11
[24]
The remark in Adcock-Ingram Laboratories Ltd v Lennon Ltd, referred to
above, that it is the ‘doctor’s responsibility as to what the patient should have, and
his alone’, has a sense of unreality in modern circumstances, where patients play,
and are expected to play, an active role in relation to their own health. It reduces the
patient to a passive bystander in the process of providing him or her with treatment
and medication. Such an approach is hardly reconcilable with s 8 of the National
Health Act 61 of 2003 which gives the patient the right to participate ‘in any decision
affecting his or her personal health and treatment’. Patients often discuss their
medication among themselves and with their doctors. They exchange information on
which product they find most efficacious. This information may then be discussed
with their doctors or pharmacists when the issue of substituting a medicine for a
generic or the more expensive innovator product is raised. Often they provide the
names of their medicines, particularly chronic medication, to the medical
practitioners treating them. They discuss the advantages and disadvantages with
them. They consider different options. In a case of emergency a Schedule 3
medicine may be sold, for use during a period not exceeding 30 days in accordance
with the original prescription, if the pharmacist is ‘satisfied that an authorised
prescriber initiated the therapy’13 – clearly on information provided by the patient.
Whatever the position may have been in 1983, the patient is no longer a passive
bystander when treated and receiving prescribed medication.
[25]
The provisions of s 22F of the Medicines and Related Substances Act widen
the scope of the enquiry to be made. Section 22F deals with generic substitution or
interchangeable multi-source medicines, and, it was submitted, envisages a situation
where the patient forms part of the decision-making process thereby increasing the
likelihood of deception or confusion. It provides as follows:
‘Generic substitution.—
(1) Subject to subsections (2), (3) and (4), a pharmacist or a person licensed in terms of
section 22C (1) (a) shall —
(a)
inform all members of the public who visit the pharmacy or any other place
where dispensing takes place, as the case may be, with a prescription for dispensing, of the
benefits of the substitution for a branded medicine by an interchangeable multi-source
13
Section 22A(6)(l) of the Medicines and Related Substances Act.