Tuesday, July 31, 2012

Drugs, Doctors, Chemists and you.

You are an ordinary law abiding person. You pay your taxes, you ask for bills when buying the smallest things and pay the VAT, have a drinking permit, obey traffic lights and, like our most Honourable Dr. Manmohan Singh, are a victim, silent sufferer of coalition politics. It is tough balancing the pulls and pressures of your wife/husband, children, employers and whoever else pressures you. You believe that you should be a good citizen. You read the Times of India, your blood pressure rises when you see Anna Hazardous on TV spouting homily after homily and Prashant Bhushan smirking as he accuses everyone of corruption.

Then one Saturday day, like many of us, you go to a party have more to drink than in good for you and wake the next morning feeling like shit with a pounding headache, daggers being thrown by your wife in protest of your behaviour the previous night. In these trying circumstances, you drag yourself to the neighbourhood Chemist and get yourself a Combiflam to take care of the headache. Your wife, to make you feel worse, has ordered you to also get some Corex cough syrup as her throat is a bit itchy. You decide to buy some Erythrocin just in case your wife’s itchy throat becomes an infection. Loaded with this you head home and try to enjoy the fragrant Dum Biryani your wife has made for Sunday lunch.

While you are still in your drink infused haze, let me tell you that you have done something very wrong. You have bought not one, but three prescription medicines, all without the mandatory prescription. Have I got your attention now?

Let me be clear, I do not wish to enter the controversy of how due to the indiscriminate use of antibiotics in India drug resistance is building up and other such larger matters. Neither am I questioning the point of whether Homeopaths, Ayurveds and Unnani Doctors should be regulated and so on and so forth. My point is something slightly different.

Did you realise that the sale of the medicines as seemingly ordinary as what I have listed is supposedly strictly regulated? Did you realise that despite such strict legislation, almost all dispensing chemists routinely flout all these regulations? Did you realise that you too are breaking the law? And, did you know, that one of the medicines I have listed is often abused to induce a `high’. Read on, it gets interesting.

India, like the best of the first world nations, has stringent, extensive and reasonably logical laws regulating the manufacture, sale, prescription and consumption of medicines. There is a plethora of legislation regulating medicines; however the one legislation that is of most relevance to us is the Drugs and Cosmetics Act, 1940 along with its Rules. It’s a massive body of legislation, and the official Government of India publication of the basic Act along with its Rules is some 617 pages.

This Act, briefly, contains most of the legislation relating to the manufacture, sale, prescription and consumption of prescription medicines. The Act has Schedules attached which list medicines that are to be sold only on prescription. The way the Act is supposed to work is that a Registered Medical Practitioner i.e. a doctor is to prescribe medicines to make you well. If the doctor prescribes any medicines that are to be sold only on a prescription then you as the patient have to take this prescription to your dispensing chemist who then sells you the medicines. The Act mandates that the dispensing chemist has to sell you only as much medicine as has been prescribed. The dispensing chemist is required to maintain a register which contains details of, among other things, name of the doctor prescribing the drug, name and address of the patient, the name of the manufactures and the potency of the medicine, the quantity sold and the signature of the chemist. If the dispensing chemist prefers, he can issue an invoice containing all these details and do away with the register. Not only is the dispensing chemist supposed to dispense only the quantity prescribed, but the dispensing chemist is to dispense the medicines only once.

In addition to the three very `ordinary’ medicines I have referred to viz. Combiflam, Corex cough syrup and Erythrocin a simple antibiotic. By the way almost all antibiotics can only be sold on a prescription. Despite this clear and unambiguous legislation, breach is universal. I am not talking about more `serious’ medicines like sleeping pills or tranquilizers but medicines that have become part of our almost regular self medication expertise. Have you ever thought what will happen if every dispensing chemist was to insist on selling you a prescription medicine only on a prescription? There would be anarchy. We have let the situation slide so much that a pull back is going to be very painful. Some of the effects would be that patients used to buying strong analgesics like Combiflam will find they have to use less powerful analgesics like a simple paracetamol which may not provide them with the instant relief they are used to getting with a sledge-hammer drug,. They will proceed to argue with the dispensing chemist saying that they have in the past bought Combiflam without a prescription so why is the chemist being difficult now. Doctors will find even more patients at their doorsteps. Patients will find costs of medical help shooting up. The poor will be hard pressed. Absenteeism will rise. The number of patients would be far in excess of doctors who could service them. Does this mean that we should abandon the very sensible practice of requiring a prescription to dispense medicines? I think not, but how does one get over these very practical difficulties?

Why have we reached this situation in India? One where prescription medicines are dispensed for the asking without the need for a prescription? Why do we self medicate? I believe the answers lie in the reasons I have listed in the preceeding paragraph. Who is responsible for this state of affairs? Obviously, we ourselves with our laziness to visit a doctor, we with our self medication, our chemists who have no fear of dispensing medicines in flagrant breach of the law and of course our vastly inadequate enforcement machinery that is also corrupt.

You may well ask how does a dispensing chemist maintain his registers if he is selling medicines without a prescription. Well the answer is, just like the liquor store owners do with their sales. Fictitious doctors and fictitious patients. So once again you have a situation where the records of the dispensing chemist are fudged and would show that Dr. Bijlani has been prescribing a multitude of medicines to a multitude of patients. On the other hand Dr. Bijlani when questioned would have no record, no knowledge, no idea and, in fact would never have had the patients nor the medicines prescribed on his files.

Here is something else I bet you did not know. Corex the cough syrup is regularly used by those addicted to induce some sort of stupor. Corex is India’s largest selling prescription drug. Ketamine, the drug used at raves, is regularly prescribed by dentists as a powerful analgesic. Prescription drugs are a serious and should not be abused.

India has the world’s second largest population, and this population is not in the best of health and the population is poor. Logically, India should have at the very least the world’s second largest number of dispensing chemists in addition to pharmaceutical sales. To regulate all this we should have the world’s second largest admistrative, regulatory and Governmental set up. Are we in any way capable of this, I mean the regulation?  I certainly think not. I am sure you agree. In that case, now how about considering this. Due to the indiscriminate use of antibiotics in India, which will only increase with time and affluence, will drug resistance become a really serious issue?      

Tuesday, July 24, 2012

Oh God - Give us our rain!!!

I had a bit of time on my hands before dinner, so I switched on the television to waste the time. I caught the beginning of a show on NDTV which fascinated me, and got me thinking. Needless to say, the show had 4 or 5 participants with diametrically opposite views, approaches, ideologies and beliefs that is so typical of Indian television. You can have a look at the programme here. Having such people on a show ensures a continual shouting match as well as absolutely no reconciliation on the matter in issue.

Here is the nub of the matter. Rains have failed or are failing or are desperately short, depending on whom you ask. Many states are experiencing problems consequent to the rains being inadequate. Karnataka, BJP ruled, is one such state. The BJP, or Bharatiya Janata Party, is supposed to be a Hindu Nationalist party. The BJP Government in Karnataka has apparently directed that (i) all temples near water bodies and near rivers have to perform `parjanya japa’ (special prayer for rain God) on 27th July and 2nd August and (ii) all other temples will have to perform `jalabhisheka puja’ (showering holy water on idol). This is at an estimated cost of Rs 17 crores, which the Minister insisted is not being paid for by the State but is being met out of the respective temple treasuries. This was the subject of an almost 30 minute brawl on national television. The questions being raised were whether the State should be making such directives; would such directives not result in a rise in peoples beliefs in superstition, mumbo jumbo etc.; should not the 17 crores be spent on fodder and drinking water; and other such ridiculous questions? By the end of the programme the participants had worked up a substantial froth.

Here is why I was left scratching my head.

Personally, I have very little belief or faith in `God’, however, that is my view. I do wish that people read Richard Dawkins – The God Delusion before making up their minds. Anyway, I am in the minority here. How many of us perform myriad Poojas, whether it is on buying a house, getting married, buying a new car, Poojas on deaths, Poojas for ancestors, praying before an exam or the simple all purpose Satyanarayana Pooja? I am not even including those who pray every day. Many, if not most of us. I am referring to Poojas that are more than the daily prayer. How many of us have plastic and wooden `Gods’ in our car dashboard? For some reason a `God’ on the dashboard has to have, nestling alongside, a deodorant. Be that as it may, why do we who do pray and have `God’ in our car, look at the diktaat for rain with amusement, or, something bordering on ridicule? If you do believe in praying and asking `God’ to give you something, you should, logically, have no truck with the BJP government in Karnataka directing temples to perform the special Poojas.

You may well say, “Look here Stonethrower, I don’t understand how the State can order, direct or get involved in such matters”? I assume that `such’ means matters relating to performing Poojas? Well, I ask you, what about the State, India, giving you a subsidy for going on Haj? What about the State, India along with Jammu & Kashmir, organising or facilitating the Amarnath Yatra? How is either of these any different? What I am trying to get at is that if are a believer in `God’ then honestly and logically how can you say that asking for Poojas for rain is any different.

I am still scratching my head.

Monday, July 9, 2012

Saayba Hotel revisited. Talk about a price increase!

In March of 2012 I had posted a rather effusive piece on Saayba Hotel. I started the piece with the words “Saayba Hotel at Bandra is a little delight”. I also sounded a note of caution. “Saayba is in a state of change. Earlier you had stainless steel Thaalis or `Taats’ [pronounced like `Tarts’ with a silent `R’] in which you ate and the food was served in stainless steel bowls. Reminded me of eating at my maternal grandmother’s house as a child. But alas, all that has gone. It’s now white Melamine plates and bowls and the `Indian breads’ are served in a stainless steel serving bowl. Prices have increased and quantities have, I believe, reduced, but I may be wrong on the portions. Oh yes, they now have a dedicated order taker who is dressed in a white shirt and apron.

Well, we had a meal at Saayba Hotel a couple of days ago, some 3 ½ months after the last meal. Unfortunately, it looks like things have gone a little pear shaped for Saayba Hotel. It was a Friday night, a good time – 9 pm – and I presume a day with no religious complications to prevent the consumption of meat or fish. To my shock there were just two persons in the restaurant. I was 3 and my nephew who I was dining with was 4. I have never seen this state of affairs at Saayba Hotel. Disturbing. Anyway, the menu was presented and I nearly fell of my chair. Prices had increased, dramatically, very dramatically. Was this why there were no punters in the restaurant?

Gritting my teeth, I ordered the usual things. Mutton Sagoti Fry, Teesrya Masala, an Usal, a plate of Vade, a plate of Rice Bhakri and a Chicken Pulao to round of the meal. I am happy to report that the food was completely up to scratch, it was delicious, and it had not changed in quality. However, quantities have most certainly diminished.  Eating from a Melamine plate, which has warped, is not the easiest thing to do. The damn plate kept rotating as I tried to chase the Mutton Sagoti with my Bhakri! To my mind, the decision to go `upscale’ by changing, among other things, from steel thaalis to God-awful melamine plates is not working. The tweaking of the prices and quantities seems to have had a similarly negative effect. 

OK, OK, let’s get to the business end. How much have prices increased? I had with me the take away menu from March 2012 and July 2012. I have tabulated but a few of the changes for you:

March 2012 price
July 2012 price
Whole stuffed promfret
Mutton Sukha Sagoti
Prawns with Balchaw Dip
Prawns Masala

Despite what I have written, a single dish is still not that expensive by Mumbai standards. The food was still very good. I do however question the logic. I can absolutely guarantee that the price of meat and fish has not risen so dramatically as to warrant this increase. But, I am just an eater; the owners have decided what obviously works for them. I have a choice, pay the price or find somewhere else to eat. I may just do the latter. To put it differently, should I pay the same amount for a dish at Saayba Hotel as I pay for at Lings Pavillion?

Is this still a little gem despite the price increase? Probably yes so long as the quality of the food is not compromised.