DRUG ISSUE - PLANS FOR VISUALS
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7a
RF_DR_5_SUDHA
HEALTH FOR ALL - AN ALTERNATIVE STRATEGY
report of a study group set up jointly 'by the
INDIAN COUNCIL OF SOCIAL SCIENCE RESEARCH (ICSSR)
and the
INDIAN COUNCIL OF MEDICAL RESEARCH (ICMR)
1961
on drugs’ ‘and’ p’Harmaceuti'cars’
I
THE INDUSTRY
THE TOTAL output of the industry increased a
hundredfold - from Rs.lOO million in 1947 to Rs.10,500
million in 1976-79. This was due to expanded production,
especially of an ever-increasing number of sophisticated
drugs, and rising prices...
THE DRUG industry has enjoyed a higher man-average
profitability so thac investment therein has increaseci
substantially from RS.240 million in 1952 to Rs.4,5OO million
in 1977.
THERE ARE about 125 large and medium factories and
nearly 3,000
small scale sector units engaged in this
industry which provides employment to about 100,000 workers.
(11.03)
PATTERN OF DRUG PRODUCTION
THERE IS now an overproduction of drugs (oftenvcry costly)
meant for the rich and the well-to-do while the drugs
needed by the poor people (and these must be cheap) are
not adequately available. This skewed pattern of drug
production is in keeping with our inequitous social
structure which stresses the production of luxury goods
for the rich at the cost of the basic needs of the poor.
(11.05)
2
2
OUT OF a total production of Rs.70^ crores in
1976} 25 percent is taken away by vitamins, tonics,
health restoratives and enzyme digestants, mostly
consumed by the relatively well-fed urban population.
Twenty percent is covered by antibiotics, only 1.3 percent
by sulphonamides (a very cheap and useful anti-infective)
and 1.4 percent by anti-tuberculosis drugs
(11.07).
PATTERN pF PlffiSCRIBING
ONE OF the most distressing aspects of the present
health situation in India is the habit of doctors
to over-prescribe glamorous and costly drugs with limited
medieax potential. It is also unfortunate that the drug
producers alvays try to push doctors into using their
products by all means—fair or foul. These basic facts
are more responsible for distortions in drug production
and consumption than anything else.
STRUCTURE OF THE INDUSTRY
THE EXISTING drug policy rightly emphasises the
attainment of self-sufficiency in the production of
drugs, in increasing the share of the Indian producers
and in giving a more significant role to public sector.
(11.14)
THE FOREIGN companies account for about 40 percent
of the total drug production in the country? their
share in the production of basic drugs was about 2d percent
and that in formulations, 44 percent (197d-79). This
is still high*
(11.15)
PRICE CONTROL
THE DRUG prices are high and continue to rise. In
some instances, Indian prices are even higher than
the international ones
(11.Id)
3
PACKAGING INCREASES the cost of drugs very
greatly because the trend is to make it attractive
and highly elegant and to add cosmetic embellishments
to promote sales...
(11.19)
THERE MAY indeed be a glut of applications for
the introduction of *Me~Toc Drugs • which will
not attract new legislation for another five years
in regard to price control...
(11.19)
GENUINE 'BREAKTHROUGH' research has declined
in recent times.
(11.19)
EXISTING PRICES of drugs including those of
essential drugs of everyday use is highly
inflated. Ebr example, the cost of analgin sold
over the counter is 30 times the cost of production.
(11.19)
PRICES ARE often inflated by the use of brand
names....
(11.19)
VERY OFTEN, prolonged controversy over the price
of a drug has resulted in stopring its production.
(11.19)
THE BILL for import of bulk drugs, intermediates,
solvents etc., has jumped from Rs.53.77 crores
in 1976-77 to about Rs.119 cror<_s in 1979-bO.
4
QUALITY
CONTROL
I„
yr tir fc*~n» ■>>•>« •
THE' STANDARDS prescribed are unrealistic., are
mechanically copred from books. ....and not unformly
enforced in all parts of the country.
CONSUMPTION OF DRUGS
AT PRi SENT the supplies of drugs to urban and
rural institutions within the health care system
is very uneven. In an urban hospital, for instance,
the drug cost is Rs.6 per .patient per year while in
a Primary Health Centre, it is about 40 paise per
patient per year...
3
6
On a world-wide scale, an estimated $2 billion are
spent annually on Research and Development in drugs
Of this, less than $70 million or 3.5% is spent
on tropical diseases. At the same time, over 1 billion
poor people or about 30% of the world's population
are extremely vulnerable to these diseases.
— Drugs and the Thirld World, Anil Agarwal
7
In India, at present, some 20,000 branded medicines
are on the market, a large number of which are
considered irrational. The basic bulk drugs used for
their formulation number only 400. The Hath! Committee
considered just 117 generic drugs (0.6% of the number
of drugs currently marketed) sufficient for satisfying
the basic requirements of the country.
— Aspects of the Drug Industry in India,
Mukarram Bhagat
8
The Lavraj Kumar Committee, which investigated the profitability
of multinational drug firms during the 1970's found that
their research and development outlays accounted for only 0.83%
of their total costs, with the exception of only 2 companies,
against this, sales promotion, administrative overhead
expenses accounted for 33% of their total costs.
—Foreign Drug Finns Spend Too little on R & D,
The Hindu, 12 March 1980.
4
4
9
A peculiar feature of the drug industry is that
the consumer is 'captive*. He normally does not
possess sufficient knowledge to make his choice from
a bewildering array of branded products available on
the market. It is his physician who makes this choice
for him. However, the confusion is no less for the
pr scribing physician too: it isvirtually impossible
for him to make a rational evaluation of the thousands
of price and quality alternatives the market is flooded
with.
Further, most doctors can hardly find enough time to
keep abreast of all the latest pharmacological
developments in their respective fields through the
scientific journals. Thus the doctors mainly depend
on information provided by the large manufacturers
as part of their promotional cainpaign. As one would expect
much of this information transmitted through beautiful
pamphlets and company medical representatives (the
ubiquitous salesman of the drug industry), is of doubtful
objectivity. In the enthusiasm to promote their products,
many *ifs* and *buts* of vital importance are simply
left out in the promotional literature.
— Aspects of the Drug Industry in India,
Mukarram Bhagat,
"Because of the great differences between countries, the
preparation of a drug list of uniform, general applicability
and acceptability is not feasible or possible. Therefore,
each country has the direct responsibility of evaluating and
adopting a list of essential drugs, according to its own
policy in the field of health."
—WHO Technical Report Series No.615
Criteria for selection of essential drugs.
E S s E N T I A L __D R U_G_S_
A_T
T H E_
N_E_E_D_E_D
C 0_M M_U_N_I_T_Y__L_E_V_E_L
ASPIRIN
MEBENDAZOLE
CHLOEOQUIN
DI - IOP OHYDF. O'/ Y QUINOLINE
SULPHONAMIDES
METRONIDAZOLE
STREPTOMYCIN
FERROUS SULPHATE
PENICILLIN
VITAMIN - A
ISONIAZID
VITAMIN B COMPLEX
thiacetazcne
thiocarbamazine
PIPERAZINE
ORAL DEHYDRATION SALT
ICNR/ICSSR STUDY
THE PHILOSOPHY OF VHAI
WE PEGIN WITH THE COMMUNITY.
OOP GOAL IS A HEALTHY COMMUNITY.
OUR AIM IS TO MAINTAIN THE HEALTH OF THE COMMUNITY. .
WE PROMOTE SOCIAL JUSTICE IN THE PROVISION
ANT DISTRIBUTION OF HEALTH CARE
WE KNOW ENOUGH ALREADY TO PROVIDE ALL
CITIZENS WITH SIMPLE HEALTH CARE
IF THE POO:- TO NOT HAVE HEALTH,
IT IS NOT
BECAUSE WE CO NOT HAVE SUFFICIENT KNOWLEDGE
IT IS BECAUSE WE AS THE ORGANISED PEOPLE OF
INCIA LACK THE WILL.
OUR OLE HEALTH SERVICES HAVE BEEN BUILT TO
FAVOUR. THE EDUCATED, THE PRIVILEGED AND THE
POWERFUL.
WE WISH ALL GOOES AN? SERVICES TO BE MORE
EQUALLY SHARED WITH THE WHOLE COMMUNITY.
THE WORLD COMAUNITY JOINS US TO PROCLAIM
HEALTH CAPE FOP. ALL BY THE
YEAR
2000 A.D.
THE SPIRITUAL TESTAMENT OF
V H A I
" FROM THE BEGINNING OUR PRINCIPLE HAS BEEN '
TO EMPHASIZE AREAS OF AGREEMENT AND
DE-EMFHASIZE AFEAS OF CONTROVERSY.
PEOPLE ARE NOT MERELY INDIVIDUALS.
ALL OF US ARE ALSO SOCIAL,
ECONOMIC ALT RELIGIOUS
POLITICAL,
.................... "
DRUG POLICY OF GOVERNMENT OF INDIA (1978)
BROAD OBJECTIVES
a) TO DEVELOP SELF RELIANCE IN ERUG TECHNOLOGY,
bj TO PROVIDE A LEADERSHIP ROLE TO THE PUBLIC SECTOR,
c) TO AIM AT QUICK SELF SUFFICIENCY IN THE OUTPUT OF
DRUGS AND TO REDUCE THE QUANTUM OF IMPORTS,
c5 ) TO FOSTER AID ENCOURAGE THE GROWTH OF THE
INF IAN SECTOR.,
e) TO ENSURE THAT DRUGS ARE AVAILABLE IN ABUNDANCE
IN THE COUNTRY TO LEET THE HEALTH NEEDS OF CUR
PEOPLE,
f) TO KEEP A CAREFUL WATCH ON THE QUALITY OF
PRODUCTION AND PREVENT ADULTERATION ARD MALPRACTICE.
COMMUNITY HEALTH rm
BAIm
-'3''Oad
research
; RUT v;hat about tropical
DISEASES
- THE DISEASES: THAT AFFECT DEVELOPING COUNTRIES
APE .VAINLY INFECTIOUS CR COMMUNICABLE.
- ONE BILLION PEOPLE,
MOST OF THEM AMONGST
THE POOREST IN THE WORLD, ARE EXPOSED TO
THESE DISEASES.
- UNTIL THE MID-1970S THE TOTAL WORLDWIDE
ANNUAL RESEARCH EXPEND ITUT'E ON THESE TROPICAL
DISEASES AMOUNTED ’’O ABOUT $30 MILLION.
-
"EQUIVALENT TO THE COST OF BUILDING A FEW
MILES OF MOTORWAY" SAYS W H 0.
- $30 MILLION IS LESS THAN ONE FIFTIETH OF
THE ANNUAL EXPENDITURE ON CANCER RESEARCH.
One of the most distressing aspects of the present health
situation in India is the habit of doctors to over prescribe
or to prescribe glamorous and costly drugs with limited
medical potential. It is also unfortunate that the drug
producers always try to push doctors into using their products
by all means - fair or foul ....If the medical profession
could be made more discriminating in its prescribing habits,
there would be no market for irrational and unnecessary medicines.
—ICMR/ICSSR ’Health for All’ Report
The physician who sets about to treat a disease without
knowing anything about it is to be punished even if he is
a qualified physician; if he does not give proper treatment,
he is to be punished more severely; and if by his treatment
the vital functions of the patient are impaired he must be
punished most severely.
—Koutilya Arthashastra
Physicians prescribe medicine of which they know little,
to cure diseases of which they know less, in human beings of
which they know nothing.
—Voltaire, 18th century
There are two types of physicians;
Those who promote life and attack diseases
Those who promote diseases and attack life.
—Charaka Samhita
.'.’..I’d
"; ■
s_TH CELL
••■■■■) 3t. Marks Uoad
:
’ .j.:c - 580 001
2
4.
As far as sub-standard drugs are concerned, there
is an urgent need to tighten up the drug control
machinery of the states. This will require larger
resources in the form of trained personnel and fully
equipped testing laboratories being made available
to the states. The Food and Drug administration of the
states need to be made more effective. It is well known
that sub-standard and spurious drugs originate largely
in those states where the drug control administration is
ineffective.
— Aspects of the Drug Industry in India
Mukaram Bhagat, 1982.
5
According to some estimates upto 80% of the present
output of many foreign drug companies comprises of
simple household remedies and inessential formulations.
Essential drugs like insulin, anti-leprosy drugs,
anti-TB drugs, vaccines etc., account for only 30%
of the value of formulations sold by many large firms.
— Drugs on the Market by Jug Suraiya
The Statesman, 8 December 1980.
3
2
Drug:
Ovulen (birth control pills: GD Searle Co.) in US used for
contraception only. In some Latin countries, Searle recommends
it also for regulating menstrual cycles, premenstrual tension,
menopausal problems.
U.S.A.
Caution against use
Adverse reactions publicized
If patient has tendency
to blood clot, liver
Nausea, loss of hair,
nervousness, jaundice, high
dysfunction, abnormal
blood pressure, weight change,
vaginal bleeding,
epilepsy, migrain,
headaches.
asthma, heart problem.
MEXICO
If patient has tendency
Nausea, weight change.
to blood clot, liver
dysfunction.
BRAZIL
If patient has tendency to
None
blood clot.
ARGENTINA
If patient has tendency
None
to blood clot.
(Taken from the Mother Jones, Courtesy—Health and Society, also mfc
bulletin 73-4, Jan-Feb 1982).
DRUG ALERT!
DRUGS FOR ARTHRITIS IN THE DOCK
On 17th May 1984, local newspapers announced
that two popular drugs used for arthritis (Tanderil
and Tendacot) — both oxyphenbutazone derivatives
•— were ordered to be immediately withdrawn, from
the market in UK by a government order1. The action
was taken on the recommendations of the Committee
on Safety of Medicines (CSM). Though the manu
facturer Ciba Geigy had exercised its right of appeal
under the Medicines Act to stall the government’s
decision, which actually had been taken sometime
ago, the Medicines commission had upheld the deci
sion to revoke the licence.
phenbutazone (Algesin-0, Axistopyrin cream, Butacortindon, Butadex, Butaproxyvon, Disiflam, FlamarP., Ganrilon, Inflavan, Kilpane, Maxigesic, Oxalgin,
Oxyrin, Oxytriactin, Reducin-A, Reparil, Rumatin,
Suganril, Tendon, Tromagesic) and 8 formulations
of phenylbutazone (Actimol, Algesin, Aristopyrin,
Butapred, Ebeflam, Parazolandin, Zolandin, ZolandinAlka) recommended for use by doctors in India.
How many patients must die before something is
done about this in India as well?
An mfc annual meet background paper in 1982
concluded that the ideal anti-inflammatory drug was
yet to be discovered and Aspirin remained the agent
of choice when cost-factor and benefit to risk consi
deration were taken into account0. Have events in
UK endorsed this?
400 deaths are reported to have taken place in
Britain in the last two years due to these drugs2.
The committee found them twice as dangerous as three
kither drugs belonging to the phenylbutazone group
^Butazone, Butacodine and Butacote) which were
withdrawn in March this year. The CSM had conti
nued to receive reports of adverse reactions including
fatal ones due to blood disorders, gastro-intestinal
intolerance and bleeding3.
With such a large number of anti-inflammatory
drugs in the docks, will homeopathy7, ayurveda and
non-drug therapies have a role to play in the treat
ment of arthritis?
— Community Health Cell, Bangalore
Sidney Wolfe, Director of the Health Research
group (sponsored by Ralph Nader) has estimated that
world wide probably more than 10,000 patients had
died as a result of taking these drugs. In his letter to
the Department of Health and Human Services, he
gave anaemia, agranulocytosis, leukemia, gastro
intestinal bleeding and peptic ulcerations as the lead
ing causes of drug induced deaths. Other deaths were
also attributed to hepatitis, thrombocytopenia and
renal failure1.
References
Interestingly in the last two years, three other
non-steroidal anti-inflammatory drugs benoxaprofen,
indoprofen jtnd .zomepirac and a formulation of indo.’lhacin (osmosin) were also withdrawn. A review
a current CIMS° shows 20 formulations of oxy-
f
1.
Hindu, 17th May 1984.
2.
Pune Journal of Continuing Health Education, Issue 69,
May 1984.
3.
Luncct: January 2-, 1984 (Nou steroidal anti inflammatory.
drugs — have we been spoilt for choice)
4.
Lancet, March 31, 1984 (phenylbutazone and oxyphenbut t
nzonc: FDA considers petition for ban in USA).
5.
CIMSCurrent Index of Medical Specialities, May 1984.
6.
Meena Kelkar, Anti-inflammatory Agents: Pune Journal of
continuing Health Education.
7.
World Health Forum, Vol 4, 1983: Homeopathy today—
round table.
addresses of people who may be potential subscribers
and share our perspectives?
VOCAL FIGURES
Our current state-wise break up of readers are
— Maharashtra (212); Gujarat (63); Karnataka
(36); Delhi (28); Bengal (27); Kprala (26); Bihar
(19); Andhra Pradesh (17); Tamil Nadu (17);
Madhya Pradesh (13); Punjab (9); Uttar Pradesh
(8); Orissa (5); Goa (2); Assam, Himachal Pradesh,
Meghalaya and Haryana have one each, mfc has yet
to make an entry into Arunachal, Kashmir, Mizoram,
Nagaland, Tripura, Manipur, Pondicherry, Andaman
and Nicobar. How national are we?
•Two bulletins will be sent free to them as a
trial subscription!
mfc office, Bangalore
WARDHA MEETING
The mid-annual EC/Core group meeting of mfc
will be held at Wardha from 27-29th July 1984 at
Gauri Bhavan, Sevagram Ashram, Sevagram (Maha
rashtra). At this meeting discussions will be held on
organizational issues and plans for the annual meet
on 'TB problem and control’..
Can members/subscribers/readers help us to
reach out to more people by sending us names and
7
RSJ. 27565/76
mjc bulletin:
UUllOrld:
>»nov-e rvne>nt".
THE IGMR/ICSSR report on ‘Health for AU’
has warned that “eternal vigilance is required to
ensure that the health care system does not get medicalised, that-the doctor-drug producer axis does not
exploit the people and that the abundance cf drugs
does not become a vested interest in ill-health1”. The
Drug Action Network which has come together in the
last two years is symbolic of this vigilance, which is
growing in India. The memorandum drawn up by
the participating organisations, which is featured in
this issue highlights the diverse aspects of drug policy
towards which this vigilance has to be directed.
THE banning of a wide range of commonly used
drugs for arthritis in U.K., in recent weeks (article
on Drugs alert) raises questions about the complexi
ties of this vigilance. In countries like U. K. and
U.S.A, in spite of drug safety committees, compre
hensive drug laws, efficient drug control authorities,
active consumer groups and socially sensitive elements
in the profession — drugs continue to slip through and
get used for years before their dangers get known and
bans are instituted.2 How much more difficult will it
be in our country where all these elements of ‘vigi
lance’ are still only in the process of evolving?
William Osier’s exhortation that one of the
first duties of the physician is to educate the
masses not to take medicine-1 is particulaly
relevant in today’s drug situation.
The role
of doctors in acting as watchdogs is primary
Subscribers are informed that due to an RMS
go slow in Bangalore, clearance of the mfc bulletins
in June was delayed. The bulletins must have reached
in the third/fourth week. We apologise for the un
avoidable delay!
In future bulletins will be despatched on the
10th of every month. Please let us know if you do
not receive them by the 17th of the month (this
applies to Indian subscribers only).
mfc office, Bangalore
editor:
ravi narayan
— laws, controls and authorities notwithstanding.
Are doctors prepared adequately for this role in India?
Medical education stresses the minutiae in pharma
cology and medicine without stressing the factors of
cost, safety and social relevance. It also does not
consciously immunize the doctors against the half
truths of persuasive medical advertising4.
In the
absence of programmes of continuing education in
the country, practicing doctors continue to be infor
med only by the profit oriented pharmaceutical indus
try, thus worsening the situation.
UNLESS there is a growing realisation among
medical students, young doctors, teachers, health
workers, professional associations, consumer educa
tion groups and science movements that this problem
needs to be tackled in. the form of an organized
movement very little change can be expected in the
present situation. Satchidanandan’s critique presents
an analytical framework and background against
which such a movement would have to evolve. I^k
suggestions for a multi-dimensional campaign^w
demystification, conscientization, study, curriculum
change and deprofessionalization could well be initia
ted taking drug issues as the focal point. It would,
however, be important to keep in mind that over
seventy five percent of the people in India have little
or no access to health care. Hence an action pro
gramme only on drug matters would be cut off from
the needs and aspirations of the majority’. However,
if this became part of a wider people’s movement for
socio-political change, the drugs problem would be
tackled at its very roots.
References
Please note
Editorial Committee :
kamala jayarao
anant phadke
padma prakash
ulhas jaju
dhruv mankad
JULY 198-4 Go-a’)__________ Regd. No. L/N P/K R N U/202
1.
HEALTH FOR ALL — AN ALTERNATIVE STRATEGY:
ICMR REPORT, 1981.
2.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS:
Lancet Editorial, 21st January, 1984.
3.
FEED BACK ONfPRESCRIBING: Lancet Editorial, 11th
February 1984.
4.
WHAT IS RATIONAL DRUG THERAPY?: Health^
the Millions, April-June 1981.
5.
CONSUMER ALERT-CONSUMER ACTION: Bulletin
of Sciences, Vol. 1, No. 2, December 1983.
Views and( opinions expressed in the bulletin are those of the authors and not necessarily
of the organisation.
Annual subscription — Inland Rs. 15-00
Foreign;
Sea Mail —US$4 for all countries
Air Mail : -Asia — US $ 6; Africa & Europe — US $ 9; Canada & USA — USS 11
Edited by Ravi[Narayari, 326, Vth Main, 1st Block, Koramangala, Bangalore-560034
Printed by Thelma Narayan at Prulir.cPrinting Press, 44, Ulsoor Road, Bangalore-560042
Published by Thelma Narayan for medico friend circle, 326, Vth Main, 1st Block,
Koramangala, Bangalore-560 034
1
DRUG ALERT1
DRUGS FOR ARTHRITIS IN THE DOCK
On 17th May 1984, local newspapers announced
that two popular drugs used for arthritis (Tanderil
and Tendacot) — both oxyphenbutazone derivatives
— were ordered to be immediately withdrawn, from
the market in UK by a government order1. The action
was taken on the recommendations of the Committee
on Safety of Medicines (CSM). Though the manu
facturer Ciba Geigy had exercised its right of appeal
under the Medicines Act to stall the government’s
decision, which actually had been- taken sometime
ago, the Medicines commission had upheld the deci
sion to revoke the licence.
phenbutazone (Algesin-0, Aristopyrin cream, Butacortindon, Butadex, Butaproxyvon, Disiflam, FlamarP., Ganrilon, Inflavan, Kilpane, Maxigesic, Oxalgin,
Oxyrm, Oxytriactin, Reducin-A, Reparil, Rumatin,
Suganril, Tendon, Tromagesic) and 8 formulations
of phenylbutazone (Actimol, Algesin, Aristopyrin,
Butapred, Ebeflam, Parazolandin, Zolandin, ZolandinAlka) recommended for use by doctors in India.
How 'many patients must die before something is
done about this in India as well?
Ari mfc annual meet background paper in 1982
concluded that the ideal anti-inflammatory drug was
yet to be discovered and Aspirin remained the agent
of choice when cost-factor and benefit to risk consi
deration were taken into account0. Have events in
UK endorsed this?
400 deaths are reported to have taken place in
Britain in the last two years due to these drugs2.
The committee found them twice as dangerous as three
ther drugs belonging io the phenylbutazone group
Butazone, Butacodine and Butacote) which were
withdrawn in March this year. The CSM had conti
nued to receive reports of adverse reactions including
fatal ones due to blood disorders, gastro-intestinal
intolerance and bleeding3.
t
With such a large number of anti-inflammatory
drugs in the docks, will homeopathy7, ayurveda and
non-drug therapies have a role to play in the treat
ment of arthritis?
— Community Health Cell, Bangalore
Sidney Wolfe, Director of the Health Research
group (sponsored by Ralph Nader) has estimated that
world wide probably more than 10,000 patients had
died as a result of taking these drugs, in his letter to
the Department of Health and Human Services, he
gave anaemia, agranulocytosis, leukemia, gastro•'ntestinal bleeding and peptic ulcerations as the lead,.:g causes of drug induced deaths. Other deaths were
also attributed to hepatitis, thrombocytopenia and
renal failure4.
References
Interestingly in the last two years, three other
non-steroidal anti-inflammatory drugs benoxaprofen,
indoprofen jind .zomepirac and a formulation of indojcethacin (osmosin) were also withdrawn. A review
a current CIMS3 shows 20 formulations of oxy
J.
Hindu, 17th May 1984.
2,
Pune Journal of Continuing Health Education, Issue 69,
May 1984.
3.
Lancet: January 2; 1984 (Nou steroidal anti inflammatory
drugs — have we been spoilt for choice)
4.
Lancet, March 31, 1984 (phenylbutazone and oxyphenbut
nzone: FDA considers petition for ban in USA).
5.
CIMS— Current Index of Medical Specialities, May 1984.
6.
Mecna Kelkar, Anti-inflammatory Agents: Pune Journal of
continuing Health Education.
7.
World Health Forum, Vol 4, 1983: Homeopathy today —
round table.
■ ■
addresses of people who may be potential subscribers
and share our perspectives?
VOCAL' FIGURES
Our current state-wise break up of readers are
— Maharashtra (212); Gujarat (63); Karnataka
(36); Delhi (28); Bengal (27); Kprala (26); Bihar
(19); Andhra Pradesh (17); Tamil Nadu (17);
Madhya Pradesh (13); Punjab (9); Uttar Pradesh
(8); Orissa (5); Goa (2); Assam, Himachal Pradesh,
Meghalaya and Haryana have one each, mfc has yet
to make an entry into Arunachal, Kashmir, Mizoram,
Nagaland, Tripura, Manipur, Pondicherry, Andaman
and Nicobar. How national are we?
■Two bulletins will be sent free to them as a
trial subscription!
mfc office, Bangalore
WARDHA MEETING
The mid-annual EC/Core group meeting of mfc
will be held at Wardha from 27-29th July 1984 at
Gauri Bhavan, Sevagram Ashram, Sevagram (Maha
rashtra). At this meeting discussions will be held on
organizational issues and plans for the annual meet
on ‘TB problem and control’..
Can members/subscribers/readers help us to
reach out to more people by sending us names and
7
RN. 27565/76
tUllOllSg
rnic bulletin: JULY 1984 Go-a')__________ Regd. No. L/NP/KRNU/202
WjU'WJCi.' (novement
THE TGMR/ICSSR report on ‘Health for AH’
has warned that “eternal vigilance is required to
ensure that the health care system does not get medicalised, that-the doctor-drug producer axis does not
exploit the people and that the abundance of drugs
does not become a vested interest in ill-health1”. The
Drug Action' Network which has come together in the
last two years is symbolic of this vigilance, which is
growing in India. The memorandum drawn up by
the participating organisations, which is featured in
this issue highlights the diverse aspects of drug policy
towards which this vigilance has to be directed.
THE banning of a wide range of commonly used
drugs for arthritis in U.K., in recent weeks (article
on Drugs alert) raises questions about the complexi
ties of this vigilance. In countries like U. K. and
U.S.A, in spite of drug safety committees, compre
hensive drug laws, efficient drug control authorities,
active consumer groups and socially sensitive elements
in the profession — drugs continue to slip through and
get used for years before their dangers get known and
bans are instituted.2 How much more difficult will it
be in our country where all these ele'ments of ‘vigi
lance’ are still only in the process of evolving?
William Osier’s exhortation that one of the
first duties of the physician is to educate the
masses not to take medicine’ is particulaly
relevant in today’s drug situation.
The role
of doctors in acting as watchdogs is primary
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editor :
ravi narayan
UNLESS there is a growing realisation among
medical students, young doctors, teachers, health
workers, professional associations, consumer education groups and science movements that this problem
needs to be tackled in. the form of an organized
movement very little change can be expected in the
present situation. Satchidanandan’s critique presents
an analytical framework and background against
which such a movement would have to evolve.
suggestions for a multi-dimensional campaigrj^
demystification, conscientization, study, curriculum
change and deprofessionalization could well be initia
ted taking drug issues as the focal point. It would,
however, be important to keep in mind that over
seventy five percent of the people in India have little
or no access to health care. Hence an action pro
gramme only on drug matters would be cut off from
the needs and aspirations of the majority5. However,
if this became part of a wider people’s movement for
socio-political change, the drugs problem would be
tackled at its very roots.
References
Please note
Editorial Committee :
kamala jayarao
anant phadke
padma prakash
ulhas jaju
dhruv mankad
— laws, controls and authorities notwithstanding.
Are doctors prepared adequately for this role in India?
Medical education stresses the minutiae in pharma
cology and medicine without stressing the factors of
cost, safety and social relevance. It also does not
consciously immunize the doctors against the half
truths of persuasive medical -advertising4.
In the
absence of programmes of continuing education in
the country, practicing doctors continue to be infor
med only by the profit oriented pharmaceutical indus
try, thus worsening the situation.
I.
HEALTH FOR ALL — AN ALTERNATIVE STRATEGY:
ICMR REPORT, 1981.
2.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS:
Lancet Editorial, 21st January, 1984.
3.
FEED BACK ONfPRESCRIBING: Lancet Editorial, 11th
February 1984.
4.
WHAT IS RATIONAL DRUG THERAPY?: Health^
the Millions, April-June 1981.
5.
CONSUMER ALERT—CONSUMER ACTION: Bulletin
of Sciences, Vol. 1, No. 2, December 1983.
Views andt opinions expressed in the bulletin are those of the authors and not necessarily
of the organisation.
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Edited by RaviJNarayari, 326, Vth Main, 1st Block, Koramangala, Bangalore-560034
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