for pharmacists responsible for dispensing medication. The presence of a pharmacist with extensive experience —”eight years, for instance”— could help reduce errors in reading prescriptions and distinguishing between look-alike medications. But he stresses that holding pharmacies alone responsible for the error will not prevent similar mistakes from happening again — a view shared by the syndicate official. “The primary objective of mandating generic prescription must be patient protection,” the pharmacy owner concludes, pointing to the Health Ministry as the entity primarily responsible for enforcing this measure.The post Why prescribe drugs by brand name? Pharmacists call for change after child endangered by drug dispensing error first appeared on Mada Masr.
