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Chemistry Over The Counter: Is It Just What The Doctor Ordered?

The dynamic field of medical tourism has created new vistas, enabling a panorama of cutting-edge healthcare services across the world.// In the race for being the best in the market and offering out-of-the-box solutions, the contributions of the industry’s powerful trident - Pharmaceutical Industry, Doctors and Pharmacists, is no mere coincidence. “Medicine heals doubts as well as diseases”, said Karl Marx, and what better time other than the pharmacy week, to laud the efforts of the pillars of healthcare, and their services to public health.

A veritable hotbed in the demanding field of Information Technology, India is soon finding a foothold in the world for quality healthcare services. Speciality surgeries, dedicated teams, world-class hospitals and services have made India a landmark in healthcare. Laudable efforts in complex heart surgeries of people from yonder, enabling life over near-death situations, has won India world-wide acclaim, apart from cementing troubled relationships across borders.

The Indian Pharmaceutical Industry today is worth a whopping 4 million dollars, and is growing at almost 9% yearly. India is one of the leading global players in the manufacture of pharmaceuticals – it currently holds the 4th position in terms of volume and 13th in terms of the value of production. The country is also able to augment its stock of tablets, capsules, bulk drugs almost to the tune of 70%, the remaining 30% is enabled by the global market. Not surprising that the market is ridden with competition and price wars that have trickled into the society, giving rise to unscrupulous practices.

Compounding Cures

The drug stores are a conduit to enable prompt medicines, and pharmacists are vital associates of physicians. Zooming in on the role of pharmacists, one cannot over emphasise the need for impeccable standards of product and professional practice in pharmacy. When we talk of pharmacists, what comes to the mi nd instantly is the ease with which drugs, even the ones that require a prescription are available over the counter. Pharmacists sometimes double up as doctors and offer medicines; enabling prescription drugs without a prescription is undoubtedly a violation of the law, but a mutual understanding between the chemist and consumers allows this practice to thrive, encouraging indiscriminate use of drugs and self-medication.

Self-medication is a growing evil that has to be uprooted. It is estimated that 37% in urban India and 17% in rural population are in the throes of this malady. The easy reach of drugs such as crocin, rantac, gelucil, saridon, anacin, nice, avil, brufen, paracetamol, antidiarrheals plus cold medicines, has enhanced the sales of these drugs in India. Banned drugs such as anlagen, brufen, Anacin, are sold unchecked, raising concern amongst the medical community. Phenylpropanolamine (PPA), finds itself in many medical mixtures in India, but was banned in the US. Chloramphenicol, used as a last resort during life and death situations, makes up about 11% of antibiotic use, and is still one of the popular antibiotics available over the counter without a prescription.

Another drug that has stirred the hornets nest incessantly is the worldwide banned non-steroidal anti-inflammatory drug (NSAID) Nimesulide A, with anti-inflammatory, analgesic and antipyretic effects. Nimesulide, dynamically propagated in India, has raked up a controversy in recent years, with nearly 17 adverse drug reactions. In spite of the abuse and misuse of Nimesulide, causing death of children, the Drug Controller of India thought it befitting to restrict the action to a mere probe, while other countries ordered a ban on this drug. Sadly, this drug is still available over the counter.

The Heady Mix

India manufactures psychotropic drugs for medicinal purposes, and many of these drugs are easily available without an authentic prescription . The IT Boom has thrown asunder many healthy lifestyles in its wake of immense competition and high stress. Nowadays, young professionals, executives, socialites, models and also housewives are caught in the mires of stress, so much so that they fallback on tranquillisers and stress relieving drugs. The National Addiction Research Centre enlightened the public with a study in 2005 that found nearly 30% of Indians hooked on to anti-anxiety drugs. A trend such as this would not have taken off, if the pharmacy practice adopted strict and stringent norms for drug dispensation. Prescription re-use and unchecked purchase of drugs over the counter without a prescription have got many adults and teens addicted to drugs and stimulants.

Tonic Mania

The indiscriminate use of vitamin supplements is an alarming trend. To compensate for unhealthy eating habits, many are going overboard with intake of tonics and vitamin supplements. Crafty advertisements are making headway with the public and Vitamin manufacturers are raking in the moolah at the expense of public health. It is estimated that the sales of vitamin supplements have gone up by 200 percent in the last five years, ostensibly callous to the adverse effect of vitamin overdose, triggering organ damage and even death.

A Taste of Your Own Medicine

The erratic use of drugs in India is due to the paltry budget for healthcare. This void in the budget has been compensated to a great extent in the 2006 drug policy, yet the benefits will truly be realised with continued education through discussion, workshops, seminars, and training to update medical practitioners and pharmacists.

Specific pharmacovigilance is need of the hour, and the timely reports of critical and conflicting events need to be reported by patient, pharmacist and physician. The pharmaceutical industry can draw upon these inputs, to tweak a formulation or halt a certain drug from making its way in to the market. However, disseminated information does not sometimes reach the entire audience due to the illiterate numbers, comprising nearly 70% of the total population. It is here that the pharmacist can go much beyond his role, with true integrity, and strive to provide sound advice about medicinal products.

The Pharmacists in urban and rural India are generally considered very knowledgeable. Therefore it is important to ensure that a pharmacist is adequately trained so that they are more responsible while dispensing drugs. To give an impetus to a nation-wide movement on healthy practices, the drug manufacturing companies should resort to responsible advertising that is not driven by mere bottom line figures.

The Silver Lining:

The 2006 Drug Policy is equipped to enable financial resources to the National Pharmaceutical Pricing Authority (NPPA), to set the consumer awareness initiatives take shape in the form of education and training through print and electronic media. Programs and publicity will be instituted in English and other Indian languages, so that the rural lot are a part of the campaign. In addition to all this, The Consumer Affairs Department is coming out with a help line in order to provide solution to consumer grievances about the quality, pricing, availability and accessibility of drugs. A website complete with pharmaceutical drug related information, is also on the anvil.

The planned strategies will realise its full potential only if the country improves its literacy rate. It is here that the Pharmacologist can contribute immensely, by doing research, chipping in with the government in giving shape to the drug policy, and most importantly educating the community regarding the use and abuse of drugs.


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