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?      

1 comment:

  1. very good and a thought provoking article:and thanks for trying to help doctors to get more patients! patients have no paitience!! they do not want to waste time and money if they can get treatment by self prescription and help of a drug store!