In my ten-year medical career, I have encountered a wide variety of patients and medical conditions. One of the common problems is that patients wonder about medicines: why do we doctors not recommend some drugs even though they are cheap and claim to be effective? Today, I would like to share my experience of diagnosis and treatment to uncover the reason behind this.
About two years ago, on an ordinary weekday, I met a middle-aged patient, Mr. Wang, who came to our hospital with persistent stomach pain. He was holding some medicines he had bought online, which were advertised as "quick pain relief and effective results" and were very cheap. Mr. Wang wanted me to confirm whether the medication he had purchased was suitable for treatment.
After reviewing the ingredients and manufacturing information he provided, I found that although these drugs contained ingredients that could relieve stomach pain, the concentration of the active ingredient was below the standard required for treatment, and the source of production and quality certification were not clearly labeled. Not only may this medication not work well with treatment, but it may also cause more health problems due to side effects.
I explained to Mr. Wang why I couldn't recommend this drug and introduced him to some drugs that have been verified and the quality meets the national standards. Although the price of these drugs may be slightly higher, their safety and efficacy are guaranteed. After a period of correct treatment, Mr. Wang's condition has improved significantly.
Pharmacodynamic ingredients and concentration issues
Pharmacodynamic ingredients and concentration issues
When choosing a drug, in addition to price and brand, the active ingredient and its concentration are key factors in determining the effectiveness of the treatment. Many times, cheaper drugs are not preferred by doctors, and one of the reasons is that the concentration of the active ingredient in these drugs may not be sufficient to achieve the desired therapeutic effect.
The concentration of the active ingredient is insufficient
The efficacy of a drug depends on the concentration of its active ingredient. If the concentration of the active ingredient of a drug is below the therapeutic threshold, it will not be effective even if it is used for a long time, and it may bring more health risks due to side effects. For example, some antibiotics can complicate the condition by not only having poor treatment results if they are not concentrated in sufficient concentrations, but can also lead to bacterial resistance.
Quality control during production
Cheaper drugs may be manufactured using lower-cost raw materials or more simplified production techniques. These factors can all affect the purity and concentration of the active ingredient in a drug. In a manufacturing environment that does not strictly follow Good Manufacturing Practice (GMP) standards, it is often difficult to ensure the quality and consistency of drugs.
The importance of GMP standards
GMP (Good Manufacturing Practice) is an important international standard to ensure the quality of pharmaceutical production, covering every link from raw material procurement, production, packaging to quality control. Pharmaceutical manufacturers that follow GMP standards are able to ensure that the quality of each batch is consistent and that the active ingredients meet the therapeutic needs. As a result, doctors tend to favor those that have proven to follow GMP standards when recommending medicines.
Case study
For example, some of the cheaper medicines on the market advertise that they contain antiviral ingredients, but the actual concentration of the active ingredients is much lower than what is needed for treatment, so it is difficult to see rapid improvement even if you take it for a long time. Conversely, drugs that are slightly more expensive but follow strict manufacturing standards have more precise concentrations of active ingredients, provide rapid symptom relief, and are more economical.
Drug Sources and Manufacturing Standards
GMP certified
What is GMP?
GMP, or Good Manufacturing Practice, is the basic manufacturing and quality management standard in the pharmaceutical industry. It ensures the quality and safety of drugs in the manufacturing process, including the cleanliness of the manufacturing environment, the standardized use of raw materials, the strict control of the production process, and the strict inspection of finished products.
Importance of GMP:
Quality consistency: GMP-certified facilities must ensure batch-to-batch consistency in the quality of the drug produced, avoid fluctuations in active ingredient content, and ensure that every dose of the drug is safe and effective.
Prevent cross-contamination: In GMP-certified facilities, there are strict systems in place to prevent cross-contamination between raw materials or products, which is especially important to prevent drug side effects and allergic reactions.
Strict supervision: GMP factories are strictly supervised by the National Medical Products Administration, and any non-compliant production behaviors will be corrected in time to protect the interests of consumers.
The difference between imported and domestic drugs
Quality control:
Imported drugs: Typically, imported drugs are subject to rigorous international quality reviews, including FDA (Food and Drug Administration) and EMA (European Medicines Agency) certifications, which require drugs to meet high standards of potency, purity, and safety.
Domestic drugs: Domestic drugs in the Chinese market also need to meet the standards of the CFDA (now known as the NMPA, National Medical Products Administration), which are in line with international standards to ensure the safety and efficacy of drugs.
Selection Guide:
When choosing an imported or domestically produced drug, consideration should be given to the specific use of the drug, the specific situation of the patient, and the cost-benefit ratio of the drug. Based on these factors, the doctor usually recommends the most suitable medicine based on the patient's condition and financial situation.
Case Study
Taking a commonly used hypertension medication as an example, let's compare an imported drug with a domestic drug with the same active ingredient:
Imported drugs: The drug is produced by a well-known pharmaceutical factory in Europe, and each batch of drug is subject to strict quality control and multi-country efficacy verification to ensure its efficacy consistency and safety worldwide.
Domestic drugs: The corresponding domestic version is produced by domestic GMP certified factories, although the cost is lower, but it also follows the national drug production and quality standards, ensuring the basic safety and therapeutic effect of the drug.
Professional Responsibility and Ethics of Doctors
Putting the patient's interests first
When recommending medicines, doctors must put the health and safety of their patients first. This means that the drug chosen must be based on its scientifically proven efficacy and safety, rather than the cost of the drug or other external factors. For example, even if some drugs are less expensive, I as a doctor will not recommend them to patients if their safety and efficacy are not fully clinically validated.
Avoid conflicts of interest
In the healthcare industry, conflicts of interest must be strictly avoided. Physicians should base their recommendations solely on the results of a medical assessment and should not be influenced by sponsorship or promotional activities by drug companies. For example, accepting sponsored travel or gifts from a pharmaceutical company may influence the doctor's objective judgment to recommend drugs that are not best for the patient.
Adherence to professional ethics
Physicians should uphold professional ethics and honestly inform patients about the possible side effects and risks of medications, as well as all available options for treatment. This includes transparent descriptions of drug ingredients, manufacturing standards, and clinical data, ensuring patients can make informed decisions. In addition, doctors should keep their medical knowledge and skills up-to-date in order to accurately judge the suitability of new drugs and their possible health risks.
Patient education and communication
Effective doctor-patient communication is key to ensuring the right choice of medicines. Doctors should use clear, understandable language to explain treatment options, including why a certain drug was chosen, how to use it correctly, and possible side effects. This not only helps patients understand the treatment process, but also increases patient trust and satisfaction with the treatment plan.
As physicians, we have a responsibility to provide patients with the safest and most effective treatment options. This requires us to constantly learn about the latest medical developments, maintain high standards of professional ethics, and earn the trust of our patients through open and honest communication. In the process of drug selection, we must consider the scientific data of the drug, the cost-effectiveness of the drug, and the specific situation of the patient to make the most appropriate choice. This practice is not only ethical, but also ensures that patients receive the best possible medical care.