DRUG ACTION FORUM KARNATAKA
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- DRUG ACTION FORUM KARNATAKA
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JANUARY 1991
MONT E-ILY
RExORC
January 1991 was the moot active month in the last
years.
21/?
it all started during last week of December 1990 when
we received a letter from FUVORD-K, inviting us to participate
in a preparatory meeting at Bangalore on "involvement of
people in development of degraded forest. ".
Though we have
been working for last two years, we had no idea regarding the
exact situation of Forest in Kulai/alli
area.
So Gopal met
the Range Forest Officer at Golihalli to find out regarding
the same.
To give an outline of our village work Gopal gave
a copy of annual report, which in its introduction gives a
background about the land and forest issue in Kulayalli area
including giving an outline of Inamti land and local politicians
involvement,
in smuggling
of
wood.
On 3 lot December 1990 the Kdttur forest beat caught ten
cycles of Kulayalli villagers, which were carrying wood towards
Kittur, infact these villagers make livelihood by soiling wood.
ihe forest beat told these villagers "Doctor sab has given
a
complaint at Bangalore and told that all cycles will have to
be stopped from taking wood".
carts of Machi
Cn 3rd January 1991, three bullock
village were stopped by Inamdar at Kularalli
and all the Machi Villagers were forced to come for a meeting
at Kulas-alli.
Gungadhar sent a chit to Gopal asking him to come to
Kulayulli along with forest
boat.
it war; expected that the
.Be.it will tell the people lhat there is no complaint lodged.
But on reaching the village the forest beat started dancing to
the tiijnes
of Inamdar and others.
And what happened at the
village was an eight hours drama where Gopal was surrounded by
about 40 people all drunk and equipped with material for viilence.
Gop&l succumbed to the situation and agreed to pay the ransom
-2-
Next day the
of Rs.1000/- as a compensation plus taxi fare.
forest beat and cunstable came home and. demanded Rs.BOO/- as
they had helped in settling the issue, ultimately it was a
agreed to pay Rs.400/On the other side Machi’- villagers were again culled to
Kulayalli and made to axt entire day and agree to the conditions
that the Machi Mahila Sangha should stop functioning,- Gopal
and Gangadhar should ho longer be allowed to the village.four
days later Imamdar, Panchayat member and Prakash
Marihal
forcibley took the Machi Mahila Sangha members in a jeep to
Bailhongal to get the Kiisan Nursery
But the RFC
money.
got wild and set them away.
BCM GROUND; There is enough reason for Inamdar and
thers to
get upset and angry with Gopal and Gangadhar.
During the British regime, the Inunidur, hud been gifted
with 12500/— acres of land ao he hud helped the British in
capturing Sangolli Rayanna
land,
a freedom fighter.
Part of this
Inamdar has leased out to Dandeli Paper mills to grow
Bculyptus and this contract ends next year.
Though Inamki act
has been abolished the Inamdar continues the pseudo land lordship
and thus exploit the ignorant farmers, by changing hands of -.»«
the land repeatedly.
According to our calculations Inamdar *.<
makes around a lakh rupees every year.
Gangadhar on his own,
was trying to educate these farmers, by asking them to take a
receipt from Inamdar for land payments and also giving village
mupa to furmero.
all this had definately irked and made Inamdar uncomfertable.
And on top of this the Machi Mahila Sangha was growing stronger
and had got registered.
The women had taken up certain local
issues which had irked the big politicians. The Inamdar had
ordered cutting down a # huge tree at Machi, about five manths
..3..
-3-
The Machi Mahila Sangha members decided not to give
back.
away the
tree instead they took, the money into Mahila
Sangha and similarly the tamarind money.
The Machi
V illagers were also trying to look for alienate source of
income.
This had also frieghtened the local politicians
aw they were involved in wood fi&ling and they hud to take
help of Machi Villager's for this.
When the marginalised and exploited get organised, the
expIoitaters try to break the organised group.
Probably they
were looking for a chance and the copy of annual report which
we
had given to RFO was used as an effective tool and thus
divide the village Kulayalli and Machi.
After the Incident: Machi villagers repeatedly came to Zilia
Parishad members house at Kittur and requested her to allow
Gangadhar back to the village, but all this prooved of no
avail.
h u pport:
It was unnatural for us to expect any support from
Kdttur us very close relatives of the Zilla Parishat member
who stays at Kittur are involved in smuggling wood.
But the support we got from outside friends and other
v-aluntary agencies was overhelming.
Hr. Anand Kabbur of
IDS Dharwad and also the present president of FEVORD - K,
Sr i, Dileep Kamat of SPS, Dr. S.L.Pawar from Ranebennur and
Sri. S.R.Hiremath from Dharwad.
Sri.' Dileep Kamat introduced
us to Sri.Ram Apte an advocate and trade unionist on 20th
January, Dileep Kamat and Pr.l’awar attended the weekly meeting
a ut Kittur.
Dileep Kamat immediately contacted Sri. Sadanand
Kunuvulli who know the Kittur P31 and Bel gaum DIG.
..4.
-4-
On 31st January 1991, Dr. Anand Kabbur, Dr.fawar, Sri.Dileep
Kamut, Dr, Go pal and Garigudhur Maddimani wet the DC at Belgaum
.tint bi’Jiil'nl h bn about Lho situation .
bC uuuurud to look,
into
the mutter and promised to visit Kittur.bn 1st of February
1991 all these persons including Sri.
Vasu from KUDINA
'
Sri. Narasimha Dabade and Sri, Sadanang Kanavalli visited all
three villages Machi, ^ingapur and Galaginamada.
On 3rd January 1991, ?S1 Kittur along with Gopal,
Jhurudu and Gangudhar Muddiinunl visited Kulayahll i and Machi
Hid had a nice and healthy discussion with villagers wnich
has helped us tremendously.
Villagers from Wlngupur arid Galuginumudu met us arid
promised to give us the support the Machi Mahila Sangha has
started ugarn with its weekly meetings.
Before we conclude this report we would like to thank
Sri. Sadanand Kanavalli, Sri.Dilaep Kamat, Sri.Anand Kabbur,
Dri. S.L.Pawar Sri.Vasu, Narashimha Dabade and also local
Raita Sangha leaders at Kittur who gave the needed support
and encouragement at right time.
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DRUG ACTION FORUM-KARNATAKA
Sharing our_Experiences
CONTENTS
A. Experiences
1. The beginning
2. Bringing drug action to the 'lay person*1
3. Contacts with voluntary agencies/other groups
in Karnataka
4. Teachers
Training
5. Workshop with voluntary agencies in Health
Care
6. Campaigns
7. The future
B. Events
a. The early meetings
b. Ringing drug action to the 'lay person'
c. Contacts with groups
d. Teachers training
C. Drug Action Forum-Karnataka - ficticn_Plan
D. Post-Script
P„R_E_F_A_C_E
These writings are an attempt to share an account of
the development that took place when a group of individuals
thought of forming a Forum for ^rug Action in Karnataka.
The 'report' is not just a recording of events; it tries
to share the experiences of the group over the last three
years.
This is under two major heads:
1.
Experiences: Relating to the group
2.
Events
: This highlights the important
events and the attempts made.
The Report has been written for reflection and discussion
by.interested individuals with a view to eliciting their
suggestions, comments and reactions so that future drug
work may be undertaken accordingly.
We would like to thank all those who were/are associated
with this Forum for their encouragement and support.
Dur special thanks to Community Health Cell, Bangalore,
whose report of a Study-reflection-experiment inspired
us to record our experiences in our efforts.
31 FlAY 1989
Copal Dabade
Kittur 591 115
Bailhohgal Taluk
Belgaum District
EXPERIENCES
Twa individuals involved in health and development
visited various voluntary agencies in South India during
November 1984, and on reflection, it was discovered that
many of them gave a lot of importance to drugs in their
health programmes.
They got a deeper understanding
of the problems related to drugs when they participated
in a meeting organised by an all India body, the 1 All
India Drug Action Network'.
A few other individuals
from voluntary agencies in Karnataka who were participating
in this meet felt the seriousness of the issue, thus
attracting them into’the fold.
This resulted in the
formation of Drug Action Forum-Karnataka (OAF-K).
It is
worth recording here that at the time of formation of
DAF-K, in the dispensary of an individual, working in a
rural health programme, several unwanted and hazardous
drugs were stored and dispensed ubknowinglyThis
brought the members closer to the problem.
This group wanting to draw other's attention to the
issue, in.order to strengthen the body, contacted several
people from diverse backgrounds' like [journalism, social
work, medicine, health, law etc., and held a series of
meetings at regular intervals in Bangalore. The idea
was to form a Core group, who would be able to spare
sometime from their schedule of work, and guide the
course of action of the Forum with the support of other
members.
Since the initiators of these meetingsdid not
want to thrust the idea of drug work on others but rather
wanted the group to study and understand the issue, the
formation of a Coi?e group did not take place for two
years.
However, during these two years, the larger group was
adequately made aware-of the drug issue through greater
continous interactions with it.
It may be recounted
here that a funding agency introducing -the discussion on
drug issue, to the group of agencies seeking more funds,
asked how relevant it was to spend huge amounts on drugs.
This was an eye opener to many of the participants.
For eg., a young medico who was to start a project for
tribals had initially planned to earmark a substantial
amount of his budget to drugs but on reflecting on the
issues raised, he had a second thought whether it was
necessary to spend such a huge amopnt on drugs, when
social and economic programmes were of greater importance
and relevance to the tribal population.
Two major advantages of organising these meetings were:
a. the group was enabled to know other groups who
2
2
b.
were showing interest on the issue like the
Karnataka Rajya Vignana Parishad (KRUP) and others
in Karnataka; and
Updating of knowledge/information on drug issues
through reading of literature/write ups/posters and
legal decisions, the resource materials on which
were made available to the group by Community.
Health Cell, Bangalore.
This was-of immense help
not only in knowing other like minded groups in
India but in translating the information into the
Regional language.
By the second half of 1987, more and more agencies and
individuals started showing interest in the issue.
The
Federation of Voluntary Organisations in Rural Development
Karnataka (FEVORD-K) organised three meetings in that
year to drive home the problems related to drugs.
Later
on another agency - Institute for Cultural Research and
Action (ICRA) organised a meeting and they are now activel.y
involved in this field by preparing appropriate material .
including a video cassette (in the Name of Medicine).
2. Bringing Drug_fiction to the_General gopulace
It was realised that there was a lot of information on
drug issues of impc lance existing but it was not being
dissemina'ted to the benefit-of the general public.
With
this in mind, six articles were prepared in Kannada and
sent to populat publications.
The response was really
encouraging.
In one article a brief mention of L0C05T,
Baroda (an agency engaged in the supply of certain
essential druns under generic names and educating the
public of issues related to drug) had been made.
The
response was .so enormous that we received more than two
hundred letters from the readers!.
This has resulted
in strengthening the working relationship with LOCOST.
Later on five meetings at Dharwad, Hubli, Shimoga, Ranibennur
and Bangalore were conducted with the-groups/individuals
who had evinced interest and the Core team of LDCOST.
These meetings generated quite an amount of discussions
and gave the participants a deeper understanding of the
situation.
On the whole, the experiences of working with a wide range
of groups confirmed our earlier impression and experience
that the lay public was much more open to any new
.. .3
3
or scientific thought.
On the other hand, the medical
profession, especially the Consultants would outrightly
deny or refer several scientific ideas on the pretext
that "in my experience------------3,
Contacts with Voluntary Agencies/Other Grougs in
Karnataka
In our meetings with the Volags in Karnataka, we had
discussed the role of drugs in community health programmes
and also the importance of the drug industry in relation
to its drug production pattern.
Several of them inter
nalised the idea of rational therapeutics to a certain
extent with the usual starting problems.
Once the idea
clicked, then it was easy going later, for majority of the
groups. • There were, however, some groups which were totally
closed to the issue of rational therapeutics, but such
groups were few.
In particular the groups totally closed
to the idea were the local Indian Dedical Association.
The relationship with Karnataka ^ajya Vignan Parishad
was one which has borne fruit.
Two years back, when we
had approached them with a request to put up some posters
on drug related issues in an exhibition arranged by them
at Gulbarga, the immediate response was not an encouraging
one.
But the next day tahen .they gave us five minutes for a
talk on the issue, a whole lot of doubts that existed
in their minds cleared up, which was obviously because of
the response from the people, being addressed.
Subsequent
to this we were invited to write articles in their
bulletin, meet the members of their organisation, teachersand publish a book, entitled 'Aushada Mathu Navu' (Medicine
and us) in Kannada.
The other group with .whom- an ongoing relationship was
build was Arogya Vikas Prakalpa '(an organisation working
for rural development in Shimoga and Sagar).
Many of its
volunteers were city based and doctors and hence an
interesting discussion with them could take place.
The
action initiated by this group was so interesting that 'they
even challenged the local chemist for selling expired
drugs.
The other institutions apart from Hubli Hospital for the
Handicapped, Hubli, 'Hindu Mission' hospital at Madikeri,
with whom, Drug Action Forum could achieve a continuing
relationship.
It was this contact with Hindu Mission
....4
4
Hospital which resulted in us participating in the
’fill India Hindu Mission Fleet
*
of hospitals.
In 1984, the Community Health Cell, organised a Workshop
on 'A more people oriented Drug Policy' for the members
of the Catholic Hospital Association of India, when
more than 400 people participated.
An audio-visual
slide was prepared,and an exhibition and a street
play on the theme was arranged during the workshop.
4.
Teachers Training
A meeting of the People's Science Movement at Dharuad
held about a year back led us to interaction with a group
of teachers who were interested in drug issues.
Following
this, our coordinating working relationship increased
including, talks with Principals, Teachers Centre who had
evinced great interest in the issue of drugs and thus a
plan for the training of rural primary school teachers
was evolved to be conducted on the first Sunday of every
month, for six months.
The venue for. this programme was
at the Hubli Hospital for the, Handicapped and the issues
discussed ranged from unessential and hazardous drugs in
the market to the role of teachers in creating awareness
on the drug issue among the public.
The most often
repeated question by teachers in this training.programme
was 'Why is it that the doctor prescribes these drugs?
Is he/she not trained in College?1.
It was also
experienced that ti e teachers were th best persons to
take up issues, as certain leadership qualities existed
within them.
The selection of teachers was done by the
AEO (Assistant Educational Officer) Dharwad rural, the
choice being made pf individuals who had earlier evinced
interest in social issues.
The consistant message that was stressed throughout these
training sessions was that, the market is flooded with many.
unessential drugs and wo really do not require these many
drugs.
The presence of' hazardous drugs being so freely
available in the market bewildered the teachers.
One
particular teacher explained to the group how his wife
had taken EP Forte during her early months of pregnancy
consequent perhaps on which the child born is of unsound
mind.
It was a stunning experience for all of us.
It
also so happened that all these teachers who had attended
the one day training programmes had earlier been given a
two week intensive training by the Government Primary
Health Centre, Medical Officer.
They had also been
5
5
provided with a kit containing essential drugs for
Primary Health Care.
With this background in health the
one day training brought them much closer to an under
standing of the drug issue.
It was this continuous interaction with the teachers
that made us prepare a slide set entitled 'Tonics and
Health' and write its script in Kannada.
Several posters
in Kannada on drug related issues, Oral Rehydration
solution etc., were also prepared and extensively used
in the training programmes.
5.
Workshop with Voluntary Agencies in Health Care
The Workshops conducted for voluntary agencies were
participatory in which the participants brought out the
number and type of drugs that were in use in their
projects.
It was astonishing to note that a number of
unessential drugs were being used by them.
Several
scientific and technical details including the WHO list
of essential drugs for Primary Health Care were discussed
in the workshop.
Another important issue discussed was h
how to evolve a programme at the village level with only
the required number of essential drugs.
The participants
were of the opinion that any new project in health and
development should be exposed ' to this important issue.
A larger workshop for the voluntary agencies is being
planned.
6.
Campaigns
The members of the Drug Action Forum-Karnataka were
involved in two major campaigns' initiated by the All
India Drug Action Network.
The first campaign in which
many people were involved was before the National Drug
Policy was framed.
The second one-was against Hatch
in US. 'Earlier some women's organisations had taken up
the issue along with other groups in India of Injectable
Contraceptives.
It is hoped that many more such campaigns would be
undertaken in the future.
7.
The Future
In the year 19B8, a Steering Committee with a few
. . .6
6
individuals/organisations who have found sometime to
spare for this issue came into existence under the
aegis of DAF-K, which has recently started functioning.
Experience in the past has shown that the DAF-K should
concentrate their attention on grass root level volun-'
tary agencies especially in disseminating information on
drug issues For, it is through them one could bring in
some attitudional changes in the general public as far
as drugs and its usage are concerned.
It was observed
that many volags were not aware of the practice of
rational therapeutics.
A few amongst them, even if
they were aware of it, were not putting into practice
for fear of losing their patients to other general
practitioners.
Initiating legal action against the drug manufacturing
firms who are flouting the government orders and also
against the law enforcing authorities was viewed with
equal importance.
The story of Estrogen-Progesterone
combination formulations could be taken as an example. .
It is unfortunate to learn that even after its ban, the
firms continued to manufacture and market while the ban
enforcing authorities acted as silent spectators to the
audacity of these firms.
It would, however, take some
more time before such a step is initiated.
In order
to obtain a legal entity to the Forum, necessary
action is under way to register it.
A two year plan of action has been outlined and is in
the:process of being discussed and artualised by
members of the group.
7
7
B EVENTS
Under this head, the dates of early meetings; list of
articles contributed to various Kannada magazines
with a view to bringing drug action to lay persons;
contact groups; and teachers training programmes
conducted are presented.
I.
The early Meetings:
Dates
1.
2,
3.
4.
II.
a.
22nd February 1985
19th May 1985
15th August 1985
13th October 1985
List of articles contributed to Kannada magazines
with a view to bringing Drug Action to the 'Lay
Person'
'Jeeva Hinduva Aushadhagalu'
'Sudha'
b.
(Kannada Weekly) May 22-28,
Duly 1986 (Kannada monthly)
'Uthana'
c.
'Tonic Shudha Mosa'
'Taranga'
d.
(Kannada weekly) 9th November 1986.
'Aushadharoopi Brahma Rakshssha'
'Sudha'
e.
(Kannada Weekly) November 1987.
'Aushadhagalu Mathu Nivu'
'Hosa Diganta'
III.
1986
'Nishadhita Aushadhagala Nirantara Prabhutva'
2nd November 1986.
Contacts with groups
1.
IMA (Indian Medical Association), Dharwad, Ranebennur
and Shimoga.
2.
Arogya Vikas Prakalpa, Bangalore.
3.
KRVP (Karnataka Rajya Vignana Parishad), Bangalore
4.
ICRA (institute for Cultural Research and Action)
Bangalore.
5.
CHC (Community Health Cell), Bangalore.
8
a
6.
HHH (Hubli Hospital for the Handicapped) ,Hubli-.
7.
IDS (India Development Service), Dharwad
8.
SPS (Samaj Parivarthana Samudaya),Dharwad
9.
BGSS (Bharatiya Grameena Seva Samiti), Hubli
10.
VGKK (Vivekananda Girijana Kalyana Kendra), B.R.Hills
11.
Ashwini Hospital, fladikeri
12.
FCUORD-K (Federation of Voluntary Organisations
for Rural Development in Karnataka), Bangalore
13.
Concerned Lawyers.
IV.
Teachers Training
Date of Training
Number of Participants
1.
06-09-1987
2.
04-10-1987
18
3.
12-11-1987
17
4.
06-12-1987
18
5.
03-01-1988
14
6.
06-02-1988
10
15
.9
9
C ACTION PLAN FDR TUP YEARS - JUNE 1988 to JUNE 1990
An important action to be taken by the DAF-K is to
register itself as a non-profit organisation.
This will
ofcourse depend on the interest of the members.
The other areas around which DAF-K should work are:
a.
Setting up of an information dissemination centre
in Karnataka on issues around drugs ano health,
b.
Conducting training programmes,
c.
Forming rational therapeutic cell,
d.
Identifying issues which can be taken up to the
Government at State level and bringing it to its
notice for needful action,
e.
Conduct seminar/conference by organising the various
South Indian Drug Action groups,
f.
Conducting studies on relevant issues.
It would be very difficult to compartmentalise all these
actions, but for the sake of clarity, the plan is worked
out under ato.ve headings,
The difficulty being appreciated
because each one is linked to one another.
Setting up of an information dissemination centre in
a.
Karnataka on issues around drugs
Much work needs to be done in this particular area such as:
1. Setting up a documentation centre
2.
Translating it appropriately in Kannada
3.
Dissemination
4.
Getting Feed-back.
1.
Setting up a documentation centre:
This would consist of magazines and bulletins on
drug issues by various organisations.
This is to
keep ourselves updated on various issues.
2.
Translation should be made appropriately and major
thrust will be on identifying the issue that has
to be dealt, depending upon the need of the time and
people's reactions.
. . .10
10
3.
Dissemination of information will je to the following
groups:
i.
Those voluntary agencies involved in
integrated development projects along
with health programmes.
ii.
Voluntary hospitals.
Member institutions of FEVORD-K.
Various voluntary hospitals in Karnataka.
CHAI, CMAI and VHA-K members.
iii.
Voluntary agencies involved in non-health
programmes.
Members of PRARAMBHA, Bangalore
Members of Karnataka Rajya Vignana Parishad.
iv.
2.
3.
4.
Other mission institutions
Action groups in Karnataka
i.
Women Forums
ii.
Lawyers associations
iii.
Consumer Forums
iv.
Environmental groups
Teaching institutions in Karnataka
i.
Medical colleges
ii.
Pharmacy colleges
iii.
Other colleges
Professional bodies
i.
Indian Medical Association, Karnataka and its
members
ii.
Expert professional bodies
The major objective of disseminating information to them
will be to:
1.
Internalise drug action into their institutions
2.
Write issues about drugs in their own bulletins
.11
11
3.
To become members of Drug Action
4.
To involve them in. social action programmes.
orum-Karnataka
Method of_approach
As we are cutting across a variety of groups, the range
being from grass root level workers to medical colleges,
the information needed to be disseminated will be
different.
As for groups 3 and 4 i.e., Teaching institutions in
Karnataka and Professional bodies, much material has
already been prepared by AIDAN in English.
This will
have to be linked up or to kept abreast of them or
recent development.
Action Plan:
A single page bulletin every month to groups 3 and 4
which will link them up with other publications of
AIDAN etc., and also keep them abreast on specific
issues.
For groups 1 and 2 i.e., Voluntary Agencies and Action
Groups in Karnataka, the information will need to be made
more appropriate for grass root level and will need to
be in regional language.
Action Plan:
A single page bulletin every month for groups 1 and 2
in simple Kannada will have to be distributed and further
information in which they may be interested, may be
provided.
d. Getting feed-back
The information disseminated will have feed-backs,
which will be be carefully analysed and incorporated
into next bulletin.
b.
Conducting training programmes:
1. Training programme for health workers from various
voluntary agencies:
It has been observed that voluntary agencies, them
selves are promoting many' unwanted and dangerous drugs,
ofcourse doing it unawarely.
At a training programme
. . . 12
12
for four voluntary agencies in the first week of
January 1988, it was revealing to see how the voluntary
agencies used a lot of unwanted and even some dangerous
drugs.
A continuation of this to cover more voluntary
agencies in Karnataka would be planned.
Atleast two
such training programmes in the ensuing two years
would have to be arranged.
It may be mentioned here that the expenses towards
attending the training programmes should be borne
by the sponsoring organisations.
2. A similar one day training/orientation camp for
social action and voluntary organisation working in
other areas of development will have to be organised.
c.
Forming Rational Therapeutic Cell (RTC)
It is appreciated that educational efforts would be a
major stress of DAF-K, and 'forming a RTC would be an
effort to promote awareness about the correct use of
medicines.
The formation of RTC would help both
prescriber as well as patients.
It is a usual occurance that when patient visits doctor,
he is advised a long list of drugs,
Why RTC?
When patient visits doctor, the docto; is seen as a high
priest and also the patient has unquestioned faith in
the power of drugs, tonics and injections.
At times even
reputed doctors are guilty of irrational prescriptions
on the fear that 'if I do not do the same, I will lose
my patients to some other doctor'.
The major reason for wrong prescription is because the
doctors are misinformed by the drug companies through
false advertisments.
The medical representative . p.ersuade
doctors to push unwanted and irrational drugs.
The RTC is an attempt to bring a balance in this gross
imbalance.
The patient who is the consumer is at the
questioning and demanding end and hence it is a consumer
movement.
It is also made clear that DAF-K has no
intention of putting the doctor in the spot.
It aim's
to educate the people.
Approach of Rational Therapeutic Cell
1. The patient sends the prescription faith relevant
. . . .13
13
details to DAF-K.
2. The prescription so sent by patient would be referred
to RTC who would study it and send its comments to the
prescriber.
3. The RTC would consist of expert doctors from various
medical specialities who are conscious of rational therapy.
The RTC members would meet every three months to evaluate
the progress of work and also to exchange ideas.
The RTC would make its final comments on the prescription
of the doctor.
4. The RTC would then send its studied final comment to
the patient with a copy to the prescribing doctor.
Information to be sent by patient to DAF-K
The patient will bo requested to send the following
information:
1. Name and address of the patient
2. Name and address of prescriber to whom a copy has to
be sent
3.
Age, Sex, history of patient and symptoms at the time
of consultation of the doctor
4.
Diagnosis
5.
List of medicines with dosage taken during last six
months
6.
Details of investigation
7.
Any other relevant material
8.
Photostat of prescriotion of doctor.
Limitation of RTC
RTC members do not have the accessibility of clinical
examination of the patients, which is the most important
thing in medical field before writing a prescription.
It is also made clear that RTC would not like to involve
at this stage into legal battles either with doctor or
drug companies.
The methods of RTC are only an attempt
to educate the patient and the doctor.
. . .14
d.
Identifying issues uhich can betaken unite the
Government at State lev/el and bringing it to its
notice for needful action
The State Government has its machinary, which is respon
sible for upholding the drug situation at State level, ■
but it is hardly a match for the strength of the mighty
drug companies.
But many a time the Government is not
even aware of issues that are happening even in its own
neighbouring states.
For example the Andhra Pradesh
State Government has issued an order to all its hospitals
to use only the drugs selected by WHO.
But more often it is the lack of political will on the
part of the Government in which case suitable action at
all levels will need to be initiated co achieve the
issue identified.
This will be a major thrust for the
members of DAF-K, if it is for lobbying.
Apart from issues to be taken to the Government, the
group should also be able to see issues which can be
taken up at legal level.
This will be a process of
involving socially conscious lawyers,
The initial step
of this has already begun by keeping contact with them. .
e.
Conduc. seminar/conference bv organising various
South India Drug Action groups for collective action
It is ultimately collective action which is going to pay
dividend for any social action movement, and this would
be the most important platform.
Initially we will have
to keep them informed of our activities until we identify
common interests for action.
f . Conducting studies on relevant_issues
There are several drug companies mushrooming up in various
parts of the State and all of them have their own subtle
mechanism to push the product into the market; so, a study
of their products and promotional literatures could be
initiated.
IN ORDER TO UNDERTAKE THE FOREGOING ACTION °LANS,
THE DAF-K WOULD REQUIRE FINANCIAL SUPPORT, MEMBERS
HAVE TO, THEREFORE, EVOLVE WAYS AND MEANS TO
GENERATE FUNDS FOR THE PROGRAMME.
IT IS CONSIDERED
AN ONEROUS RESPONSIBILITY ON THE PART OF MEMBERS.
15
15
0 POST SCRIPT
It is gratifying to record here that in the last one year
several individuals and groups including a consumer
forum have been showing interest in the efforts of DAF-K
and participating in the meetings organised by it.
A
group of concerned lawyers in Bangalore have come forward
to extend their cooperation to the efforts of DAF-K.
The need for undertaking research in the field of drugs
has been felt amongst several of us; but it should be
one which would help in the campaign and not just an
academic exercise.
A group of scientists at the Indian
Institute of Scoence, Bangalore have expressed their
willingness to help DAF-K in this direction and the
issues to be taken up for research have been suggested
to them for the needful. This we are sure, would help
us in a big way in our efforts and interactions with
various groups.
The DAF-K used to meet every two months to discuss issues
of interest apart from sending out occasional newslerr ers
but of late, the meeting has become a monthly feature,
where issues related to certain bannable dr ms are
discussed.
'I' h
'
■ 7
2&JJS_ACTI0N_F®yM__KARNATAK
24th May 1992 - di. Olle Hansson's Day
"
Indigenous Medicine - Facts and Myths”
History of Health Culture is as old .as human civilization.
Every
civilization has given brith to a specific health culture which
in turn responded to the health needs of that area.
Variety of health problems were managed by the available local
knowledge and resources.
This was a totally decentralised system.
People were able to adjust their inner nature to the external one
e.
i.
people were living in perfect harmony with their environment.
Recently since last one decade there is a rekindling of interest
in the traditional system of healing.
The basis for this current
interest as the belief, that traditional system offers a harmless,
harmonious and holistic approach in contrast to the segmented and
narrow vision of modern medicine.
This is widely prevalent notion
^/hich has, in fact supported the forces that encouraged the commer
cialisation of traditional systems and their entry into the medical
market.
This happened due to the "UNHOLINESS" of modern allopathic medicine
which is slowly dawning upon its prosperous users as a sophisticated
technology.
High costs,
over medicalisation and iatrogenesis
pervade their lives.
The commercial market force which has engulfed the modern medicine,
is looking towards other alternatives.
Ayurveda emphasise on healthy life styles (Dinacharya, Rithuckarya,
^jhara and Vihara ).
Use of herbs for curative purposes is a tiny
part of this ancient heritage.
Looking at the vast potential of
herbs pharmaceutical companies started manufacturing c mmercially.
This led to the compromise with quality.
with the lu'ze of huge
profits spurious substandard products flooded the mrrket in the
name of Ayurveda.
Pharmaceutical companies started exploiting
people's psyche i.e. "anything herbal is safoi
On the one hand both Government acu NGO's started giving a fillip
to the promotion and development of Indigenous medicines.
On the
other hand pharmaceutical companies started dumping spurious
indigenous herbal produces.
With all good intensions to support indigenous medicine industry,
the Government exempted Ayurvedic and Herbal based products from
paying excise duty.
This was greatly misused by the industry and
started labelling anything as "HERBAL".
As there is no strict
quality control and monitoring system, spurious•products from
P.T.O.
2
toffees to shampoos appeared in the market.
The Drug control organisation is handicapped due to inadequate,
and
qualified manpower to supervise the pharmaceutical companies regu
larly.
Hence there is a total failure in implementations of
provisions enlisted in the Drugs and Cosmetics Act 1940 (Amendment
1964
extended to ISM's).
There is only one Ayurvedic, Unani Drug
Testing Unit at Ghaziabad, UP for the whole country.
Coming to the price front Ayurvedic, Unani and Herbal based produots
do not come under any price control.
with this the prices of Ayurve
dic and Herbal products are soaring and unimaginable.
Moreover there
is a laxity in providing licences for herbal production units. Hence
hundreds of herbal units are mushrooming all ever the country.
Finally, there is no policy on Ayurvedic, Unani, Herbal drugs,
which has led to want on growth of herbal units.
Policy should aim at (1) clear guidelines starting from procuring
herbs from its natural abode up to the finished product (2) companies
should manufacture only essential products based on
common disease profile of- the country.
Above all it is essential to bring back the decentralised self-re
liant, ncn-exploitative system, wherein the people start treating
themselves using simple receipes for day-to-day ailments.
In case
of need people should use herbs grown in their home gatdens and
surroundings.
This makes people to understand the value of using
herbs grown at backyard or gardens or in pots,
There is no alternative to a healthy life more than adhering to
healthy life styles.
Dr. T.N, Manjunath
^roframme Officer
Community Health Promotion, VHAI.
’
I \
Drug Action tain-taflto
57,
Son: Tejaswin&g&r,
DHARWAD - 5SO 002
(KARNATAKA)
GOVERNMENT OF ANDRA
PRADESH
abstract
Medical Institutions - Drugs - Purchase by Government Institutions
list of 200 Drugs - approved.
MEDICAL AND HEALTH (CL) DEPARTMENT
G.O.Ms.No.386 M & H
1.
2.
Dated:2nd July 1985.
Read the following:-
From the DME D.O,. Lr.No.DME/Peshi/84, dt.3.8.1984.
From the Chairman, State Advisory Board on Health
letter Rc.No.7/SABH/84, dt. 11.12.1984.
ORDER:
There has been considerable increase in the recent years
in the number of pharamaceutical products in the market. While
judicious use of drugs can save life, indiscrimate use of drugs
can be hazardous. There is enormous increase in the incidence
of iotrogenic (diseases caused by drugs disorders in recent years.
This matter was referred to the state Advisory Board on Health
fo.r its consideration and advice.
2.
The State Advisory Board on Health had reviewed the
World Health Organisation list of drugs, along with the senior
Professors of various specialities in medical colleges and
submitted a list of common drugs to be stocked in the General
Hospitals limiting the number to 200. The Board has also reco
mmended that the director demanding officers (Superintendents/
District Medical and Health Officers etc.) may be instructed to
strictly limit the drugs to the above list and that, as a
special case, they may be permitted to buy any other drug from
the rate contract items, if required for any particular disease.
3.
The Government, after careful consideration, accept the
recommendations of the State Advisory ^oard on Health and direct
that the purchase of Drugs for utilisation in the Medical Insti-.
tutions be limited to 200 drugs mentioned in the Annexure to
this order.
4.
The Director of ^edical Education/Dir.-ctor of Health
and Family welfare is recjuested to identify the drugs to be
purchased for Taluk Hospitals and Primary Health Centres and
dispensaries out of the drugs indicated in the Annexure and
communicate the same to the concerned Direct Demanding Officers.
5.
If during the course of treatment, drugs outside the
approved list, are required' the concerned Superintendent/Medical
Officer-in-charge is permitted to purchase the same from the
rate contract items within the budgetary allocation. The
total purchases of such medicines in a year should not exceed
2CP/<> of the budget for medicines in Medical Institutions other
than Teaching Hospitals.
6.
This order does not require the concurrence of
Finance and planning Department.
(BZ ORDER and in THE NAME OF THE GOVERNOR OF aNDRA PRADESH)
S.V.GIRI
Secretary to Government
T'he Director of Medical Aducation, A. P. Hyderabad.
The Director of Health and Family Welfare, Hyderabad.
The Chairman, State Advisory Board on Health, Secretariat,
Hyderabad.
All Superintendents, Teaching and Non-teaching Hospitals.
Copy to all district Medical and Health Officers.
Copy to the Pay & Accounts Officer, Hyderabad.
Copy to all district Treasury Officers
*
Copy to Accountant General A.P.I., Hyderabad.
Copy to P.s. to M (H.& M).
Copy to P.A. to Secretary to Government, M. & H. Department.
Copy to Liaison Officer, Publicity Cell G.a.D.
Sd/Section Officer
p.t.o. for Annexure
//forwarded by order//
GOVERNMENT OF ANDRAPRADESH
1.
ANAESTHESTICS
1.1
General Anaesthetics
Esther
Halothane
Nitrous Oxide
Oxygen
Thiopental sodium
.. •
1 • 2 Local Anaesthetics
Bupivacaine
Lidocaine.
2.
ANALGESICS ANTI-PYRETICS,NARCOTICS:
Acetylsalicylic acid tables.
Paracetamol Tablets and injections.
Oxyphenbutazone Tgolets
Morphine
Pethidine
Pentazocine
3•
ANTI-HISTAMINES:
Chlorpheniramine 4 mg. Tablet and 10 mg injection.
4.
ANUL-EPILEPTICS:
'
Diasepam Tablets 5 mg and Inj. 10 mg.
Phenobarbitone
Phenytoin
Phenobarbitone Injections.
5.
ANTI-INFECTIVE DRUGS
••
Amoeb icicles
5.1
Metronidazole 200 nig tablets
Tinidazole 300 mg tablets
5.2
5.3
5.4
Anthelmntic drugs:
Mebendazole
Piperazine
Thiabendazole
Mephenium Hydroxynaphthoate
Antj-bacterial Drugs
v
Ampicillin Campsule, Syrup and Injections.
Benzathine Benzylpencillin
Benzyl /'encillin
■
Precaine Pencillin 4 lakh and 12 lakh
Chloramphenicol Capsules, Suspension and Injection.
Erythromycin Tables and Granules.
■ Gentamycin
Metronidazole (injection.)
Sulphadimidine
Sulphamethoxazole
Trimethoprim
Tetracycline Capsules-and Injections.
Mandelic Acid
Nitrofurantoin
Anti-Filarial Drugs
Diethyl Carbamazine.
2
-25.5
Anti-Leprosy Drugs
Dapsone
Clofazimine
5 r6 Ant i-rM alarials
Chloroquine tablets and Injections.
Primaquine
Quinine
5•
Anti-tuoerculosis Drugs
Ethambutol
Isoniazid■
Streptomycin
Thiacetazone
.
For T.B. Hospital Only
Rifampicin
Cycles' rine
Ethionamide
Pyrazinamide
6•
ANTI NEOPLASTIC AND IMMUNOSUPPREGIVE DRUGS
Busulphan
Chlorambucil
Cyclophospham ide
Vincristine
Azathioprine
For Cancer Hospital Only:
Bleomycin
Fluarouracil
Methotrexate
6 Mercaptopurine
Mitomycin
Tamoxifen
7•
DRUGS AFFECTING THE BLOOD
7.1
Antianaemic Drugs:
Ferrous Sulphate tablets
Iron Syrup
*olic Acid
'' '
Hydroxycooalamin (B.12)
Iron Dextran complex injections.
712 Anti-coagulants and antagonists
Heparin injectionwarfarin tablets
Phenindione
Protamine Sulphate
8• CaRDIO- WASCULAR' DRUGS
8•1 Anti-anginal drugs
Glyceryl Trinitate
Isosbrbide dinitrate
8,2
Anti-arrhythamic drugs
Lidocaine
Procainamide
Verapamil Tablets and injections.
. .3
-3
Anti-hypertensive Drugs:.
8.3
• 1
Hydralazine
Hydrochlorothiazide
Methyl Dopa
Propranolol
’
.
■. i. -
Drugs used in Shock or anaphylaxis
8.4
Dopamine
Epinephrine
Isoprenaline
Nor Adrenaline.
-•
CERE3R0 VASCULAR DRUGS
9.
Levo Dopa
Trihexyphenidyl
Xanthinol Nicotinate (Complainina) 150 mg.
Cyclandelate 200 mg and 400 mg (Cyclospasmol)
Isoxsuprine Hydrochloride 10 mg (Duvadilon)
DERMATOLOGICAL DRUGS
10.
Bactitracin oin'tment
Aluminium acetate solution
Benzoic acid + Salicylic acid ointment or cream(whittled
ointment)
Coal tar solution
Salicylic Acid solution
Titanium dioxide
Benzyl benzoate lotion
Gamma Benzene Hexachloride Cream or lotion.
DIAGNOSTIC AGENTS
11.
Radiconotrast Media
Bgirum Sulphate
Sodium Iothalamate
Myodil
12.
...
DIURATICS
Acetazolamide
Furosemide
Hydrochlorothiaze-de
Mannitol
13 •
e.n.t.
Genticin H.C, ear drops
Chloromycetin ear drops.
Waxolen ear drops.
Oxymetazoline Nasal drops.
Acetic acid ear drops.
14• GASTRO INTESTINAL DRUGS
14.1
14.2
Antacids
Aluminium Hydroxide ■
Mag.nesium Hydroxide
•
Antiemetics
Promethazine
Metaclopramide 10 mg.
4
-4-
14.3
Anti-spasmodics
Atropine tablets and injections
Oxyphenonium Bromide 5 mg (Antrenyl)
Hyoscine Butylbromide (Duscopan)
14.4 Cathfcrtics
14.5
15.
Senna Tablets
Anti-diarrhoeal
Codeine
Furazolidone
GYNAECOLOGICAL DRUGS
Obstetric Cream
Mycostatin Vaginal tables
Floraquine Vaginal Tablets
Ethacradine Lactate vials
Isaptent vials.
16 .
HaRMONES
Dexamethasone or Betamethasone
Hydrocortisone riamesuccinate
Prednisolone
Testosterone
Ethinylestradiol 0.05 mg.
Ethinylestradiol+ Levonorgestrel (Oral contraceptives)
Narethisterone 5 mg.
Hydroxyprogesterone (Prolutin)
Progesterone 5 mg.
Eltroxin
Carb imazole
Clomifene
Lente Insulin
Plain Insulin
Oral Hypc-glyclaemic Agents
Clibenclamide
Chlorpropamide
Phenformin
17.
IMMUNOLOGICALS
Sera and Vaccines:
Anti-Dimmunogloblin (Human)
Antirabies Hyperimmune serum
Anti—snake venom
Diphtheria Anti-Toxin
NCG Vaccine (Dried)
Diptheria Pertussis - Tetanus Vaccine
Poliomyelitis Vaccine
Tatanus Toxoid
Raoies Vaccine.
18•
MUSCLE TELAXANTS
Neostigmine
Suxamethonium
Tubocurarine
Pancuronium
19*
OPTHAIMOLOGICAL PREPARATIONS?
Silver Nitrate solution
Sulphacetamide Eye ointment
Tetramyclin■eye ointment
Hydrocortisone eye ointment
lodoxuridine eye drops.
Fluroresoin
. .5
-520. OXYTOCICS
Methyl Ergonetrine Maleate
Oxytocin 5 i.u.
21. PERITONEAL DIALYSIS SOLUTION
2 2. HAEMODIAL YSIS CONCENTRATE
23. PSYCHOTHERAPEUTIC DRUGS
Amitriptyline
Chlorpromazine
Lithium Carbonate
Imipramine
Trifluperazine
Carbamezepine
Doxepin
24. RESPIRATORY TRACT DRUGS ACTING ON THE
Aminophylene
Deriphylene
Salbutamol
2 5.' SOLUTIONS CONTAINING WATER ELECTROLYTE
25,1 Oral rehydration solution
For 1 It. of water:
Sodium chloride(sachet) 3.5 g.Na mmol/1...90
Sodium bicarbon-,tre (Sachet) 2. 5 g HC03 mmol/1..3 0
Potassium chloride (Sachet) 1.5 g K+ mmol/1..20
Glucose (destrose (Sachet) 20.0 g. glucose mmol/l..lll
2 5.2 Parenteral
5% Dextrose
5% Destrose with sodium chloride
Potassium chloride
Sodium bicarbon-t e solution
Sodium chloride
Molar Lactate
Darrows
Ringer lactate
Extra Cellular replacement solution
Gastric replacement solution
Maintenance solution
Paediatric Maintenance solution.
26.
VITAMINS AND MINERALS
Asorbic acid (vitamin c)
Vitamin A
Vitamin A and B
Vitamin K
Vitamin B-complex
Vitamin B.6
Calcium Gluconate
Circulated by:
Andra Pradesh Voluntary Health
Association.
//true copy//
ESSENTIAL DRUGS - W.H.O.
criteria eor the selection of essential drugs
(WHO's Technical R port Series No. 722, 1985).
Essential drugs are those that satisfy the health care needs
of the majority of the population;- they should therefore be
available at all times in adeuate amounts and in the appropriate
dosage forms.
The choice of such drugs, depends on many factors, such as
the. pattern 6f prevalent ’diseases, the treatment facilities
the training and experience of the available personnel;
the financial resources; the genetic, demographic and en
vironmental factors.
’
Only those drugs should be selected for which sound, adequate
data on efficacy and safety are available from clinical studies
and for which evidence of performance in general use in a variety
of medical settings has been obtained.
Each selected drug must be available in a form in which adequate
quality, including bio/availability, can be assured, its stability
under the anticipated conditions of storage and use must be
established.
Where two or more drugs appear to be approximately similar in the'
above respects, the choice between them should be made on the
basis of a careful evaluation of their relative efficacy, safety,
quality, price, and availability.
In cost, comparisons between
drugs and cost of the total treatment, and not only the unit cost
of the drug, must be considered. In some cases the choice may
also be influenced by other factors, such as comparative pharmaco
kinetic properties, or by local considerations such as the
availability of facilities for manufacture or storage.
In the great majority of cases, essential drugs should be for
mulated as single compounds. Fixed-ratio combination products
are acceptable only when th. dosage of each ingredient meets
the recuirements of a defined population group and when the
combination provides a proven advantage in therapeutic effect,
safety, or compliance over a single compound adm^nstrated
separately.
d/ ,/
Guidelines for Establishing a National ^rog^mrtje for
Ess&tial Drugs
Jp f
In order to ensure that an essential drugs -programme is ade
quately instituted at the national level, several steps are
advised:
1) The establishment of a list of essential drugs programme is
adequately instituted at the national level, several steps
are advised:
1)
establishment of a list of essential’drugs, based on the
recommendations of a local committee, is the starting point of
the programme. The committee should include individuals
competent in the field of medicine, pharmacology, and pharmacy,
as well as peripheral health workers. Where individuals with
adequate- training are not available within the country, co
operation from WHO could be sought.
2. The international nonproprietary(generic) names fir drug
or pharmaceutical substances should be used whenever available
and prescribers should be provided with a cross-index of
2
-2-
of non-propriety and propriety names.
3. Concise, accurate, and comprehensive drug information
should be prepared to accompany the list of essential drugs.
4. Quality, including stability and bjo-availability. should
be assured through testing or regulation where national resources
are not available for this type of control, the suppliers should
provide documentation of the products's compliance with the
required specifications.
5. Local health authorties should delineate the level of
expertise required to prescribe individual drugs in a the
rapeutic category. Consideration should be given,- in particular
to the competence of the personnel to make a correct diagnosis
In' some instances, while individuals with advanced training
are necessary to prescribe initial therapy, individuals with
less training could be responsible for maintenance therapy.
6. The success of the entire drugs programme is dependent
upon the efficient administration of supply, storage and
d-istrioution at every point from the manufacturer to the end
user. Government intervention may be necessary to ensure the
availability of some drugs in the formulations listed, and
special arrangements may need to be instituted for the storage
and distribution of drugs that have a short shelf-life or
require refrigeration.
7-. Efficient management of stock is necessary to elimin-te
waste and to ensure continuity of supplies, Procurement policy
should be based upon detailed records- of turnover.
In some
instances, drug utilisation studies may contribute to a better
understanding of true requirements.
8.
both clinical and pharmaceutical, is sometimes
required to settle the choice of a particular drug product
under local conditions.
MEMORANDUM
We, the health personnel and citizens of India recognize' health as a
. fundamental right of the people in .this-, our welfare state. We recognize
and strongly believe that the health status of our people is more dependent
on their access to adequate food, safe and adequate water, proper sanitation
and clean environment.
While we support the overall perspective and approach of the new
National Health Policy Statement and demand its proper implementation, we
believe that a 'Rational Drug Policy1 is an integral part of a good National
Health Policy.
We therefore, demand the following:
We have a right to safe, essential, quality drugs which are in keeping
with the health needs of the people, at costs which the majority can
afford.
2. We urge our government to accept and implement the Hath! Comnittee
Recommendations which arc also in keeping with the WHO Guidelines for
a Rational Drug Policy.
3. Further the national drug formulary should be revised and compiled by
an expert multi disciplinary committee keeping the following criteria in
mind;
Essentiality
Efficacy
Safety
Cost
Ease of administration
Availability
Potential for misuse.
Such evaluation of the drugs in the market and revision of the lists
should be done periodically.
4. The Essential Drugs Policy should be adopted for all health services,
government and private, and priority in production, distribution and
dispensing should be given to these essential drugs.
5, The public sector should produce essential and life saving drugs on a
priority basis at the national level.
6. Drug production by multinationals and private manufacturers in India
should also be aligned with national health priorities.
7. Bulk procurement of essential and needed drugs should be through world
wide competitive tenders and rationalization of drug purchases should
. govern both the public sector as well as private health sector.
8. Imports and production of non essential, specially hazardous drugs,
should be strictly curtailed.
9. Drugs which have been banned frem sale after being marketed for seme
time in one country may net bo submitted for clinical trial or marketing
in India. The onus of proving 'why a non-essential drug should be intro
duced or allowed to continue on the market should be with the manufact
urer and such introduction should be preceded by adequate trials and
evaluation by Drug Control Authorities.
10, Comprehensive drug legislation which covers areas such as price control
at different levels, patents, and marketing practices should be incor
porated to servo the objectives of the nati ■nal drug policy and there
should be
levies, sales tax or excise duty on any pharmaceutical pro
duct in the essential drugs list by the Central or State governments.
11. No technology transfer agreement shall bo legal and binding which cont
ains restrictive practices, disproportionate and unnecessary use of
imported intermediaries or obsolete technologies or unfair arrangements
with respect to prices,■payments or repatriation of profits.
12. The National Drug Policy should state clearly the steps towards''a
complete abolition of brand names and as a first step use of generic
names should bo made compulsory in medical education, prescribing and
labelling of drugs. Generic names should appear mere prominently on all
packagings
•„ ..
1.
13.
It shall be the primary responsibility of the manufacturer to ensure the
quality of drug products. However, it shall be the statutory responsibi
lity of the Drug Control Authorities to monitor the standards and ensure
a minimum uniform, level of government control. Consequently, the govern
ment shall take all necessary measures to enable the Drug Control Autho
rities to function in an effective manner and discharge the statutory
duties cast upon them.
14. It shall be the statutory duty of the drug control authorities to inform
health personnel and ^consumers of the essential drugs lists, policies,
categories or brands0 drugs banned for manufacture or sale, through pub
lication in the national newspapers, magazines, medical journals with
adequate explanations and details.
15. Availability of drugs required in the Governments National Programmes
should be ensured on a priority basis to the government as well as
voluntary and private health institutions. Quotas for anti TB, anti
leprosy, anti malarial drugs, iodized salt etc should be made easily
available with regularity of supply to the voluntary health institute''-ns ,
whereever possible, specially when their performance, in health care
delivery is known tc be effective.
16. In all review committees, statutory bodies and ether such bodies, there
should be adequate representation of consumer groups and voluntary health
sector.
17. Drug companies should follow ethical marketing practices, and this should
be ensured by their own organizations like OPPI,1INA, IFFMA. We deplore
the tendency of those companies and associations to get around every
progressive measure of the government through repcurseCqtechnicalities of
the law and through the courts.
18. The marketing code drawn up by HAI(Health Action International) should
form the basis for a National Code for Marketing Practices.. This should
be accepted by our government and should be suitabla implemented through
legislation.
19.
The government of India should take a lead and endeavour tc influence
the-WHA and WHO to adopt ti.o Code in the interests of the other develo
ping countries and their peoples.
(IFPMA and HAI Code attached).
- Voluntary Health Association of India
- Centre for Science and Environment
- Centre of Social Medicine and Ccnununity Health-Jawataarlal Nehru Univer-
- Kerala Sahitya Shastra Parishad
- Medico Friends Circle
- Arogya Dakshata Mandal
- Lok Vigyan Sanghatana
- Consumer Guidance Health Services
- Consumer Education Research Centre
- Federation of Medical Representatives Association of India.
t?<7A7C
9
T_
Pj
A auk
"Dis- Vu-TP-
DRUG POLICIES - GOVERNMENT OF INDIA 1978
The Hathi Committee- Report
The- Government of India set up on February 8, 1974 a
Committee under the Chairmanship of zShri Jaiskhlal Hathi and
other members of Parliament along with various officials and
non-officials, to enquire into the various facts of the drug
Industry in India.
The Hathi Committee submitted its report to Government
in April 1975.
The Eport was laid on the tables of both houses
of Parliament in May 1975.
After several inter ministeral
discussion, and discussions with representatives of drug industry,
the views of the cabinet committee was put in February 1977, but
could not be considered.
Final decisions of Government based on the'
reports were made on 29th March 1978.
Broad objects of the New Drug Policy
(i)
To develop self-reliance in drug technology;
(ii)
To provide a leadership role of the public sector;
(iii)
To aim at c; ..ick self-sufficiency in the output
of drugs with a view to reduce the quantum of
imports;
(iv)
To fester and encourage the growth of the Indian
sector;
(v)
To ensure that the drugs are available in abundance
in the country to meet the health needs of our people;
(vi)
To make drugs available at reasonable prices;
(viij To keep a careful watch on the quality of production
and prevent adulteration and mal-practices;
(viii) To offer special incentives to- firms which are
engaged it, Research and Development; and
(ix) To provide other parameters to control, regulate
and rejuvenate this industry as a whole, with parti
cular reference to containing and channelizing the
activity of foreign companies in accord with national
objectives and priorities.
The new drug policy aims at promoting the Indian Drug
Industry. At first the Hathi Committee also recommended that the
Multinationals should be taken up by Government, however, since this
was a drastic change, this view was not adopted.
If nationalisation
takes place Government would also take over Indian companies above
a certain size.
Certain stringencies were, however, laid down with
regard to foreign companies like Small Scale Sector will be a
prohibitec area, formulation licences for foreign companies will be
given only if they.are linked with the production of ohiah technology
bulk drugs from the basic stage.
Another important policy adopted was with regard to Brand
names.
Brand names shall be abolished in the first instance in
respect of the following five drugs ;- ■
. . .2
: 2 :
Analgin
Aspirin
Chlorpromazine
Ferrous sulphate
Piperazine and its salts such as
adipate, citrate and phosphate.
All single ingredient dosage form of the above drugs shall
be marketed only under generic names,
Drugs which are to be
exported will be allowed to bear brand names.
The Hathi Committee also recommended the use of medicinal
plants.
Thus in the order of importance, the Hathi Committee had
identified 14 plants having medicicinal value, out of which 8,
namely dioscorea species, cinchona, poppy, ergot, digitalis,
ipecac, dubesia (or atropa'), and lemon grass are the sources for
essential drugs identified by this Committee.
The Hathi Committee
had endorsed the recommendations of the NCST for increased culti
vations of the 14 plant materials and also production of active
principles obtainable therefrom with updated technology.
Recommended reading
Chemical and Medical formulary of India 1980
(Page 1J
MINISTRY OF HEALTH AND FAMILY
WELFARE
NOTIFICATION
New Delhi, the 23rd. July, '83G.S.R.578(e) •* Whereas the Central Government is satisfied
that the use of the drugs specified in the Table below is likely to
involve risk to human beings or the said drugs do not have the
therapeutic value claimed or purported to be claimed for them or contain
ingredients and in such quantity for which there is no therapeutic
justification and it is necessary and expedient in the public interest
so to do:
Now, therefore, in exercise of powers conferred by section
26 A of the Drugs and Cosmetics Act, 1940 ( 23 of 1940 ), the Central
Government hereby prohibits the manufacture and sale of the said drugs
namely:
TABLE
1.
Amidopyrine
2.
Fixed dose combinations of Vitamins with anti-inflamatory agents
and tranquillisers.
3-
Fixed dose combinations of Atropine in Analgesies and Antipyretics
4-
Fixed dose combinations of Streychnine and Caffeine in tonics.
5.
Fixed dose combinations of Yohimbine and Strychnine with
Testosterone and Vitamins.
6.
Fixed dose combinations of Iron with Streychnine, Arsanic and
Yohimbine..
7-
Fixed dose combinations of Sodium Bromide Chloral hydrate with
other drugs.
8.
Phenecat in
9«
Fixed dose combinations of anti-histaminics with anti-diarrhoeals.
10.
Fixed dose combinations of Penicillin with Sulphonamides.
11.
Fixed dose combinations of Vitamins with Analgesics.
12.
Fixed dose combinations of Tetracycline with Vitamin C.
13.
Fixed dose combinations of Hydroxyquinoline group of drugs
except preparations which are used for the treatment of
diarrhoea and dysentery and for external use only.
*
14
Fixed dose combinations of Steroids for internal use except
combination of Steroids with other drugs for the treatment
of Asthma.
15.
Fixed dose combinations of Chloramphenicol for internal
use except combination of Chloramphanicol and Streptomycin.
16.
Fixed dose combinations of Ergot.
17.
Fixed dose combinations of Vitamins with anti T.B. drugs
except combination of I soniazide with Pyridoxine Hydrochloride
(Vitamin B 6 )
18.
Pencillin skin/eye ointment.
19.
Tetracycline liquid oral prepatations.
20.
Nialamide.
21.
Practolol
22.
Methapyrilene, its salts.
(
101 4/l/83-IMS & PPA )
S.V. SUBRAMANIYAN, Jt.Secy.
A t2_z_2f_Prot|lem_Drugs
(A check list of hazardous, banned, bannable and dumped drugs in India.)
A
=
Analgin - is a potentially toxic drug and may cause
agranulocytosis. Fixed dose combinations (FDC)
eS- any other category of drug in oral dosage form
are considered harmful.
Amidopyrin - was used as an analgesic anti-inflammatory agent
' “for over 7 years.
It has now been found to increase the risk of
agranulocytosis and in large doses to be associated
with renal tabular necrosis (Banned July 1983).
Ancoloxin - a widely used anti-nausea drug which is reported
’
to have teratogenic potential and hence is a hazard to
pregnant women. Sold in India without warning.
Anabolic steroids - Synthetic derivatives of male sex hormone
which have an androgenic and anabolic (body building)
effect. It is chiefly indicated for tr atment of
senile and post-menopausal bone disorders and a^plastic
anemia. In India it is advised for malnutrition, appetite
stimulant and for increasing growth. All these are foolish
especially in the light of irreversible harm it can have
on children's growth and sexual development. After much
publicity of these side effects, CIBA Geigy has withdrawn
p-'i/'iar a. fla-n a
Dianabol,one of the commonest^; Many more preparations
continue to be marketed in India.
B
=
Bromides - On prolonged administration, they replace chloride
ions in the body, cumulative poisoning manifests
as conjunctivitis, gastro-intestinal symptoms,
dermatitis and mental disturbances. It was a commonly
used hypnotic of low potency but unreliable (Banned
9
2
in July 1983).
C
=
Chloral Hydrate - used as a hypnoti c.y hasj( found to be an
irritant of the gastric mucosa causing nausea,
vomiting, flatulence and epigastric distress.
It can also cause hepatic or renal damage. It
should no longer be used as a hypnotic (Banned
July
in fczr? 1983) .
Clioguinol -• or hydroxyquinolines have been popularly used
wk-. ■-
for prophylaxis and treament of gastro-enteritis
amoebiasis and traveller's diarrhoea. Ever since
the report of its association with SMON (subacute
myelo-optic neuropathy) its use has been restricted
or banned in many countries. In India they are
supposed to be prescription drugs but are obtainable
over the counter. A warning in English (small print)
does occur on the product but it hardly succeeds
in warning consumers.
D = Dipyrone -
is the sodium sulphonate of amidopyrines having
similar properties and adverse effects particularly
fatal agranulocytosis. The incidence and risk of this
hazard far outweighs any benefit that can be derived
from its use.
E
=
£
>P Forte - these are high dose estrogen-progesterone
combinations which are dangerous for use in pregnant
women because of the associied/fetal malforrn .tion.
In spite of the banning of production and sales of
these drugs by the drug controller in March/June 1983
these continue to be misused for hormonal pregnancy
3
3
tests and for induction of abortion.
Enzymes - A very wide range of enzymes preparations are available
in India as digestives and for specific conditions.
Though by themselves they are not harmful, their
production in large amounts along with tonics, vitamins
and health restoratives are an indication of our
irrational drug policy at the cost of larger social
needs. 'lhese ere mostly consumed by the relatively
well-fed urban population.
Ergot -
is an alkaloid effective in the treatment of migraine.
However fixed dose combinations with drugs like
paracetamol, prochlorperazine etc,, have no therapeutic
advantage and hence are irrational (FDCs of ergot are
banned in July 1983).
F = FDC or Fixed Drug Combinations: These are formulations where two
or more drugs are combined for the following reasons:
a)
synergistic action; b) corrective action;
c) two or more drugs normally prescribed together aril taken
by patient simultaneously; d) when dosage of each drug
need not be individualised; e) where combination ensure
better patient compliance due to convenience of
administration. Conversely FDCs are irrational and should
not be permitted if (a) adverse interactions occur; (b)
when one of the combined drugs becomes toxic on prolonged use
(c)
when abrupt withdrawal of one causes withdrawal symptoms;
(d)
if sub-therapeutic ■MMB doses are used in the
absence of clinically demonstrable synergism;
4
(e)
when pharmacokinetic behaviour of individual
agents is different. (22 FDCs were banned in July-
1983 - refer Government order).
G - Gripe Water - These are popular preparations promoted for
colic in children. Contain alcohol and sodium bicarbonate.
Chronic use of the latter can cause milk-alkali syndrome.
Uncomfortable but rarely dangerous gastric distension can
also occur. Despite toxicity and side effects gripe water
does a thriving business through medical and consumer
ignorance (Banned in Bangladesh in June 1982).
H = Hydroxyquinolines or halogenated oxyguinoline derivatives
which include iodochlor-hydroxyquinoline, proxyquinoline,
halquinol, diiodohydroxyquinoline, chlorquinaldol,
chiniofon). For hazard see Clioquinol.
Hormonal Pregnancy Tests - Oestrogen-progesterone combinations
have been indiscriminately used in pregnant women
as a hormonal test to detect pregnancy. (See EP Forte)
Since there is an increased risk of foetal abnormalities
and the test is false positive in one out of five women
these tests should not longer be done.^Drugs controller
had • issued a directive to strengthen warning on packages
(March 1982) and banned manufacture(Dec 1982) and sale
(June 1983). Due to legal controversy, and professional
and consumer ignorance it still continues to be used.
I = Injections - have played a very important role in the modern
medicine and form one of its most distinctive features.
5
5
However, it has also lent itself to a very large degree of
misuse-overuse because of the mystique associated with it
in the minds of the public and the temptation of the medical
practitioners to pander to this need and pressure si their own
economic gain,
J = Junk Drugs - these are newer formulations in the market whose only
additional values are cosmetic embellishments, added flavours,
elegant packing, irrational combinations - all of which help
to increase its cost.
K = Kaolin - is hydrated and purified aluminium silicate, a common
addition in antidiarrhoeal mixtures. Along with pectin and bismuth
salts it forms a group called adsorbents, astringents and binding
agents. These drugs may cause loss of electrolytes by preventing
absorption through gastrointestinal tracts. If at all, they are
of cosmetic value and may actually mask the severity of disease.
L - Lomotil or diphenoxylate and Loperamide are drugs whose risks of
treatment outvB.gh their benefits especially in children. They
arc commonly used in diarrhoeas and the dangers of paralytic
ileus leading to inaccurate assessment of fluid loss and toxaemia
if associated with gut infections make them especially dangerous
in pediatric practice. The use for children under six has been
banned in India. In most other countries its use is banned
altogether,
M = Methapyrilene and its salts (Banned in July 1983).
N = Nialamide or Niamid - a MAO inhibitor used in the treatment of
depressive disorders (Banned in July 1983)
6
0 = OTC drugs or over the counter drugs. These are drugs that are
available to consumers without prescription and are mainly
painkillers, anti-cold, anti-cough preparations, cough
mixtures, tonics, food substitutes and protein powders. Many
The-y
of them ar- costly compared to the benefits they render,,/have
some ingredients which are unnecessary or useless but helping
to push up cost, awd are widely advertised with false claims
to push up s les. Their scientific scrutiny is a need as
also a systematic campaign against their irrational
ingredients or claims.
Oxyphenbutazone - these are a group of non-steroidal antiinflammatory
drugs which also have mild antipyretic and analgesic
properties . The dangers associated with use are bone
marrow toxicity and liver toxicity. They are widely used
/overused/misused group of drugs and there is great need
for building professional awareness and consumer alert
on this group of drugs. Recently these drugs have been
banned in the U.K.
P = Phenacetin - was a commonly used analgesic/antipyretic agent
which has been reported to cause kidney damage and
failure and hemolytic anemia. Hence fixed dose combinations
containing it are now considered outdated and hazardous.
Thes^iave been recommended for weeding out by the Hathi
Committee.
Phenylbutazones - another group of non-steroidal antiinflammatory
drugs which give only symptomatic relief and in no way
alter the course of the illness. Its main indications
7
are for ankylosing spondylitis and rheumatoid and
gouty arthritis though they are being widely promoted
and used for non-rheumatic disorders and aches, pains
and fever. Bone marrow toxicity is a real danger with
the use of this drug and hence its use should be
severely restricted. Its present availability—freely
over the counter-should be drastically controlled and
its deadly combinations with .amidopyrin, analgin,
paracetamol, diazepam, vitamin B, dextrapropoxyphene
acetaminophen should be banned or adequate warnings
in labels instituted.
Practolol (Banned in July 1983).
Penicillin - Still an important constitutent of antibacterial
therapy in spite of the risk of anaphylactic reaction
and allergic reactions. (Its combination with
sulphonamides and its preparations as skin/eye ointments
are banned from July 1983).
Q = Quinine - was the sheet i anchor of anti-malarial treatment
till safer 4 aminoquinolines and 8 aminoquinolines
were developed. Its use leads to black water fever
,r
so^is restricted now-a-days for treatment of
chloroquin resistant cases or sometimes in cerebral malar-'
R - Rational Drug Therapy - is the art/science of prescribing the
best suited drugs to individuals who need them taking
and not to those who merely want them. Its takes
into account factors like efficiency, safety (low
8
incidence of side effects), cost and ease of administration
It scruplously avoids extravagant prescribing over or
under prescribing, multiple prescribing or incorrect
prescribing.
S
= Sulphonamides - These have an important role to play in the
therapy of inf ctions. The combination with penicillins
is undesirable because of the antagonism of antibacterial
effect when bacteriostatic and bacteriocidal drugs are
given together. (FDCs of sulphonamides and penicillins
are banned since July 1983).
Streptomycin - Since it is one of the most effective drugs
in anti-tb treatment its use should be limited to
TB treatment and mixed infections of the gut. Its
combination with penicillins is undesirable since its
use in small doses promotes development of resistance.
Steroids - one of the most misused drugs in general practice
because of acute onset of beneficial effects. Patients
are exposed to a wide range of toxic cumulative effects
and adrenal insufficiency due to adrenal suppression.
Its a life saving drug to be used in special circumstances.
Their doses should be adjusted to the minimum that can
produce the effects. Fixed dose combinations with other
drugs are therefore irrational and objectionable since
this individualization of the dose cennot be done. (FDCs
of steroid for internal use except for treatment of
asthma are banned since July 1983).
9
9
Strychnine - This was a drug formerly used as an appetiser.
Its use in tonics can induce convulsions particularly
in susceptible individuals. An absolete drug! (FDCs
of strychnine with caffeine, yohimbine, testosterone
and vitamins are banned since July 1983).
T = Tetracyclines - One of the most commonly misused/overused broad
spectrum antibiotic mistakenly thought to be free
of dangers. Reports of its ability to cause discolouration
of teeth, catabolic effect on protein synthesis,
diarrhoea, increased intracranial pressure o in children,
Fanconi syndrome (if outdated, degraded drug is used),
liver damage in pregnant women have put it in the
list of hazardous drugs. It should not be used in
paediatric practice and in pregnant mothers. Its
t>,
flz-r-m Po-r-
•==
manufacture; is supposed to be banned from January
1982.
Tonics - Apart from being an economic waste, most tonics in the
market contain alcohol which is the main appetite
stimulant and also vitamin and mineral constituents
in amounts greater than the physiological absorptive
capacities of average attracts. Their overuse thus
mainly help to vitamin!se our sewage systems!
U = Unani and Ayurvedic drugs - These are difficult to standardise
since official standardisation methods are not available
FDCs of these with allopathic drugs have no therapeutic
rationale or justification or’proven
1
efficacy.
10
10
(FDCs of ayurvedic and unani drugs with modern
drugs have been banned since July 1983).
V - Vitamins - a typically misused/overused group of agents
znuJ/f
especially as?combinations and tonics. They are
essential nw&KitionzA
tofe most people
get adequate amounts in a balanced diet. Specific an-'d
separate preparations are required for specific «£
deficiency states or as adjuncts to therapy, (Their
FDCs with analgesics, tetracyclines, anti-inflammatory
drugs, tranquillisers have no proven therapeutic effects
and have been banned since July 1983).
W = VJaterbury's is oneof the brand leaders in the tonic market
whose main effects if any ere because of the 9-10%
alcohol content. It contains insufficient amounts of iron
and creosates and guaicols whose role in man has not been
definitively established. Like incremin, phosphomin^CJc^
hemiphos their advertised claims for surpass their actual
chemical content. Advertisements of such tonics are the
most symbolic of high pressure, half truths gimmicry of
medical advertising.
X «=
Y = Yohimbine - a drug often combined with strychnine, vitamines,
testosterone, arsenic, iron and vitamins»/has been found to
penetrate the CNS and cause centra excitation including
rise of blood pressure, heart rate, hyperexcitability and
tremor (Its use especially in such combinations is banned
since July 1983).
Further Reading
1.
Banned Brand Drug List
2.
Hazardous Banned Bannable and Dumped Drugs
3.
Rationality in Banning Fixed Dose Combinations
4.
Some painful facts about a pain killer called Amidopyrine
5.
Why not to prescribe anabolic steroids?
6.
Irrational use- of antibiotics
7.
The clioquinol controversy
8.
Using tetracyclines for children and pregnant women
9.
Consumer Alert—Phenylbutazone and Oxyphenbutazone
10.
Scientific scrutiny of some over the counter drugs
11.
The case against EP Forte
12.
National Drug Policy guidelines and list of banned drugs
(Banghdesh)
E32 Available from Low Cost Drugs and Rational Therapeutic
Cell, Voluntary Health Association of India, C-14 Community
Centre, SDA, New Delhi 110016.
ICSA/CMS-I
Telephones;
Telegraphic Address :
Office:
Exi. Trustea Residence :
869143/869244/869545
33850
DIAKONEIA
COMPREHENSIVE MEDICAL SERVICES, INDIA (CMS-I)
A Public Charitable Trust promoted by ICSA and Constituted by a Regi stored Trust Deed under the Trust Law
Chairman, Trust Board
Executive Trustee :
93, PANTHEON ROAD.
Justice C, J. R. PAUL
Prof. D. YESUDHAS
EGMORE,
MADRAS - 600 008.
October 8,
1988
Jr. Bavi Narayan,
47/1
St. Mark’s iioad,
First Floor,
BANGALORE 560 001 .
Dear Jr, Ravi Narayan,
I iiave been very much impressed by your Article in the Health Action on
Essential Jrugs and the Indian conditions. I understand that we have to
go a long way in helping the Society and the Government accept the
philosophy of Essential Jrugs.
Nith this conviction we have started a Project to manufacture the Essential
Jrugs stipulated by IfHO.
Je have been able to procure all the Licences
required and a dozen products are ready at the moment.
tie will contintu.
manufactaring and within four weeks time we are expecting to have 24
produces
to be distributed to Charitable Hospitals and Voluntary
Health Agencies.
I am enclosing a write-up on the Project and the Price List. Kindly
introduce this wherever it is required as it is a cause for which
you are also working.
Thanking you.
fours Sincerely,
Encl: As stated above
Telephones:
r
)
Telegraphic Address :
ICSA / CMS-I Office:
Exi. Trustee Residence :
869143/863244/869545
33850
DIAKONEIA
COMPREHENSIVE MEDICAL SERVICES, INDIA (CMS-I)
A Public Charitable Trust promoted by ICSA and Constituted by a Registered Trust Deed under the Trust Law
Chairman. Trust Board
Executive Trustee .
Justice C. J. R. PAUL
Prof. D. YESUDHAS
93, PANTHEON ROAD,
EGMORE,
MADRAS - 600 008,
Essential
Drugs -For Effective Community Health
A Project Proposal
The Comprehensive
Medical Services,
India (CMS-I), has proposed
to manufacture selected Life-saving and Essential drugs out of the WHO
List of Essential Drugs which the Hathi Commission has also identified
as the basic drugs required for medi—care in
our country.
The Drugs
produced will
be made
available to
Voluntary Health
Works at cost
price and thus kept
much
lower
than
the ■ price
prevail .ing
in the
market.
tij The Background
This
decision
is
the
out-come
of a series of discussions with the
Medical Community.
The
Inter-Church Service
Association (ICSA) has
been
providing
a
Forum
for
Medical
Practitioners
and
HealthProfessionals involved in Voluntary Health Work in the
city and rural
areas to
come together
periodically for fellowship and discussion of
matters of common interest.
One of the
concerns that
emerged out of
the discussions
was that
of the
spurious and sub-standard nature of
some of the common drugs in the market and the
ever spiralling prices
of Essential and Life-Saving Drugs which keep them out of the reach of
the Poor.
§ CMS-I - Essential Drug® Project
Against this background the need arose to initiate a Voluntary Medical
Service which
will have
as one
of its main Objects, the manufacture
and distribution
of Essential
Life Saving
Drugs which
are in short
supply, or whose market-cost is prohibitive. The Comprehensive Medical
Services, India (CMS-I) is promoted as a Public
Charitable Trust with
the exclusive
Object of
providing a low-cost health delivery system,
with emphasis on Preventive and Promotive
aspects of
health, and the
manufacture and supply of Essential Drugs for Voluntary Health Work.
The First Project of CMS-I will
Essential Drugs.
§ Th
*
be the manufacture and distribution of
Philosophy
The Philosophy of the Project is
making available
low-cost, without compromising on the quality.
Essential
Drugs at
g Ths Target Group
The
Target
Group
Health-Care.
is
the
Weaker Section who cannot afford adequate
All
I.P.,
B.P.
and
U.S.P.
Drugs will be manufactured and marketed
under 'Generic names' to effect saving
on 'Brand
names'. Formulation
and combination
drugs are avoided as far as possible.
But where they
are absolutely necessary, self-evident
names which
are suggestive of
such simple combinations have been coined. Eg. Hemo-feron for Iron and
Vitamin.
A concerted effort is made
to
cut
down
avoidable
expenses on
extravagant
packing
materials,
trimmings and decoration by settling
for
the
most
cost-effective,
purpose-serving
protective
packing
materials.
A
further
effort
in
this
direction
is sought to be
achieved
by
distributing
the
drugs
in
Hospital-Packs,
Strips in
Cardboard Cartons and Loose in Plastic Containers.
Drugs will
be marked
with the label name, CMS-I Essential Drugs
Project, and shall
be
made
available
at
this
stage
to Voluntary
Hospitals and
Health Agencies
involved in Community Health to enable
them to bring down the cost of patient-care which is
on the increase,
mainly on account of escalating cost of commonly used drugs.
We shall
supply the products at our Cost-price.
The recommended
Retail Price is indicated in the Label .
El Project lmp?em®nftatien
The Essential Drugs Project
has
started
functioning
in
the leased
premises
of
a
fully
equipped Pharmaceutical Production Centre in a
Pharmaceutical
Industrial
Complex
promoted
by
the
Government
of
Tamilnadu at
Alathur, in
Chinglepet District, about 25 kms away from
the city.
To ensure quality at its best, the factory is wel1-equipped
with
a
modern
analytical
Laboratory with all the latest equipments
capable of analysing and assessing all
our products
and ensuring the
standards
specified
by
the
Indian,
British,
and
the
U.S.
Pharmacopoeias.
This venture will be our contribution to the Nation in its effort
to provide adequate health care for all its citizens by the year 2000.
We trust
our products
will receive the patronage of all welfare
agencies involved in community health.
Thanking you.
Respectfully submitted,
D. YESUDHAS
Execut ive Trustee-Di rector
CMS-I
COMPREHENSIVE MEDICAL SERVICES , INDIA
ESSENTIAL DRUGS PROJECT
93, Pantheon Road, Egmore, Madras 600 008.
PRICE LIST
15.9.88
Strength
500
1000
1000
Cap'S
caps
tabs
1000
1000
tabs
cape
60 .00
260.00
mg
mg
100
250
caps
caps
185 .00
Chinroquine Phosphate
Co-Tri moxazol e
mg
S aS
D «S
1000
1000
500
tabs
tabs
tabs
lapsone
.»
mg
mg
mg
1000
1000
1000
tabs
tabs
■cabs
100
400
800
40
Fi
mg
mc
mg
mg
mg
1000
1000
500
1000
1000
1000
tabs
tabs
tabs
tabs
' tabs
cans
mg
mg
mg
mg
mg
mg
mg
tabs
1000
1000
tabs
tabs
1000
tabs
1000
cabs
600
tabs
1000
tabs
1000
14.,00 gm
sachet
1000
t ab s
tabs
1000
tabs
1000
tabs
615.00
500
tabs
920 .00
500
tabs
82.00
1000
tabs
415.00
1000
Ampici11 in
250
Antacid Tablets
Comoosit 1 on :
Al urnini urn Hydrnxide
250
Magnesium Trisilicate
250
Symeth i con
50
Ascorbic Acid
100
3 Complex c Vit C caps
Cannasi t i on;
Bl-lOmg,B2-10mg ,B6-3mg ,
Niacinamide 50mg,
Vitamin C-150mg,Calcium D
Pantothenate 12.5mg,
Fol ic acid Img , B12—5mcg
Cep h a 1 ex in
250
Diazepam
Diethyl Carbamaz ine
Citrate
Ethambutol
H
Fursemifde
G1 ibenclamide
Hemoferon Capsul<
Comaosit ion;
Ferrous Fumarate 350 mg ,
Vit—C 150' mg,B12--15mcg,
FolicAc id 1 ,5mg
200
Ibuprofen
!«
400
200
Matronidaznle
’1
400
. i J()
Mebendazole
r_Nifedipine
H
10
□ r a 1 R e h y d r a t i c n sal t
Paracetamol
Propranol ol
Rifampicin
Salbutamol
Tetracycl ine
M B.
Packi ng
Cost - r'rice
Loose_____ Strip
420.00
835.00
55.00
95.00
Product
mg
mg
mg
mg
mg
mg
mg
mg
mg
mg
mg
mg
mg
See averleaf for Terms and Conditions of
315.00
(Blister)
480 .00
(Blistar)
360.00
365 .00
(Blister)
38.00
60.00
38 .00
60 .00
82.00
120 .00
110.00
287 .00
(Blister)
170.00
282 .00
96.00
95 .00
80 .00
130 .00
120.00
Supply of Drugs.
Terms ana Conditions for supply of Drugs
Supplies are confined to Christian Hospitals and Voluntary Health
Agencies involved in Community-Health.
2.
Prices mentioned in the
List
are
our Cost-Price/Sel 1 ing-F'r ice.
The
recommended
Retail
Price
(adding
a
10%
margin
for
hand’ing/dispensing) is given in the label .
3.
The
Price
List
is
subject
to
revision
depending
on
the
fluctuation in the purchase—price of Raw Materials.
Supplies
will
be
made
at
the rates prevailing at the time of
C E? s p S C Cf3 a
Terms of payment
shall
be
either
Draft,
drawn
in
favour
of
the
consignment.
by
Cheque
CMS—I,
on
(Local lor Demand
receipt
of
the
Consignments will be despatched by Lorry/Rail
Parcel Service and
Lorry/Rail
Freight-Charges
will
be
borne
by
the
consignor.
Charges on despatch by
Post-parcel , if
ordered, should entirely
be borne by the consignee.
Soods are
to be
checked on
receipt , and discrepancy if any, be
informed immediately, for rectificat ion.
Sales Tax will be
charged as
per Rules
Central and State Governments.
'and Regulations
of the
As per
Drug Rules,
Orders for Drugs should have the Name of the
Doctor on the Lette.—Head, or his Signature at the bottom
of the
Order .
Products are guaranteed for their quality, and the quality of the
raw materials used.
Copies of
Quality Control
Certificate for
any E<atch will be made available on request, specifying the Batch
number.
10.
While ordering Drugs please
a)the mode
indicate;
payment;
blthe mode of transport and the
nearest Rail
Station or Lorry
Office as the case may be.
Director
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Hone We£-‘
Supplement to Special Issue of
the Medical Service on
"Towards a People Oriented Drug Policy"
Widening Horizons—on Drug Issues
A. Books
1,
1982, Rs. 10.00 from : medico friend
circle office, 326, 5th Main, I Block
Koramangala,
Bangalore 560034
Raises relevant
issues regarding
peoples health. Questions why
is there a lack of political will
to solve pressing health problems
of the country. How detrimental is^s
the alliance between medical profe™ '
ssionals and the drug industry to
people's health.
Hathi Committee : Report of the Com
mittee on the Drugs and Pharmaceu
tical industry. Ministry of Petroleum
and Chemicals, Govt of India, April
1975, Rs. 17.00.
The essential drug list suggested
here could provide the foundat
ion for a demand for a Rational
National Drug Policy.
2.
2
Health for All—an Alternative Strat
egy. ICSSR & ICMR, 1981, Rs. 18.00
Available from VHAI. In focussing
on a comprehensive national policy
of health and a new operational
strategy, the report is intended to be
a basic document to initiate a nation
wide debate on the subject as well
as positive action towards certain
radical changes to correct the present
imbalances in our health caresystem.
Has a very comprehensive chapter
on drugs and pharmaceuticals.
3.
Aspects of the Drug Industry in
India. Mukarram Bhagat, Feb 1982,
Rs. 19.00 From Centre for Education
and Documentation (CED), 3, Sule
man Chambers, Battery Street, Bom
bay.
4.
Insult or Injury. Charles Medawar,
1980, Rs. 18.00, 139 "p. Social
Audit,
England. Available
from:
Indian social Institute, Lodi Road,
New
Delhi
110003. Highlights
marketing and sales of British drugs
and food products, illustrated easy
reading.
5.
Health Care Which Way to Go
Medico Friend Circle Anthology II,
6.
Under the lens: health and medicine.
Ill Anthology of medico friend circle
is due shortly and will be available
from VHA1 and mfc office (above).
7.
Kurji Holy Family Hospital: Formulary
and Therapeutic Guide. January
1983, Rs. 12.00. Available from
VHA1. It is the result of the accum
ulated experience of senior medical
staff of the hospital over the last 10
years. It gives a comprehensive
list of drugs to treat 98% of hospital
admissions- it also gives the generic
name, dosage, indications, contrain
dications and main side effects in the.A
same page. Information about com-”
parative cost of treatment is also
provided.
8.
Drugs and the Third World. Anil
Agarwal,
1978,
§5.00.
From
Earthascan, 10 Percy Street, London
Wl PO DR. A very comprehensive
overview of the drug situation in
the third world and the problems
and causes.
9.
Prescription for change. Health Action
Internationals guide to rational health
projects, Virginia Beardshaw, Novem-
Medical Service
ber 1983, 85pp USS 10.00 from
Health Action International Clearing
House PO Box 1045, Penang, Mal
aysia. Gives more than 40 ideas for
action research projects on drugs:
—a summary of the main elements of
the rational health issues and sugg
estions about how to campaign
on it;
—advice on how to talk to drug
companies and the powers that be
—a reference section that lists the
main materials you need to rese
arch on drugs.
dation. Available from VHAI. An
excellent guideline for rational thera
peutics, giving special emphasis on
drug cost as criteria for choice of
drug diagramatico format.
12.
Management schedules for dispensa
ries: A manual for rural health workers.
Peter Petit, 1983, Rs. 35.00. African
Medical and Research Foundation.
Available from VHAI.
13.
44 problem drugs: a consumer action
and resources kit on pharmaceu
ticals. I0CU, May 1981. Available
from HA1 Clearing House (see 9)
Gives information about 44 problem
drugs, along with articles by some of
the leading drug compaigners.
Pill-fering the poor: Drugs and the
third world. An information/action
pack on drugs and the third world from
14.
A number of interesting papers to
Interfaith Center on Corporate Res
keep you upto date about the drug
ponsibility, International Health Pro
issue is available from'LowCost Drugs
gramme, 475 Riverside Drive, Room
and Therapeutics Cell, VHAI, C-14,
566, New York, NY 10115. USS.
Community Centre, Safdarjung Deve
4.00 plus postage surface mail S2.70/
lopment Area, New Delhi 110016.
air mail S/4.70. It provides an over
(write to them for a list)
view of the problems related to drug
marketing in the third world, it cont
B. Periodicals
ains articles on the need for essen
1.
Pune Journal of Continuing Health
tial drugs, on the suffering wrought
Education. Presents scientific infor
overseas by some US made drugs
mation and opinion on drugs and
and on the high price the third world
health issues to stimulate thought
poor have to pay for their medicin
and further investigation. Annual
es. This package includes an exte
subscription Rs. 10.00 or a five year
nsive annotated bibliography, basic
subscription for Rs. 45.00 from
facts and figures about the transna
Arogya Dakshata Mandal, 1913,
tional drugs industry and an outline
Sadashiv Peth, Pune 411030.
of suggestions for action on how you
can get more involved in helping to
2.
Drug Bulletin
stop abuses.
An
informative monthly
giving
unbiased technical information on
11.
Therapeutic guidelines: A manual to
drugs
and
therapeutics.
Annual
assist in the rational purchase and
subscription Rs. 10.00 from Dr. V S
prescription of drugs. Upunda, YudMathur, Professor, Department of
kin et al 1981, pp. 166, Rs. 35.00
Pharmacology and Editor, Drugs
African Medical and Research Foun
10.
October-November 1984 (Suppl)
3
Widening Horizons—on Drug Issues
A. Books
1.
1982, Rs. 10.00 from : medico friend
circle office, 326, 5th Main, I Block
Koramangala,
Bangalore 560034
Raises relevant
issues regarding
peoples health. Questions why
is there a lack of political will
to solve pressing health problems
of the country. How detrimental is^
the alliance between medical profe-V '
ssionals and the drug industry to
people's health.
Hathi Committee : Report of the Com
mittee on the Drugs and Pharmaceu
tical industry. Ministry of Petroleum
and Chemicals, Govt of India, April
1975, Rs. 17.00.
The essential drug list suggested
here could provide the foundat
ion for a demand for a Rational
National Drug Policy.
2.
2
Health for All—an Alternative Strat
egy. ICSSR & ICMR, 1981, Rs. 18.00
Available from VHAI. In focussing
on a comprehensive national policy
of health and a new operational
strategy, the report is intended to be
a basic document to initiate a nation
wide debate on the subject as well
as positive action towards certain
radical changes to correct the present
imbalances in our health caresystem.
Has a very comprehensive chapter
on drugs and pharmaceuticals.
3.
Aspects of the Drug Industry in
India. Mukarram Bhagat, Feb 1982,
Rs. 19.00 From Centre for Education
and Documentation (CED), 3, Sule
man Chambers, Battery Street, Bom
bay.
4.
Insult or Injury. Charles Medawar,
1980, Rs. 18.00, 139 'p. Social
Audit,
England. Available
from:
Indian social Institute, Lodi Road,
New
Delhi
110003. Highlights
marketing and sales of British drugs
and food products. Illustrated easy
reading.
5.
Health Care Which Way to Go
Medico Friend Circle Anthology II,
6.
Under the lens: health and medicine.
Ill Anthology of medico friend circle
is due shortly and will be available
from VHA1 and mfc office (above).
7.
Kurji Holy Family Hospital: Formulary
and Therapeutic Guide. January
1983, Rs. 12.00. Available from
VHA1. It is the result of the accum
ulated experience of senior medical
staff of the hospital over the last 10
years. It gives a comprehensive
list of drugs to treat 98% of hospital
admissions- it also gives the generic
name, dosage, indications, contrain
dications and main side effects in theA
same page. Information about com
parative cost of treatment is also
provided.
8.
Drugs and the Third World. Anil
Agarwal,
1978,
§5.00.
From
Earthascan, 10 Percy Street, London
Wl PO DR. A very comprehensive
overview of the drug situation in
the third world and the problems
and causes.
9.
Prescription for change. Health Action
Internationals guide to rational health
projects, Virginia Beardshaw, Novem-
Medical Service
ber 1983, 85pp USS 10.00 from
Health Action International Clearing
House. PO Box 1045, Penang, Mal
aysia. Gives more than 40 ideas for
action research projects on drugs:
—a summary of the main elements of
the rational health issues and sugg
estions about how to campaign
on it;
—advice on how to talk to drug
companies and the powers that be
—a reference section that lists the
main materials you need to rese
arch on drugs.
10.
dation. Available from VHAI. An
excellent guideline for rational thera
peutics, giving special emphasis on
drug cost as criteria for choice of
drug diagramatico format.
12.
Management schedules for dispensa
ries: A manual for rural health workers.
Peter Petit, 1983, Rs. 35.00. African
Medical and Research Foundation.
Available from VHAI.
13.
44 problem drugs: a consumer action
and resources kit on pharmaceu
ticals. I0CU, May 1981. Available
from HA1 Clearing House (see 9)
Gives information about 44 problem
drugs, along with articles by some of
the leading drug compaigners.
Pill-fering the poor: Drugs and the
third world. An information/action
pack on drugs and the third world from
14.
A number of interesting papers to
Interfaith Center on Corporate Res
keep you upto date about the drug
ponsibility, International Health Pro
issue is available from'LowCost Drugs
gramme, 475 Riverside Drive, Room
and Therapeutics Cell, VHAI, C-14,
566, New York, NY 10115. USS.
Community Centre, Safdarjung Deve
4.00 plus postage surface mail 82.70/
lopment Area, New Delhi 110016.
air mail S/4.70. It provides an over
(write to them for a list)
view of the problems related to drug
marketing in the third world, it cont
B. Periodicals
ains articles on the need for essen
1. Pune Journal of Continuing Health
tial drugs, on the suffering wrought
Education. Presents scientific infor
overseas by some US made drugs
mation and opinion on drugs and
and on the high price the third world
health issues to stimulate thought
poor have to pay for their medicin
and further investigation. Annual
es. This package includes an exte
subscription
Rs. 10.00 or a five year
nsive annotated bibliography, basic
subscription for Rs. 45.00 from
facts and figures about the transna
Arogya Dakshata Mandal, 1913,
tional drugs industry and an outline
Sadashiv Peth, Pune 411030.
of suggestions for action on how you
can get more involved in helping to
2. Drug Bulletin
stop abuses.
An
informative monthly
giving
unbiased technical information on
11. Therapeutic guidelines: A manual to
drugs and therapeutics.
Annual
assist in the rational purchase and
subscription Rs. 10.00 from Dr. V S
prescription of drugs. Upunda, YudMathur,
Professor,
Department
of
kin et al 1981, pp. 166, Rs. 35.00
Pharmacology and Editor, Drugs
African Medical and Research Foun
October-November 1984 (Suppl)
3
ches, 150 route de Ferney, 1211
Geneva 20, Switzerland or VHAI,
New Delhi.
Bulletin, PGI of Medical Education
and Research, Chandigarh 160012.
3.
Medico friend circle bulletin.
A monthly which discusses issues
regarding health problems, the health
care system, medical education, drug
issues etc., from the point of view of
relevance to the needs of the majority
in our country. Annual subscription
Rs. 15.00. Write to Convenor, medico
friend circle, 326, V Main I Block,
Koramangala, Bangalore 560034.
4.
1.
4
HAI News
A very informative bimonthly of the
Health Action International (HAI),
covering world drug news of special
relevance for the third world. Hai
is an informal network of health
consumer and development oriented
associations and professionals con
cerned with health and pharmaceuti
cal issues, particularly those that
adversely affect the poor. Annual
subscription: USS 10.00 from HAI
Clearinghouse, regional office for
Asia and the Pacific, International
Organization of Consumer Unions
(IOCU), PO Box 1045,
Penang.
Malaysia. A number of journals have
brought out special issues on drugs.
These may be available on request
for back issues.
Contact : from Christian
Medical
Commission, World Council of Chur
2.
3.
a.
August 1981 No. 63 : 'Getting
Essential Drugs to the People
with a model list of essential
drugs.
b.
June 1983, No. 73 :-Strengthe
ning and regulating the supply,
distribution and production of.
basic pharmaceutical products'.
Health
for the
Millions. From
Publications Department, Voluntary
Health Association of India, C-14,
Community Centre, SDA, New Delhi
11 0016.
a.
Medicines as if people matteredApril-June 1981
b.
Special Issues on diarrhoea and
tuberculosis
The Journal of the Christian Medical
Association of India.
From : The CMAI Office, Christian
Council Lodge, Nagpur 1,
Maharashtra.
Sept 1983, Vol LX, No. 9, Drugs-Fact,
fallacy and fraud.
4.
World Health : The magazine of the
World Health Organization, Avenue
Appia, 1211 Geneva 27, Switzerland.
July 1984, Essential drugs for the
World.
Medical Service
So many different brands of clioquinol recommended
for the prevention or treatment of non-specific
diarrhoeas. How does a doctor choose between them?
A brand of clioquinol from an unknown local firm?
Or Mexaform or Entero-Vioform - world leading brands
from a trusted Swiss name, CIBA?
-The choice is immaterial. This is because all
brands have this in common: In the treatment of non
specific diarrhoeas, their benefits have not been
proven. Their dangers clearly have.
Whatever the brand - with clioquinol there is no
choice. Thank you for not .prescribing it.
Yours faithfully,
SO WHY AREN'T THERE MORE
DEAR DOCTOR LETTERS
IIIJETUICO
I
a I L Sw
.
■
“ :
This ‘Dear Doctor’ leaflet
puts patients first. It was prepared and is published by
Social Audit and friends.
’ ,_________ ._____
. _____________ __
Oral dehydration - which method
is most appropriate ?
Diarrhea is one of the main causes of
death in small children. However, most of
these children actually die from dehydra
tion—the loss of too much water. It is
generally agreed that the most important
way to manage diarrhea is to replace the
liquid that the child is losing. But there
is less agreement about how to do this.
A few years ago, most doctors treated
even mild dehydration by giving intravenous
(I.V.) solution. But this was expensive, and
many children died in diarrhea epidemics
because there was not enough I.V. solution,
or not enough skilled workers to give it.
* The baking soda prevents 'acid blood',
a condition that causes fast, heavy
breathing and shock.
* The potassium helps keep the child
alert and willing the drink and eat.
2* o«fll
Gt ps
H For
T/o
Today, most health planners recognize
that oral rehydration—or giving liquid by
mouth—is the best way to manage most
cases of diarrhea and dehydration. Even in
clinics, where I.V. solution is available, it
usually makes more sense to replace liquids
by mouth. This way parents learn how to
prepare and give liquids so they can begin
treatment early, at home, the next time a
child gets diarrhea.
A Special Drink or Rehydration Drink
can be made from water mixed with small
amounts of sugar and salt. It is even better
if the drink contains a little baking soda
(bicarbonate of soda) and a mineral called
potassium—found in orange juice,- coconut
water, banana and other foods.
The salt in the special drink replaces
the salt lost through diarrhea, and
helps the child's body to keep liquid.
The sugar provides energy and also
helps the body absorb liquid more
quickly.
Courtesy—Health care which
wedtnlrtA0V\ab0Ut sugar salt-solution ? Since ages
cine for
ave ®arned money by selling if as med>anous diseases, though not for diarrhoea.
way to go MFC Anthology.
6
Medical Service
The amounts of sugar and salt in the
Special Drink do not have to be very exact.
In fact, there is great variation in the
amounts recommended by different experts.
However, too little sugar or salt does less
good, too much salt can be dangerous.
The Range of Rehydration Methods for
Children with Diarrhoea can
be
divided into two Broad Groups :
children never receive the liquid, or
are given it too late.
Group 'B'
1.
Homemade drink made with plastic
measuring spoons
2.
Homemade drink made with spoons
found in the home
3.
Homemade drink made with home
made spoons
4.
Homemade drink with salt and sugar
measured with the fingures or by
another traditional way
Group 'A'
®
1.
Intravenous solution (I.V.)
2.
3.
Factory prepared oral solution
Factory prepared packets of rehydra
tion salts for mixing in water
4.
Bags with salts, prepared at the
health centre for mixing in water.
Advantages and Disadvantages
1 )
— Control and responsibility mainly in
the hands of professionals, institu
tions, and drug companies
— Measurement
more
precise and
'controlled' (atleast in theory)
— More magical; acceptance may be
quicker but with less understanding
— More dependency—on high technol
ogy,
on
outside resources,
on
centralised services, and on local and
international politics
— More expensive
— Easier to gather data on, and prepare
statistics about
— Reaches fewer people; supply often
uncertain and inadequate
— Sometimes causes delay in treatment,
because special materials have to be
obtained; affect is more curative than
preventive
— Focus is on materials and supply (so
cost goes up each year)
— May give better (safer) results for
individuals treated in time, but has
worse results overall since many
October-November 1984 (Suppl)
Advantages and Disadvantages
— Control and responsibility mostly in
the hands of the family
— Measurements
'controlled'
less
precise,
less
— More practical and easier to under
stand
— More self-sufficiency;
uses
local
resources (whatever is available in the
home or in stores)
— Cheaper
— Harder to gather data on, and prepare
statistics about
— Reaches more people; supply is local
and almost always available
— Treatment can begin at the first sign
of diarrhea; more preventive than
curative.
— Focus is on people and on education,
so the people's capacity for self-care
increases over the years (cost goes
down)
— May be less safe in individual cases
due to the possibility of errors in pre
paring or giving it, but it probably
saves many more lives—since it
reaches more children more quickly.
— Helping Health Workers Learn
David Werner and Bill Bower
7
A to Z of Problem Drugs
(A check list of hazardous, banned, bannable and dumped drugs in India).
A = Analgin
Amidopyrin
is a potentially toxic drug and may cause agranulocytosis.
Fixed dose combinations (FDC) of any other category of drug
in oral dosage form are considered harmful.
was used as an analgesic anti-inflammatory agent for over 7
years.
It has now been found to increase the risk of agranulocytosis
and in large doses to be associated with renal tabular necrosis
(Banned July 1983).
Ancoloxin
a widely used anti-nausea drug which is reported to have
teratogenic potential and hence is a hazard to pregnant women.
Sold in India without warning.
Anabolic Steroids
Synthetic derivatives of male sex hormone which have an
androgenic and anabolic (body building) effect. It is chiefly
indicated for treatment of senile and post-menopausal bone
disorders and a plastic anemia. In India it is advised for
malnutrition, appetite stimulant and for increasing growth. All
these are foolish especially in the light of irreversible harm it
can have on children's growth and sexual development. After
much publicity of these side effects, CIBA Geigy has with
drawn Dianabol, one of the commonest. Many more prepara
tions continue to be marketed in India.
B = Bromides
On prolonged administration, they replace chloride ions in the
body, cumulative poisoning manifests as conjunctivitis, gastro
intestinal symptoms, dermatitis and mental disturbances. It
was a commonly used hypnotic of low potency but unreliable
(Banned in July 1983).
C = Chloral Hydrate
used as a hypnotic has found to be an irritant of the gastric
mucosa causing nausea, vomiting, flatulence and epigastric
distress. It can also cause hepatic or renal damage. It should
no longer be used as a hypnotic (Banned in July 1983).
Clioquinol
or hydroxyquinolines have been popularly used for prophylaxis
and treatment of gastro-enteritis amoebiasis and traveller's
diarrhoea. Ever since the report of its association with SMON
(subacute myelo-optic neuropathy) its use has been restricted
or banned m many countries. In India they are supposed to
be prescription drugs but are obtainable over the country A
8
Medical Service
warning in English small print does occur on the product but
it hardly succeeds in warning consumers.
D = Dipyrone
is the sodium sulphonate of amidopyrines having similar pro
perties and adverse effects particularly fatal agranulocytosis.
The incidence and risk of this hazard far outweighs any benefit
that can be derived from its use.
E = DP Forte
these are high dose estrogen-progesterone combinations which
are dangerous for use in pregnant women because of the associted fetal malformation. In spite of the banning of produc
tion and sales of these drugs by the drug controller in March/
June 1983 these continue to be missued for hormonal
pregnancy tests and for induction of abortion.
,Q
o
Enzymes
A very wide range of enzymes preparations are available in
India as digestives and for specific conditions. Though by
themselves they are not harmful, their production in large
amounts along with tonics, vitamins and health restoratives are
an indication of our irrational drug policy at the cost of larger
social needs. These are mostly consumed by the relatively
well-fed urban population.
Ergot
is an alkaloid effective in the treatment of migraine. However
fixed dose combinations with drugs like paracetamol, pro
chlorperazine etc., have no therapeutic advantage and hence
are irrational (FDCs of ergot are banned in July 1 983).
F = FDC or Fixed
Drug Combinations
These are formulations where two or more drugs are combined
for the following reasons : (a) synergistic action; (b) corrective
action; (c) two or more drugs normally prescribed together
and taken by patient simultaneously; d) when dosage of each
drug need not be individualised; e) where combination ensure
better patient compliance due to convenience of administration.
Conversely FDCs are irrational and should not be permitted if
(a) adverse interactions occur; b) when one of the combined
drugs becomes toxic on prolonged use (c) when abrupt with
drawal of one causes withdrawal symptoms; (d) if sub-thera
peutic doses are used in the absence of clinically demonstrable
synergism; (e) when pharmacokinetic behaviour of individual
agents is different. (22 FDCs were banned in July 1983—refer
Government order).
G = Gripe Water
These are popular preparations promoted for colic in children.
Contain alcohol and sodium bicarbonate. Chronic use of the
latter can cause milk-alkali syndrome. Uncomfortable but
October-November 1984 (Sppl)
9
rarely dangerous gastric distension can also occur. Despite
toxicity and side effects gripe water does a thriving business
through medical and consumer ignorance (Banned in Bangla
desh in June 1982).
H= Hydroxyquinolines
Hormonal Pregnancy
Tests
or halogenated oxyguinoline derivatives which include iodochlo-hydroxyquinoline, proxyquinoline, halquinol, diodohydroxyquino ine, chlorquinaldol, chiniofon). For hazard see clioquinol.
Oestrogen-progesterone combinations have been indiscrimina
tely used in pregnant women as a hormonal test to detect
pregnancy. (See EP Forte) Since there is an increased risk of
foetal abnormalities and the test is false positive in one out of
five women these tests should not longer be done. Drugs
controller had issued a directive to strengthen warning on
packages (March 1982) and banned manufacture (Dec. 1982)
and sale (June 1983). Due to legal controversy, and profes
sional and consumer ignorance it still continues to be used.
1 = Injections
have played a very important role in the modern medicine and
form one of its most distinctive features. However, it has also
lent itself to a very large degree of misuse-overuse because
of the mystique associated with it in the minds of the public
and the temptation of the medical practitioners to pander to this
need and pressure fortheir own economic gain.
J = Junk Drugs
these are newer formulations in the market whose only
additional values are cosmetic embellishments, added flavours,
elegant packing, irrational combinations—all of which help
to increase its cost.
K = Kaolin
is hydrated and purified aluminium silicate, a common addition
in antidiarrhoeal mixtures. Along with pectin and bismuth
salts it forms a group called adsorbents, astringents and bind
ing agents. These drugs may cause loss of electrolytes by
preventing absorption through gastrointestinal tracts. If at all,
they are of cosmetic value and may actually mash the severity
of disease.
L = Lomotil
or diphenoxylate and Loperamide are drugs whose risks of
treatment outwigh their benefits especially in children. They
are commonly used is diarrhoeas ano the dangers of paralytic
ileus leading to inaccurate assessment of fluid loss and toxae
mia if associated with gut infections make them especially
dangerous in pediatric practice. The use for children under
10
Medical Service
six has been banned in India.
in banned altogether.
In most other countries its use
M = Methapyrilene
and its salts (Banned in July 1 983)
N = Nialamide or Niamid
a MAO inhibitor used in the treatment of depressive disorders
(Banned in July 1983).
0 = OTC drugs
or over the counter drugs. These are drugs that are available
to consumers without prescription and are mainly painkillers,
anti-cold,, anti-cough preparations, cough mixtures, tonics,
food substitutes and protein powders. Many of them are
costly compared to the benefits they render, have some ingre
dients which are unnecessary or useless but helping to push
up cost and are widely advertised with false claims to push up
sales. Their scientific scrutiny is a need as also a systematic
campaign against their irrational ingredients or claims.
0
Oxyphenbutazone
P = Phenacetin
0
these are a group of non-steroidal antiinflammatory drugs
which also have mild antipyretic and analgesic properties.
The dangers associated with use are bone marrow toxicity and
liver toxicity. They are widely used/overused/misused group
of drugs and there is great need for building professional
awareness and consumer alert on this group of drugs. Recen
tly these drugs have been banned in the U.K.
was a commonly used analgesic/antipyretic agent which has
been reported to cause kidney damage and failure and hemo
lytic anemia. Hence fixed dose combinations containing it
are now considered outdated and hazardous. These have
been recommended for weeding out by the Hathi Committee.
Phenylbutazones
another group of non-sterodial antiinflammatory drugs which
give only symptomatic relief and in no way alter the course of
the illness. Its main indications are for ankylosing spondylitis
and rheumatoid and gouty arthritis though they are being
widely promoted and used for non-rheumatic disorders and
aches, pains and fever. Bone marrow toxicity is a real danger
with the use of this drug and hence its use should be severely
restricted. Its present availability—freely over the counter
should be drastically controlled and its deadly combinations
with amidopyrin, analgin, paracetamol, diazepam, vitamin B,
dextrapropoxyphene acetaminophen should be banned or
adequate warnings in labels instituted.
Practolol
(Banned in July 1983).
October-November 1984 (Suppl)
11
Penicillin
still an important constitutent of antibacterial therapy in spite
of the risk of anaphylactic reaction and allergic reactions.
(Its combination with sulphonamides and its preparations as
skin/eye ointments are banned from July 1983).
Q = Quinine
was the sheeti anchor of anti-malarial treatment till safer 4
aminoquinolines and 8 aminoquinolines were developed. Its
use leads to black water fever so is restricted now-a-days for
treatment of chloroquin resistant cases or sometimes in cereb
ral malaria.
R = Rational Drug
Therapy
is the art/science of prescribing the best suited drugs to indi- .~-viduals who need them taking and not to those who merely
want them. Its takes into account factors like efficiency,
safety (low incidence of side effects), cost and ease of admini
stration. It scruplously avoids extravagant prescribing over or
under prescribing, multiple prescribing or incorrect prescribing.
S = Sulphonamides
These have an important role to play in the therapy of infec
tions. The combination with penicillins is undesirable because
of the antagonism of antibacterial effect when bacteriostatic
and bacteriocidal drugs are given together. (FDCs of sulpho
namides and penicillins are banned since July 1983).
12
Streptomycin
Since it is one of the most effective drugs in anti-tb treatment
its use should be limited to TB treatment and mixed infections
of the gut. Its combination with penicillins is undesirable
since its use in small doses promotes development of resis
tance.
Steroids
one of the most misused drugs in general practice because of
acute onset of beneficial effects. Patients are exposed to a
wide range of toxic cumulative effects and adrenal insuffi
ciency due to adrenal suppression. Its a life saving drug to be
used in special circumstances. Their doses should be adjusted
to the minimum that can produce the effects. Fixed dose
combinations with other drugs are therefore irrational and
objectionable since this individualization of the dose cannot
be done. (FDCs of steroid for internal use except for treatment
of asthma are banned since July 1983).
Strychnine
This was a drug formerly used as an appetiser. Its use in
tonics can induce convulsions particularly in susceptible indi
viduals. An absolete drug! (FDCs of strychnine with caffeine,
yohimbine, testosterone and vitamins are banned since July
1983).
Medical Service-
T = Tetracyclines
One of the most commonly misused/overused broad spectrum
antibiotic mistakenly thought to be free of dangers. Reports
of its ability to cause discolouration of teeth, catabolic effect
on protein synthesis, diarrhoea, increased intracranial pressure
in children, Fanconi syndrome (if outdated, degraded drug is
used), liver damage in pregnant women have put it in the list
of hazardous drugs. It should not be used in paediatric
practice and in pregnant mothers. Its manufacture is supposed
to be banned from January 1982.
Tonics
Apart from being an economic waste, most tonics in the
market contain alcohol which is the main appetite stimulant
and also vitamin and mineral constituents in amounts greater
than the physiological absorptive capacities of average GT
tracts. Their overuse thus mainly help to vitaminise our
sewage systems!
U = Unani and Ayurvedic
drugs
These are difficult to standardise since official standardisation
methods are not available FDCs of these with allopathic drugs
have no therapeutic rationale or justification or proven efficacy.
(FDCs of ayurvedic and unani drugs with modern drugs have
been banned since July 1983).
V — Vitamins
a typically misused/overused group of agents especially as
combinations and tonics. They are essential nutritional requi
rements but most people get adequate amounts in a balanced
diet. Specific and separate preparations are required for
specific di deficiency states or as adjuncts to therapy. (Their
FDCs with analgesics, tetracyclines, anti-inflammatory drugs,
tranquillisers have no proven therapeutic effects and have been
banned since July 1983).
W =Waterbury's
is one of the brand leaders in the tonic market whose main
effects if any are because of the 9-10% alcohol content. It
contains insufficient amounts of iron and creosates and guaicols whose role in man has not been definitively established.
Like incremin, phosphomin, hemiphos their advertised claims
for surpass their actual chemical content. Advertisements of
such tonics are the most symbolic of high pressure, half truths
gimmicry of medical advertising.
X =
Y = Yohimbine
a drug often combined with strychnine, vitamines, testoste
rone, arsenic, iron and vitamins has been found to penetrate
the CNS and cause centra excitation including rise of blood
pressure, heart rate, hyperexcitability and tremor (Its use
especially in such combinations is banned since July 1983).
Z =
(Contd. to page 20)
October-November 1984 (Suppl)
13
Prescribing Drugs
Questions to ask yourself before writing a prescription.
1.
Need
Is this drug really necessary ?
Is it being given to make the patient feel that something is
being done ?
2.
Aim
What aim is to be achieved by this drug ?
What disorder of function is to be corrected ?
What symptom/s have to be relieved ?
3.
Knowledge
What is the approved or generic name ?
What class does it belong to ?
What are its characteristics ?
Do I have the requisite experience or knowledge to use it ?
Have I weighed the
benefit ?
potential
toxic
effects
against the
4.
Route and Dosage
By what route, in what dose and at what intervals is the drug
to be given and why ? In what form/s does the drug come ?
5.
Alternatives
Have I selected the best agent available for this particular
purpose ?
What other remedies might have been chosen ?
6.
Duration
For what period of time, days, weeks or months will it be
advisable to continue therapy ?
When and how could a decision be made to stop ?
7.
Observations
What observations can be made to judge whether the aim has
been achieved ?
How do these compare in efficacy, safety, cost ?
When should they be made and by whom ?
What laboratory investigation if any would
assessment ?
help
in
this
8.
Elimination
How is the drug eliminated ?
Will the patients illness change the usual pattern of distri
bution, effects or elimination of the drug ?
9.
Unwanted effects
What are the side effects or toxic effects of the drug ?
Are they acceptable ?
How frequent are they ?
How can they be modified/managed ?
14
Medical Service
10.
Precautions
Have I checked for the following :
a.
possible allergic risks
b.
possible idiosyncratic reactions
c.
patients drug diet which may interfere with the drug
What precautions can I take to ensure continuation of therapy.
Are there any conditions in which this drug is contraindicated ?
Are these 'absolute' or 'relative' ?
Are there any drugs which should be avoided when the
patient takes this treatment ?
Which and why ?
11.
Contraindications
1 2.
Patients point of view What does the patient believe about the drug ?
What has he been told about it ?
And what has he remembered ?
Does he need additional information ?
13.
Patient reliability
Does his relative need additional information ?
Is the patient reliable for this type of therapy ?
Will he need/get proper supervision by relatives or attendants ?
1 4.
Cost
Is the drug the cheapest drug of that type ?
If not could a cheaper drug do the job as well ?
1 5.
Finally is there anything else I need to know about this drug ?
Adapted from :
i.
A Herxheimer :
ii.
Formulary and Therapeutic guide—Kurji Holy Family Hospital
iii.
Prescribing drugs — MNAMS Handout, Dept of Pharmacology, St John's Medical
College, Bangalore
The Lancet II 1186-1187, 27th Nov 1976
October-November 1984 (Suppl)
15
What Can We Do ?
1.
Educate ourselves
We should make an effort to
available materials on drugs.
avail ourselves of all
the
We should purchase some of the books and subscribe to some
of the journals and bulletins mentioned in 'widening
horizons' to keep ourselves upto date.
' 2.
Share and
Disseminate
information
We should circulate all the information and resources to all
our staff and to other colleagues and centres through all
possible channels of communication. We could share our
own initiatives and experiences.
A
3.
Adopt essential
drug list
We should draw up an essential list for our institution in
which cost, efficacy, safety and quality will be important
criteria (refer to WHO's suggested list)
We could purchase and stock drugs in accordance with this
list.
4.
Adopt generic
We could use/adopt the generic drug concept during pur- J
chasing, prescribing or dispensing drugs.
5.
Stop Irrational
prescribing
Could stop prescribing drugs whose only advertised values
are :—
a.
cosmetic embellishments
b.
elegant packing
c.
irrational combinations
d.
imitative drugs
e.
inadequate evidence of greater value
We could weed out 'banned drugs' as well as restricted
drugs.
We could stop 'injection and tonic' practice.
6.
Avoid Drug
Industry Linkages
We could refuse to take gifs and physician samples
We could avoid allowing drug companies to sponsor events/
meetings
We could beware of unethical trade discounts or other forms
of inducement
7.
16
Adopt Rational :
We could adopt bulk purchasing
Drug Purchase
Support cooperative purchasing or production endeavours
Produce drugs in your hospitals'dispensaries.
Medical Service
8.
Adopt open
policy to nonallopathic systems
and non-drug
therapies
We should be open to other forms of treatment. Seek informa
tion and be willing to incorporate it in our work
Share our experience with others
Send our staff for training in these forms of treatment if
necessary.
9.
Support networks/
organization/
consumer
movements taking
up drug issues.
Find out about all such groups at local, regional, state level
or national level
Support and participate in their activities.
10.
Promote 'Health for
all' priorities.
We should actively promote the following in our work :
a. simple home remedies
herbal remedies and herbal gardens
b.
c.
health education and patient awareness
d.
training of village level workers
e.
community health initiatives
f.
development programmes
g.
awareness building.
Reporting in 1956 on the excessive amount of space taken up by advertisements in
Indian newspapers, the Indian Press Commission commented :
“The largest field of
objectionable advertising which we feel should be put down
by law is of drugs and proprietary medicines
The volume of advertising of such
commodities ranks next only to the volume of advertising of cosmetics.
—Use and Misuse of the Media
Sumanta Banerjee, World Health, Feb-March 1983
October-November 1984 (Suppl)
17
Learning to use antibiotics wisely
nous) antibiotic.
However, it is
usually not dangerous to give higher
doses of an antibiotic that is not
poisonous (penicillin or ampicillion).
Tetracycline becomes more poison
ous when old. It should never be
used beyond the expiration date or
in more than the recommended dose.
First guidelines
1.
Use an antibiotic that kills bacteria
rather than one that just slows them
down. This usually gives quicker
results, and prevents the infection
from becoming resistant to treatment.
2.
Use an antibiotic that causes fewer
side effects and is less risky. For
example, if the person is not allergic,
it is safer to use penicillin or ampicil
lin rather than an antibiotic like
erythromycin that can cause poison
ing.
3.
4.
When possible, use a narrow-range
antibiotic that attacks the specific
infection rather that one that attacks
many kinds of bacteria. Broad-range
antibiotics cause more problems—
especially diarrhoea and thrush—be
cause they attack good bacteria along
with the bad. The good bacteria
prevent the growth of harmful things
like moniliasis (fungus that
can
cause diarrhoea, thrush, etc.)
Use a broad-range antibiotic only
when no other will work, or when
several kinds of bacteria may be
causing the infection (as with infec
tions of the gut, peritonitis, appendi
citis, some urinary infections, etc.)
7.
Do not use an antibiotic that slowd^
down bacteria together with an anti
biotic that kills them. The combina
tion is often less effective than one
alone. (Once the bacteria are captur
ed or slowed, they stay hidden where
the other antibiotics cannot kill them).
For example, never use tetracycline
in combination with chloramphenicol.
8.
Whenever possible, avoid using a
toxic medicine for a person with
diarrhoea or dehydration. A dehy
drated person's body cannot get rid
of poisons as quickly in the urine.
Even normal doses of a toxic medicine
may build up and poison the person.
(Sulfas are especially riskly for treat
ing diarrhoea. Unless the person is
making a lot of urine, sulfa can form |
crystals in the kidneys and cause
damage).
9.
Do not use toxic medicines during
pregnancy—especially during the first
three months. Some medicines can
cause severe birth defects.
10.
Use a medicine the family can afford.
When choosing between medicines,
always consider the relative cost, and
weigh this with other advantages
and disadvantages.
Additional guidelines
18
5.
Use antibiotics only for bacterial
infections. Do not use them for
viral infections, because antibiotics
do nothing against viruses (common
cold, measles, chicken pox etc.)
6.
Be careful to give more than the
recommended dose of a toxic (poiso
—Helping Health Workers Learn
David Werner and Bill Bower
Medical Service
Seven Steps to success m essential drugs supply
“Essential drugs ai
hose that
satisfy the health care needs of the
majority of the people. They should.
therefore, be available at all times in
adequate amounts and in the appro
priate dosage forms "
^1)
National Drug Policy
Every country's comprehensive health.
Policy should include a National Policy on
Essential Drugs. WHO's role is to inform
governments about the basic concept and
the benefits, then to provide technical support
for policy formulation,, selection of essential
drugs, a plan of action, procurement, quality
control, programme management and aspects
such as training, evaluation and legislation.
A national essential drug policy can provide
more drugs to more people at the same cost
or even less.
(2)
Selection of Essential Drugs
Essential drugs are those that satisfy the
health care needs of the majority of the
population. Selections are based of the
fcnost common local disease and conditions
mnd on the capability of the health care sys
tem. More than 80 countries have now adop
ted lists of essential drugs based on WHO’s
Model List of Essential Drugs, as have various
non-governmental
organizations and
UN
agencies.
(3)
Drug Procurement
All too often countries pay more than they
need for their drugs. They can get better
value for money by putting out bulk orders
to international competitive tender on the
world market.
UNICEF and WHO help
countries to strengthen their procurement
October-November 1984 (Suppl)
systems and to secure, if necessary and
possible, reliable financing—internal or exter
nal—for their purchase.
4.
Logistics of Supply
WHO's goal is to make sure that people
can get the 20 most needed essential drugs
whenever they require them, within an hour's
travel. The supply chain must work; correct
ordering, packing and storage; less waste
through deterioration, loss or theft, regular
transport to the remotest dispensary despite
climatic and geographical conditions or fuel
shortage. Several countries have established
efficient drug supply management systems
with support from WHO, UNICEF and bilate
ral agencies. The pharmaceutical industry
also provides expertise.
(5)
Proper Use of Drugs
Both health professionals and the general
public are in need of better information and
education about when and howto use drugs.
Common problems are that the former tend
to overprescribe while the latter may fail to
follow the prescribers instructions or dose
themselves. Drug information sheets are
being considered by WHO that would give
the indications, contra-indications and side
effects of essential drugs. Several countries
have produced their own therapeutic guides
and standard treatment schedules for use by
health workers. Consumer groups do valu
able work among and on behalf of the
general public.
(6)
Quality Control
Essential drugs must be of reliable quality
as well as efficacious and safe. Quality has
to be assured upto the time that the drugs
19
are administrated by good manufacturing
practices and by monitoring of products at
all stages in the supply line. The IFPMA
member companies provide training in quality
control for nationals of developing countries.
Any country lacking quality control laborato
ries can obtain an assurance of the quality
of imported products at the time of export
through the WHO certification scheme on the
quality of pharmaceutical products moving in
international commerce.
formulation, selection, procurement, manage
(7)
"how it's done".
Training
ment and use of drugs, in drug legislation
and regulatory control and in production and
quality control.
WHO is approaching univer
sities, training schools, non-governmental
organizations and the pharmaceutical industry
for help with training materials and courses.
At seminars and workshops, countries that
have developed successful national essential
drugs programmes demonstrate to other^ •
Many countries lack staff trained in policy
from World Health, July 1 984
(Contd. from page 13}
Further Reading
1.
Banned Brand Drug List
2.
Hazardous Banned Bannable and Dumped Drugs
3.
Rationality in Banning Fixed Dose Combinations
4.
Some painful facts about a pain killer called Amidopyrine
5.
Why not to prescribe anabolic steroids ?
6.
Irrational use of antibiotics
7.
The clioquinol controversy
8.
Using tetracyclines for children and pregnant women
9.
Consumer Altert-Phenylbutazone and Oxyphenbutazone
10.
Scientific scrutiny of some over the counter drugs
11.
The case against EP Forte
12.
National Drug Policy guidelines and list of banned drugs (Bangladesh)
Available from Low Cost Drugs and Rational Therapeutic Cell, Voluntary Health
Association of India, C-14 Community Centre, SDA, New Delhi 110016
20
Medical Service
MS-cb/D-10.340/
25.8.1982
BRAND & DRUG
HOUSE
INGREDIENTS
COST
INDICATIONS
DOSAGE
CONTRAINDICATIONS & SPL.PRECAUTIONS
* Adroyd
(Parke-Davis)
Oxymetholonc 5mg
15-9.04
Underweight or asthenic patients Occassionally 20-30mg
convalescence frcra acute infecdaily may be required.
tious diseases^ major surgical
Usually for 10-21 days
procedurcs-pre-and post-operative- but not more than 90
ly, chronic debilitating illness; days. Ped. dosage:
osteoporosis, fractures and
see Lit.
decubitus ulcers, severe burns
Prostatic carcinoma. Although Adroyd
has a low degree of androgenicity, very
young and preadolescent individuals are
usually sensitive to the masculinising
effects of-androgens, ' Due.to this,
they should-be under ■ -medical- supervision . during therapy and-the- drug-withdrawn
if-masculinising effect.develop --Adroyd-should be used-with-caii - caution in cardiac disease, hepatic
dysfunction,- --nephritis - and nephrosis.
Anabolex Bl 2
(Cipla.)
Methandi cnorie- < mg
Vit B12 50mcg
ferric amm, cit
50mg/ml-
5ml-6.23
Loss. of. appetite and weight loss
with anaemia. Growth disorders
in children
Continuous-treatment, shcul ’. be
limited to a max. of"4 weeks with
intervals c-f 1-2 months between courses.
Methandienone
25mg
lml-5.70
Inl-i.mt weekly.
ik
*
O
ba Iwk^^
For intensive therapy
pji-.stcijf malnutrition, convales
cence, wasting diseases,
1ml on alt mate days
osteoporosis, growth retardation,
aplastic anaemia, red-cell
aplasia.
ft
ft# Dianabol
(Ciba-GejLgy)
ft
#
ANABOLIC STEROIDS FOR GROWTH
MIMS
DIMS
15-10 drops daily
for 4-6 weeks
Prostatic cancer, severe liver •
insufficiency, severe nephrosis ,
pregnancy and lactation. Should not
be given continuously for persons
periods exceeding 4 weeks. High
doses in women may produce menstrual
cycle disorders, hirutism, deepening
of voice. In children, premature
ossification of epiphyses and
virilisation may occufe
■ •A •
2
-
MS-cb/D-10.340/
25.8.1982
BRANS & DRUG
HOUSE
COST
INDICATIONS
DOSAGE
CONTRAINDICATIONS & SFL.PRECAUTIONS.
Mcthandienone Img
1 #
* Dianabol
Tabs(Ciba-Geigy) and 5mg
Img:^% C 3r
5mg:106.02
(Same as Dianabol)
Male:5mg daily.
Kaint. therapy: 2.5mg_..
daily. See lit.
Female: 2,5mg daily.
Maint:1-2mg daily.
See lit.
(Same as Dianabol)
Dianabol Drops
■' (Ciba-Geigy)
Mcthandienone Ing
per ml
5ml-5.5O
(
Children:0.01-0.04mg/
kg body wt for not
more than 4 weeks
(
...ft Durabdilin
; (Organon)
Nandrolone phenylprepi onate; 1Omg
and 25mg
10mg-t3. Protein loss folloving surgery
25mg-21.85trauma, burns, infectious
diseases or following prolonged
corticosteroid therapy, 'uraemia
due .to.acute and chronic renal
failure, general debility,
osteoporosis, aplastic anaemia,
ir.cperable mammary ^arcinana,
under weight children and
fractures.
10mg:1amp 1 .m. 25mg every 3 weeks. In
-9.28
acute renal failure upto 50mg
25mg:lamp.weekly and in chronic renal
8.53
insufficiency upto 10mg-every
3 weeks. Children: 10mgj
every 3 weeks
■'
INGREDIENTS
# Deca Durabolin Nandrolone deca
noate 10mg..and
25mg
’
X
~ JUMS
# CIMS
N.B.
"
)
l.n, 25ug' evo-aj^j^otsk
3q ^cutcS^^fei>fdJ.ure
"
. (See lit)
in chronic renal in
sufficiency uptor>50mg ,
twice weekly.
Children: 10mg every
week
-Dianabol has been deleted from the June issue of MENS and is withdrawn by Ciba-Geigy.
)
MS-cb/D-10.340/
'■ 25.8.1982
-
3
-
/
BRAND & DRUG
HOUSE
--------
INGREDIENTS
COST
i negations
Evabolin
1(Concept)
Nandrolone phenyl
propionate 25mg
Vit.E 100mg/2ml
2ml-7.O6
Convalescence, to promote
2ml-4ml i.m. once
growth in undernoursihed children weekly
adjuvant to steroid therapy.
Osteoporosis, hypoproteinaemia,
Haemolytic anaemias.
Carcinoma of prostate, pregnancy,
male breast carcinoma.
, * Neurabol M
(Cadila)
Vit B1 60mg
B6 27.5mg
Hydroxycobalamin
1OOmgg,nandrolone
phcnylpropicnate
25mg/2ml
2ml-4.42
General debility, osteoporosis, ■ 2ml i.m. every week
weight loss, refractory anaemias,
neuritis, neuralgias.
Prostatic carcinema, pregnancy,
B1 sensitive patients.
Orabolin
(Organon)
Ethylestrenol 2mg;
20-13.34
Osteoporosis, weight loss;
debility, anorexia, burns,
during steroid therapy
1 tab twice daily.
In serious conditions
dosage may be
increased
Orabolin
Drops(Organon)
Ethylostrencl 2mg
per iH
5ml~6,56
Body wb upto 10kg
Body-wt upto 10kg:
10-20 drops.
10-20kg:20-40 drops
20-30kg:40-50 drops
Moro than 30kg:
50-60 drops. Aid
daily
# Trinergic
.! (Uni chan)
r
Methandiendne 5mg
20-12.71
Vit B1 10mg, B6 10rag
B12 30mcg
Malnutrition and undo? nutriti on
convalescence, old age anorexia’
nervosa, neurological disorders,
extensive burns, severe
injuries
* Trinergic
• J Inj. (Unichem)
Methandionone 25mg
Vit B12 500mcg/ml
(Same as above)
■
i
f
' i)
/
• .j
w
MIMS
tt
Ull'iB
1ml-2.96
DOSAGE
CONTRAIIWICAIIQNS & SPL.PRgCAUgLga^
Pregnancy, prostatic carcihcma,
male breast carcinoma. Severe
liver dysfunction.
Continuous treatment should be
limited to a max. of 4 weeks
with intervals of 1-2 months
between courses.
1ml once or twice
weekly.
(Same as above)
MS^-cb/D-10.340/
25.8.1982
- 4 -
INGREDIENTS
COST
INDICATIONS
DOSAGE
Unabol
(Unichcm)
Nanlralone ph any).
propionate 25mg/
ml
1ml-7.0l
Negative nitrogen balance, old
age, osteoporosis, bone frac
tures, during prolonged corti
costeroid therapy, to promote
weight gain
25mg weekly
6 Carcinoma of prostate, pregnancy,
male breast carcinoma
Minstrel
(Cosme Farma)
Stanozolol 2mg
20-12.46
Poor protein anabolism, osteopet
rosis, convalescence, aplastic
anaemia., during corticosteroid
therapy
2-4mg thrice daily
just before or with
meals. Children 3-6
years: 1mg twice
daily; 6-12yrs:
2mg thrice daily
Pregnancy, carcinoma'of prostate,
severe.liver disease. Pre—pubertal
children where it may lead to
stunting of growth. Use lower
dosage in young fanales to minimise
androgenic side-effects. Impaired
cardiac and renal function.
* Aquaviron B12
(Nicholes)
Free testosterone
25mg,VitB12 500mcg
per ml
1ml-4.75
Depressed debilitated male
patients
1ml l.m. twice
weekly for about
6 weeks; diminish
frequency as
conditions improves
Prostatic carcinoma
*Aquaviron Inj
Free testosterone
25mg/ml
1ml-2.50
Male: hypogonadism, ■ organic
impotence, eunuchism, delayed
puberty, premature senility
Female: metropathia haemorrhagica menorrhagia, frigidity,
inoperable breast carcinoma
Malo: 1-2ml every 1-2
weeks diminishing the
doseas patient improves
Female: 1-2ml daily
until bleeding stops.
Not more than 200mg
in one month
BRAND & PRIG
HOUSE
*
#
MIMS
GINS
•-
GONTIUJNDICATIGNS & SPL.PRECAUTIONS
-
VOLUNTARY HEALTH ASSOCIATION OF INDIA
D-9/334 (l)
a:25.8.82
C-14 Community Centre,
Safdarjung Development Area,
NSV DELHI - 110 016 .
WHY NOT TO PRESCRIBE ANABOLIC STEROIDS
The unquestionable, unshakeable faith in tonics and vitamins of the
majority of us - Indians is due primarily to the excellent marketing
strategies of the drug companies, and the compliance of the health
professionals and the consumers.
The uselessness of tonics and vitamins is abundantly clear to those
who care to question their rationality. Where anabolic steroids are
concerned, the potential hazards associated with.its intake make it a
doubly black-listed.product.
Anabolic Hormones -"most of them are weak'versions of male sex
hormones and were synthesised and introduced into medicine as agents
to speed the transformation of foodstuffs into body tissues. They were’""'
originally promoted- and some still are - as drugs that could stimulate
the appetite, step up body weight, strengthen bones, increase athletic
ability, control a variety of emaciating diseases and in the recovery
from surgery, infections, burns, fractures and severe traumatic injuries"
Refs
Prescriptions for Death" p.67
Milton Silverman.
Accented Indications
Based on objective evidence anabolic hormones are
accepted for use in«
- certain kinds of (aplastic) anaemias.
- inoperable breast cancer.
- prevention and treatment of osteoporosis
- bone sofetning as seen in post-menopause of women
- senile patients.
But used as an adjuent and not as primary therapy - diet, calcium balance,
physiotherapy and good general health promoting measures need equal or
greater consideration.
Toxicity
In large quantities, they may.causes
In Women
- masculinization
- baldness
'
'
- deepening of the voice
- hirsutism
- menstrual irregularities
)
) irreversible
j virilization
)
Adverse effect on liver - jaundice, liver tumors.
May cause sodium retention -leading to edemia and heart failure.
Gan cause problems in cardiac, renal or hepatic diseases and increased- or
decreased libido.
In young children
- Early closure of epiphyses in the bones resulting-in
stunted growth.
Boys
Young girls
- precocious sexual development.
- they can produce enlargement of the- clitoris or the
development of false penis.
I
Alteration in glucose tolerance test, thyroid function
test. Electrolytes - sodium chloride water phosphates,
calcium.
•/
Liver Function Test sSerum cholesterol,suppression, of
clotting factors, II,V, VII & X
1
(Editorials Pune Journal of Ongoing Education^
How adequately these warnings are given to the prescribing doctor
2
D-9/334 (a).~a:2S.8.82
,
by the drug company or to the consumer by the doctor - is well known!!
When the actual pToblem is lack of food, the solution is not tonics
or anabolic steroids- When the desired action should be to look deeply'
into the.causes of malnutrition-our major health problem'-’a prescription
of anabolic steroids (tonics, etc) displays our ignorance or irresponsib
ility; apathy and indifference towards such medically irrational
practices.
Different anabolic steroids are promoted in various parts of the
third world (including India) for vague indications like overcoming of
loss of weight, poor general health, wasting illnesses, to aid mal
nourished children (drug experts have emphasised that these products
can help transform food to body protein only if the patient is getting
enough food, patricularly enough protein and total calories).
- for treatment of debility and emaciation.
- senility, muscular dystrophy
- for eppetite improvement
.- for pernicious anaemia, lack of energy
- poor weight•gain
- reduced resistance to infection .
t
- tiredness and debility, lack of stamina and.listiLessness---- ----------------
According to the British National Formulary "the us.e of anabolic,
steroids as body builders or tonics is quite unjustified-.'^ - •••_' -c.-'
According to AMA Drug Evaluations, the use of anabolic hormones to
improve athletic performance is- unanimously condemned. Besides the fact
that there is "no increase in the'size and strength and in the muscle size,
there is an added risk of-liver damage and interference with the testicular
function".
.
.
What is more objectionable is that the "indications for use" and
the "warnings about the drug" very in different countries depending
on the effectiveness of the country's controlling authorities and-the
general awareness of the medical community and the public".
The three most popular brands of anabolic steroids are:
- ■
- . :. .
Winstrol - a form of stanozolby Winthrop, USA
Durabolin - a form of nandrolone phenpropoinate by Organon
Dianabol - a form of methandrostenolone by CIBA GEIGY
Some of the other brands available in India, the drug houses are:
OROBOLIN DROPS - By Organon, which promoted Orbalin drops in Bangladesh
"for paddiatric use in conditions like marcismus, malnutrition,
poor weight gain, retarded growth - kwashiorkoi, etc.
According to Diana Melrose in her working paper 'Medicines and the
-Poor in Bangladesh"..
Durabolin and Decadurobolin"stimulate the appetite,ensures adequate
food intake..checks protein depletion...resistance against infections
diseases and improves general constitution and restores a sense of well
being" They also cause, "no fluid retention and free from harmful effects
on the liver".
In the UK doctors are told "not recommended for children". Warnings
include"anabolic steroids may cause fluid retention". Tumours of the liver
have been reported .occasionally.
.
*
/
Relative costs are given in the Appendix
*
Numerous tonics contain
anabolic steroids-an .exhaustive'list needs to 'be prepared. The Pune Journal
of Continuing Medical Education of June 1982 gives and editorial'on CIBA
'GEIGY withdrawing Diahohol.
We.can make sure this is really done and that
others follow suit.
/
'/
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40,
INSTITUTIONAL AREA, SOUTH
NEW DELHI - 110 016
OF
/
(
I IT
66 5018"
Telephones : 66 8071
66 80 72
Grams “VOLHEALTH" NEW DELHI - 110 016
July 12, 1938
Dear friends,
You must have gathered from the newspapers dated 30th June
that the high dose
drugs have been banned.
The Gazette Notification is dated 15th June,
vhat the reason
for IS days silence in informing the public is we don’t know. In case
this period was used by the manufacturers to chof/-their stocks to
the druggists and chemists - in that case - ensuring withdrawl of
these ;.rugs from the market, has to be our single most imp demand and
action.
From past experience we are aware that it is extremely unlikely
that the drug control authorities wiil/can enforce an effective ban
under the existing circumstances.
The amendment of the Drugs t. Cosmetics Act of 1940 was
brought about only when it became obvious that there was no clause
as hazardous drug for banning. w case has been a test case for us
in jetting a drug banned, insuring its total withdrawl from the market
is part of our responsibility.
The Health Ministry should have informed the medical pro
fession and public over the Radio & Doordarshan about the ban and the
alternatives available.
I am enclosing :
i) DCl's letter to me dated 29th June
2)
Copy of the Gazette Notification
3)
Copy of my letter to the DCI.
E'.i?. Follow up would require s
1) insuring withdrawl of all stocks of high dose
2)
3)
4)
drugs
from the manufacture and the market
Putting pressure for a deterrent punishment of the
guilty by demanding payment to the Govt
*
of all the
profits made ?>ince 1982 which should be used for setting
up Adverse Drug Reaction Cells.
Demand for warning the health professionals &
consumers at large about the drug ban.
Demand for making low cost simple end safe pregnancy
tests available as part of
prog.
VHAI assists in making community health a reality for all the people of India, with priority for the lees privileged
millions, with their involvement and participation, through the voluntary health sector.
....._2_. •
VOLUNTARY HEALTH ASSOCIATION OF INDIA
40,
INSTITUTIONAL AREA, SOUTH
NEW DELHI - 110 016
OF
I IT
66 50 18
Telephones : 66 80 71
66 80 72
Grams “VOLHEALTH" NEW DELHI - 110 016
5)
Making efforts towards informing the medical
professionals about the alternatives to high dose
S.F. for the secondary
etc.
6)
demand for expedrating for endurcement of dCC's
subcommittees recommendation to weed out drugs and
screening of the drugs in the market known to be
hazardous irrational, grossly overpriced and non-
essential
occmr.entation of evidence of continued sales and
demand for ensuring of action for violation of the
ban will need to be done.
Jince mainly Eenstrogen ( of Organ’s Infer), and E.P.
Forte (of Unichem) are involved it should not be v.
difficult.
Please inform all the drug enthusiasts and journalists
in your area
!nc 1: As above
VHAI assists in making community health a reality tor all the people of India, with priority for the less privileged
millions, with their involvement and participation, through the voluntary health sector.
EXTRAORDINARY
«TT
3—(i)
PARI’ II—Section 3—Sub-section (i)
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PUBLISHED BY AUTHORITY
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3-5-198-1
MINISTRY OF HEALTH & FAMILY WELFARE
NOTIFICATION
New Delhi, the 15th .lune, 1988
G.S.R. 700(E).—-Whereas the Central Government is satisfied that the use
of high dose formulation of Oestrogen and Progesterone is likely to involve risk
to human beings and such formulation have vto? therapeutic justification and it
is necessary and expedient in the public interest so to do;
Now. therefore, in exercise of the powers conferred by section 26-A of the
Drugs and Cosmetics Act, 1940 (23 of 1940), the Central Government hereby
makes the following further amendment in the notification of the Government
of India in the Ministry of Health and Family Welfare No. G.S.R. 578(E), dated
the 23rd July, 1983, namely ; —
In the Table appended to the said notification, after serial number 26 and
the entries relating thereto the following serial number and entries shall be
inserted namely :—
27 Fixed dose combination of Oestrogen and Progestin (other than oral
contraceptives) containing per tablet estrogen content of more than
A
w
['•Tt’T 11—7’3 3(1)]
7173 77 TIT77 : StHlHpW
50 mcg. (equivalent to Ethcnylc Estradiol) and of progestin content
of more than 3 mg (equivalent to Norethistcrone Acetate).
[No. X-11018|li88-DMS&PFA]
J. VASUDEVAN, Jt. Secy.
Note :—Government of India Ministry of Health and Family Welfare
Notification No. G.S.R. 578(E), dated 23-7-1983 was amended by
the following notification published in the Gazette of India Extra
ordinary, Part II Section 3(1) namely
I.
G.S.R. 49(E), dated 31-1-1984
2.
G.S.R. 322(E). dated 3-5-1984
3.
G.S.R. 863(E), dated 22-1 1-1985
and
BY Illi' manu.ik. oovr. or INDIA press, ring road, new Delhi-1 10064
I'l'iu Willi BY im (ONIKOI.I.IK or rum.KviiONS, phint-110054, 1988
No . X. 11018/1/87—D
From
The Drugs Controller (India),
Dte. General of Health Services.
New Delhi,
the
9 JVM 1989
DroMira Shiva, '
Voluntary Health -Associa -ion ©f India,
40, Institutional Area,
South of I.I.T,.
New Delhi-il0016o
Subject
Marketingof high dose combination
of Oestrogen & Progestins -
. A„,cop.«/_of the Notification No.GSR 700(E),
dated 15.6.1988 issued by the Govt, of India is forwarded
herewith, for your information.
By this Notification Govt, of India has
prohibited manufacture and sale of "fixed dose
combination of Oestrogen *
and
r
ogestins
(other than
Oral Contraceptives) containing per tablet 50 micrograms
(equivalent to Ethenyl Estradiol) and of progestin
content of more than 3 mg. (equivalent to Norethisterone
Acetate).
You are rcouested to give wide publicity to
the contents of the Notification.
You r s f a i t h fu 11 y,
(DR.PREM K. GUPTA)
DRUG3 CONTROLLER (INDIA)
■
41st ANNUAL CONVENTION
CATHOLIC HOSPITAL ASSOCIATION OF INDIA
23-26 NOVEMBER 1984
WORKSHOP THEME
~ug policy
00
'Eternal vigilance is required to
ensure that the health 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-health'.
—-ICMR/ICSSR Health for All Report.
Venue: ST JOHN'S MEDICAL COLLEGE, BANGALORE 560034
SIGNIFICANCE OF THE THEME
2
THE Workshop is to help participants understand the
issues relevant to.drug prescribing, drug distribution
and pharmacy policy in our institutions in the context
of the ICMR/ICSSR warning and to challenge them to
participate in the growing national response to
the problem.
WHAT does the 'abundance of drugs' mean to the millions
of the poor in our country who struggle in life to
make both ends meet? Can they ever have access to the
modern health care system which has become a business
today, rather than remaining at the service of humanity
at large? Do they have essential and life saving drugs
at their reach within a price range they can afford?
IS our drug policy today more profession-oriented, drug
industry-oriented rather than patient-oriented? Whose
interests are we serving in our institutions?
HOW can we move towards a more people and patient-oriented
drug policy?
THESE are some of the QUESTIONS which we shall respond to
in our Workshop.
"Community Health is a process
of enabling people to exercise
collectively their responsibi
lities to maintain their health
and to demand health as their
right. Thus it is beyond mere
distribution of medicines,
prevention of sickness,
and
income generating programmes".
—CHAI new vision
OBJECTIVES
1.
3
TO CREATE AN AWARENESS OF.’, =
the health situation in India, the role of drugs
in health care, the pattern of drug production
in India vis-a-vis the people's health needs, the
dynamics of the drug industry, the- pattern of drug
distribution and availability in the health system,
the national drug policies and laws.
2.
TO CREATE AN AWARENESS OFs=
irrational use, over use and misuse of drugs by
health personnel.
3.
TO DISCOVER
the social, economic, political, cultural and
other factors responsible for this problem.
4.
TO DISCOVER
how all of us are part of the problem at a
personal level.
5.
TO CONSIDER
the various responses at national/regional levels
in the areas of i— consumer awareness and people's
movements; continuing professional education;
pressure group on policy makers; search for low cost
alternatives; individual/group action; institutional
policy changes.
6.
TO DISCOVER
ways and means by which we can respond to this
situation at individual, institutional and
regional/national levels.
4
PROGRAMME HIGHLIGHTS
;;^Sessions on;
Understanding the problem
Drugs and the healing ministry
Towards rational therapeutics
What to do to tackle the problem
Some initiatives in the country
The people's medicine
ipGroup discussions on;
What/why the problem in our health institutions?
What can we do to tackle this problem?
^Liturgy
Reflecting on our calling and the faith dimension
of our response
':^Exhibition ons
Socio-political dimensions of Health and Drugs
Rational Drug Therapy
Home remedies and Herbal medicines
HjStudies on;
'
Drugs for a Community Health Center
Understanding the injection/tonic culture
Use/misuse of drugs in surgery
Drug situation in small rural hospitals
Cost of treatment
:;-Cultural Pro gramme
Understanding the problem from the poor man's
point of view.
5
gYNOPSIS OF PAPERS
Drugs for Primary Health Care (C M Francis)
An integral part of our commitment to primary health care is
the provision of essential drugs to all those who need
them, in adequate quantity and quality and at affordable
prices wherever the person is. The various aspects of
the drug problem needing our attention include production,
what drugs are required, choice of drugs, National Drug
Policy, selection of drugs, drug production and procurement,
logistics of supply, quality control, regulating the drug
trade, drugs for immunization, drugs for cure, drugs for
symptomatic relief, search for new drugs, drug information
and the need for evaluation of the efficacy of primary
health care including drugs.
The Ten Commandments of the Drug Industry (Augustine Veliath)
1.
Thou shalt have tens of thousands of drugs
2.
Thou shalt not question the price of a drug
3.
Thou shalt not tamper with nature's garden
,4. Thou shalt respect they doctor more than thyself
5. Thou shalt betray thy people and thy nation for petty rewards
or subscribe to any other
6.
Thou shalt not covet,
system of medicine
7.
Thou shalt never reveal company secrets
8.
Thou shall first seek remedies for fashionable ailments
9.
Thou shalt be a'dumping ground for banned drugs
court,
10.Thou shalt be a guinea pig for new and untried drugs.
6
The Ethics of Prescribing (George Lobo,
sj)
Discusses reasons for the unfortunate situation related to
drugs prevalent today, viz., technological model of
health care leading to manipulation of the patient,
search and demand for instantaneous cure of symptoms,
mystification of medicine, profit motive and 'free
enterprise1 of the pharmaceutical industry, a deep
rooted cultural alienation from the people, exploitation
of dependent developing countries, decreasing emphasis
being given to preventive medicinq and other systems
of medicine.
The use of drugs should be regulated by the principles of
totality (overall good of the patient) and of double
effect (the good effect overriding any harmful effect).
It suggests remedies for the development of a personcentred and holistic approach to health care.
Professionals in the Church - an introspection (George Joseph)
Serious questions have been raised about the institutional
witness of the church in India, particularly its
relevance in the social context of today. In the case of
the Healing Ministry there is urgent need to critically
look at our priorities and commitment and our style of
functioning in the light of the gospel. The role of the
professionals have to be reassessed as part of an
overall effort to bring back the true spirit of 'Diakonia'
into this ministry.
The whole issue regarding the need for evolving a 'rational
drug policy' has to be seen in this perspective.
^4^
You. take
all the
medicine now
.... we will
see the rest
later
7
What is Rational Drug Therapy?
(Mira Shiva)'
Rational drug therapy means practice of socially
conscious, relevant, concerned and yet scientifically
sound medicine, it recognizes the non-role of drugs
in certain conditions, the role of alternative systems
of medicine and recognizes the limitations of Western
Medicine
n our social context.
It emphasises selective use of drugs based on essentiality,
efficacy, safety, easy availability, easy administration,
quality drugs preferably of indigenous production.
Rational Drug Therapy recognizes the concept of essential
drugs and the concept of graded essential drug lists for
different levels of health personnel. It recognizes the
right of health personnel and consumers to drug information
and its effective communication.
It is taking of a conscious decision to boycott certain
drugs and use others only when needed. It means
prescription with awareness, to avoid as far as possible
-- iatrogenesis (drug induced problems, drug interactions,
adverse drug reactions and emerging drug resistance) .
It is understanding the role of drugs and rational drug
therapy in the 'emerging health movement.
What can be done at a pharmacy level
(Alan Cranmer)
(a)
Management of Pharmacy Services include involving the
users of the service; the Pharmacy Committee - its
constitution and functions, viz., implementation of
hospital policy, selection of medicines, sources of
medicines, cost versus quality, basic drugs and formula
tions, medicines banned in India and abroad, medicines
from other systems; .stock control; prescribing
discipline and pharmacy discipline.
(b)
Good dispensing services involve need for good
professional service to patients, proper presentation
of patient's medicines, preparation of medicines in
the pharmacy compared to purchase, medicines in the
pharmacy and at clinic level.
contd
8
(c)
Relationships with suppliers, ie., with representatives
in the pharmacy and an assessment of products offered
and their sources.
(d)
Educational requirements - basic courses, legal
requirements, course content, continuing education for
pharmacists.
(e)
Relationships with hospital colleagues.
INITIATIVES IN THE COUNTRY
(1)
Arogya Dakshata Manual, Pune has been raising awareness
about drug related issues among medical professionals
and the lay public since the past 8 years. They publish
a monthly—'Pune Journal of Continuing Health Education'—
on drug issues and are also bringing out a book >.
'Rational Drug Therapy' in December 1984.
They launched a movement called 'Operation Medicine' in
1977 against irrational prescription cf vitamins, tonics
and tinned foods.
(2)
All India Drug Action Network; A number of groups have
been working in the field of drug related issues at
various levels during the past 3-4 years. They have
been in contact with each other and have been working
informally together sharing information, putting forward
a memorandum (demanding a Rational Drug Policy),
participating in campaigns, lobbying with government etc.
In August 1984, they felt the need to have a more organized
base and have formed the All India Drug Action Network.
CHAI is also a member of the Network.
(3)
Lok Viqyan Sanghatana, Maharashtra, or the People's Science
Movement have launched campaigns about anaemia and
irrational anti-anaemia drug preparations and also about
over the counter drugs. They organize jathas, hold district/
town seminars, write in the mass media etc.
(4)
Kerala Sastra Sahitya Parishad is a voluntary non-government
organization consisting of sci ritists, doctors, engineers,
social scientists, teachers, students, workers, peasants,
technicians who arc committed to popularising science- and
channelising it for social r_.volution. Thu- KSSP has recently
decided to take up the Drug issue and Initiate a big campaign
to expose the anfi-people and exploitative tactics of the
Multinational Drug Companies. The questions of essential
versus non-essential and dangerous drugs, the inadequacy
of drug safety control measures, the rising prices cf
life saving drugs and the non-implementation of the Hath!
Committee recommendations arc. the highlights of the
programme.
10
(5)
LOCOST or Low Cost Standard Therapeutics is a collective
voluntary enterprise for rational therapeutics. LOCOST
aims to promote low cost, scientifically tested medicine
under generic names. LOCOST is a response to a growing
demand and challenge of the voluntary health sector to
meet the needs of the deprived sectors of the society
for not only low priced but also good quality medicine.
LOCOST includes procurement, quality testing and control,
distribution and educational efforts, and is located in Gujarat.
(6)
Bangarapet Mission Tablet Industry in Karnataka is a
successful small scale venture providing low cost, good
quality formulations to some mission hospitals in the
country.
(7)
Low Cost drugs and Rational Therapeutics Cell of the
Voluntary Health Association of India, New Delhi, has
been instrumental in bringing together various groups in
India on the issue of drugs. They have been providing
informational backing to these groups, organizing meetings,
informally coordinating some actions etc.
(8)
medico friends circle
is a grow of socially conscious
individuals, interested in the health problems of our
people. Through their monthly bulletin, they discuss
drug issues among others. They have formed a Rational
Drug Policy Cell and have launched a campaign on antidiarrhoeals.
(9)
The Kurji Holy Family Hospital Formulary is the result
of the accumulated experience of the hospital over the
last 10 years. It gives a comprehensive, list of drugs
to treat 98% of the hospital admissions. It also gives the
generic name, dosage, indications, contra-indications
and side effects of these drugs. Information about
comparative cost of treatment is also provided.
11
(10)
State Forums;
During the past year drug action forums
have been active in Andhra Pradesh and West Bengal.
Drug Action forums are also being initiated in Gujarat
and Orissa.
(11)
The Pharmacology Department of the Post-Graduate Institute
of Medical Education -and Roec-roh, Chandigarh, pre vide
unbiased technical information on drugs and therapeutic
through a monthly publication 'The Drugs Bulletin'.
(12)
Others;
The following organizations have also been
involved in drug related issues and arc part of the
All India Drug Action network;
Consumer guidance Society of India, Bombay
Consumer Education Research ,Centre, Ahmedabad
Federation of Medical Representatives
Association of India
Health Services Association, Calcutta
Delhi Science Forum, New Delhi
People's Participation in Science and Technology,
Madras/Bangalore
Centre for Science and Environment, Delhi
Centre of Social Medicine and Community Health/
J N University, New Delhi
W hat
wo
can
do ?
— Support them
— Join them
— Keep them informed about what you are doing
12
RESOURCE MATERIALS
H People, Pills and Prescriptions,
SERVICE since May-June 1984.,
i; Objectives of the Workshop,
column in MEDICAL
a handout.
H Understand ic the Drug situation in our Hospitals,
a chock list.
Towards a People-Oriented Drug Policy, Special
Convention Issue of MEDICAL SERVICE (October-November
1984) and a supplement to this issue will be
distributed during the Workshop.
ii Drugs awareness and Action, mfc BULLETIN Special Issue
No.107 November 1984.
;; DECCAN HERALD Supplement on the Workshop.
OOOOOOOOOOOOOOOOOOOO CO. .OOOOOOOOOOOOOOOO
"What people really need,
first
and foremost is clean drinking
water,
latrines,
school and
land, not urban hospitals with
their wonder drugs".
— Planning Commission
AN INSPIRATION
13
Reading
The story of the sickman
at the pool of Bethsaida
John 5s
1-9
Refltaction
The action of Jesus in bypassing the pool is an
invitation to us to look more critically at
our own health care system. Thanks to our
emphasis on curative health care, v/e have grown
accustomed to thinking solely in terms of the
health needs of the individual rather than addressing
ourselves to the community as a whole. While
concentrating on the symptoms, we have failed
to take into account the environment and other
social factors. Poor sanitation, polluted water
supply, the superstitious beliefs and taboos
of the community are also related to sickness and
disease.
Further, the miraculous pool in its ineffectiveness is
a symbol of our own ineffective health care system
despite the highly qualified doctors and nurses,
well equipped private and public hospitals, medical
research centres and multinational drug industry.
The poor man in the gospel story lived very close to
the pool, yet he was helpless because of his
poverty. In like, manner the poor in our midst
remain helpless in the shadow of an expensive,
curative health care system that is geared
exclusively to the service of the rich.
Source: The Bibles Aspirin or Dynamite
by Cedric Rebello s.j.
;t)K - 3s '>
THIS MONTH'S CIRCULATION OVER 7500
Further Victory of
Addcco Workers
After six months continuous
struggle, workers of Addcco
Ltd., Calcutta, once again have
come out victorious by defea
ting the designs of the manage
ment.
Last year, Addcco workers
had to resort to indefinite
strike for long seven months
and ultimately compelled the
management to enter into a
settlement. At that time it
wa^^utually agreed that com
plete charter of demands
would be settled this year. To
Biological
Evans Staff &
Workers Union ami FMRAT
arc preparing for
launching
movement jointly. In this re
gard a meeting will be held at
Hyderabad shortly.
Biological Evans Staff &
Workers Unions has been
reorganised recently under
the banner of CITU. Tn a large^Battended gate meeting at
the Company’s
Hyderabad
factory, N. Bhaskara Rao, the
President oflhe Union, decla
red to launch struggle in case
the management refuses to
settle all demands of the wor
kers amicably. The issue of
victimisation of large number
of factory workmen is pending
for long. Workers’ legitimate
ciaims for wage ievision, the
problems of contract workers
and the issues of medical re
Tn May last, FMRAT deNeo-Pharma
manded
of
management to lift lock-out
of its Bombay factory and
reinstate all dismissed medical
representatives. Management
agreed for preliminary dis
cussion with the General
Secretary of ATCAPEF. Accor
dingly, preliminary discussion
was held at Calcutta on July
13 last. Three representatives
of NPGCE Union also accom
panied the General Secretary.
From the beginning, it was
clear that the management was
not interested for a negotiated
settlement. None from the
head office management came
to participate in the discuss-
avoid a fresh settlement, the
management imposed illegal
lock-out in the factory. The
employees in depots and sales
offices resorted to indefinite
strike, in protest. FMRAT ex
tended all support.
Organ of deration of Medical Representatives’ tociate of India
July I98X
One dismissed employee was
also reinstated.
On. behalf of
Addcco
Employees’
Ltd.
Unions, apart
A settlement was signed on
15 July last, lifting the six
months’ old lock-out and call
ing off the strike by the work
ers in depot and sales offices.
An agreement has been signed
on financial benefits also for
the workers in the factory,
presentatives are also to be
settled. N. Sreeramamurthy,
Vice-President
of FMRAT,
also addressed the meeting.
The Company concentrated
their attacks on the field. Field
workers were transferred arbi
trarily, work was suspended,
charge-sheets and warning
letters were issued. The Com
pany refused to pay revised
financial benefits to the field
w'orkers, who are the active
functionaries of FMRAT, and
refused to grant leave to the
council conveners preventing
them from attending all-India
meetings.
In the meantime, it is re
ported that T. V. Srinivasan
has settled the issue of his
termination of services with
financial compensation.
The
affiliated
units of
ion. They deputed a petty
officer, the divisional manager
at Calcutta, to meet him. This
officer of the Company also
came one hour late. In this
meeting, the management in
formed that the lock-out was
lifted on 12 July and they
were prepared to reinstate the
medical representatives .on the
basis of their individual under
taking. The question of under
taking by individual field wor
ker did not arise and there
fore was rejected.
The General Secretary of
AICAPEF proposed lifting of
lock-out, reinstatement ol vic
timised medical representa-
For internal circulation only
fiJdand for casual workers.
from
ER
8S THE DR
other
office bearers of the Union,
Com. Prabir Sengupta,
Editorial
the
Minister of State lor Labour
of West Bengal Government,
signed the settlement as the
President of the Union.
FMRAT. and its local units
from different parts of the
country sent demand letters.
Andhra Pradesh Medical and
Sales Representatives Associa
tion has launched postering
campaign. A massive demontration was held in front of
' Company's conference at Kan
pur and deputation met at
Lucknow. A mass deputation
of Maharashtra Sales and
Medical Representatives Asso
ciation met
the Divisional
Manager of the Company at
Amravati and lodged protest.
FMRAT already alerted its
units throughout the country
to prepare for
intensive
struggle.
Tn this context a joint mee
(ting between the Union and
jFMRAT at Hyderabad is
ssignificant.
lives; the opinions in respect
Drugs and Cosmetics (Amendment) Bill, 1982 may come up
for discussions in the current session of the Parliament. In the
statement of objects and reasons, placed in the Parliament on
-’0 April, fiie Health Minister Sri. B Shankarannnd admitted
that “The problems of adulteration of drugs and also of pro
duction of spurious and sub-standard drugs are posing serious
threat to the health of the community". Cut, a closer scrutiny
of the proposed amendments do not show that the Government
is determined to weed out this menace in the society. Further,
it hardly makes any difference in the situation by mere amend
ments of 1 iw unless there is an effective administrative instru
ment guided by determination and political will to correct it.
T he amendments suggest that any person found manufactu
ring adulterated and spurious c’rugs, which when used is likely
to cause death or likely to cause such harm as would amount
grievous hurt within ths meaning of section 320 of the I P.C
is punishable with imprisonment for minimum 5 years and a
fine of Rs 10,000/. ft is interesting to note that simply for
producing adulterated or spurious drugs will not make the
manufacturer liable for such punishment unless otherwise it is
proved that it actually caused or was going to cause death or
it caused or was likely to cause grievous hurt. Tn such cases
charges may be framed under existing criminal laws for more
stringent punishment than what has been proposed in the
amendment.
The existing situation in respect of prosecutions for manu
facturing spurious drugs can best be revealed from a study
reported in a paper in the seminar on drug industry held in
New Delhi in November 1931. It reported prosecution procee
dings under Drug Act from Madras as follows :
Year
No. of prosecution
launched
1978-79
One
One convicted to pay a fine
of Rs. 1,500/- with simple
imprisonment til! rising of
the courts
1979-80
Four
1580-51
One
Only one was convicted
with a lesser punishment
Acquitted.
Results
of production and marketing
of various products can be
recorded by the Union and the
management in the agreement;
opinion may be sought jointly
from the drug control autho
rities as far as the promotion
of alleged misbranded drugs
are concerned. The manage
ment raised the issue of refu
sal by the medical representa
tives to carry out Company’s
order. It was told to them that
all lawful and reasonable
orders of the management will
be carried out by the medical
representatives. However, it is
Even with! > the present frame-work of the Act, the manufac
turer of a sub standard drug can be prosecuted and punished
Continued on Page 2
Continued on Page 2'
In respect of sub-standard drugs the reluctance of th.Government to punish the culprits is appalling Recently, the
Deputy Minister for Health and Family Welfare, Miss Kumud
Joshi informed the Parliament that <m an average 17.5 per
cent of the drugs manufactured and sold in the country during
last three years were found to be sub-standard. Gn further
study it will reveal that major quantity of those drugs were
produced by multinationals'and so-called reputed drug firms
At this rate around Rs. 600 crores of sub standard drugs were
sold during last 3 years without the knowledge of the prescri
bing doctors and their ailing patients. The proposed amend
ments in the Drug Act docs not suggest any effective step to
prevent this trend.
•2.
FMRAI NEWS
Editorial
Continued from Page 1
upto 3 years of imprisonment or fine or both.
But. not a
single drug manufacturer was prosecuted or punished on these
charges.
Apart from producing spurious, adulterated and sub-standard
drugs, the manufacturers are happily producing drugs without
valid licences which is punishable under law with 1 to 10 years
of imprisonment ( which is now being amended from 1 years
to 3 years of imprisonment). In a written statement in Rajya
Sabha on 19 July 1982, the Utfimrdffiaister of State for Petro
leum, Chemicals and Fertilizers, Mr. Ualbir Singh, admitted
that Pfizer Ltd., the U. S. multinational, is producing 31
drugs like Becosule capsules, Multi-Vitaplex Forte capsules,
Terramycia capsules etc. without any valid licence and autho
risation. Glaxo Laboratories, the British multinational, is
producing 26 drugs followed by Warner Hindustan, the U. S.
multinational, producing 23 drugs without valid licences. The
Minister further admitted that such instances had been noticed
in the case of a number of other drug companies also. However,
\ Government failed to take any effective step against these
' companies.
\ Drug peddling is not permitted under law. But, it is a
common practice of the industry. Motor vehicles are often
found loaded with ready stock of drugs of a particular company
and moving from place to place, particularly in the villages,
peddling drugs from shop to shop.
Drugs and Magic Remedies (Objectionable Advertisements)
Act provided punishment, as cognizable offence, for any person
resorting to advertisement direeity or iuuir.ctly giving false
impression regarding the true character of the drug, false
claims or misleading documentation, i.ui, it has become a
common practice of the drug manufacturers to resort to exac
tly such objectionable advertisements, a detailed memorandum,
enlisting such malpractices of the drug manufacturers, was
submitted by FMRAI to the then Petro-Chemical Minister
■.and the Health Minister in 1978. A thorough enquiry was
■demanded on these issues. But, the Government does not show
any will to combat such situation.
As per this Act oral adver
tisement with the help of a folder is not permissible.
It is
statutory obligation on the part of the urug manufacturers to
place the facts in respect of a drug in printed literatures to
be handed over to medical practitioners.
,nis legal obligation
is being grossly violated by most of the drug firms now
nning in 1973 with Glaxo Laboratories,
begi
ihe Government
refused to take notice of such developments.
Spurious and adulterated drugs are produced, huge quantity
of sub-standard drugs are sold, drugs ■ are produced without
valid licence, drug peddling and objectionable advertisements
bare become common
practice in the industry to-day.
situation is wors ning day by day.
The
Mere amendments of few
clauses of some laws are not going to remedy the situation.
Only powerful democratic movement involving the broadest
sections of the people can alter it and bring changes for the
interests of the suffering humanity for whom the drugs are
supposed to be produced.
Neo-Pharma Refuses Amicable Settlement
Continued from Page 1
obligatory on the part of the
management to clarify legal
positions. The management
requested withdrawal of all
agitations during negotiations.
The General Secretary replied
that all industrial actions un
der the provisions of I. D.
Act, like strike, can be called
off. It may be noted that few
medical representatives are on
strike demanding reinstate
ment of their colleagues.
Though management pro
mised to inform AICAPEF
General Secretary about their
IDIFOBD MANAGEMENT
DECEIVES
HELD WOSKERS
A cyclonie-storm alongwith
incessant rain on 3 June 1982
caused severe damage to three
coastal districts of Orissa i.e.
In West Bengal the field
Cuttack, Balasore and Puri.
workers of Fulford (I) Ltd.
The casualties to human life
(Earlier known as U.S. Scher
has exceeded two hundred and
ing) organised in councils and
thousands of people have been
are fighting for their justified
rendered homeless. There has
demands under the banner of
been wide-spread damage to
WBCRU. Being alarmed, (he
vast areas of agricultural land
management evolved a novel
because of the inflow of tidal
plan to cheat the medical re
water. Many villages still representatives of the Company.
I main water-logged.
they issued a fake circular
through one N.N. Naidu ask
Our Union has given a call
ing the representatives to join
to its members to donate toa non-existent union by sen wards relief fund. Rs. 1200/ding Rs. 5/-each.
has already been given from
the Working Committee mee
ting at Madras being held by
end of July. Presidents and
Secretaries of all affilated units
have been invited.
Committee of Unions and
Associations. A team from the
above organisation including
two of our members and a
team of doctors went with
relief materials and medicines,
mainly collected by our mem
bers, to some of the affected
areas on 24 June. The extent
of damage is such that relief
work is likely to continue for
months.
Under such circumstances,
we appeal to all affiliated units
of FMRAI to donate to the
relief fund. The contribution
may be sent to the Genial
Secretary of our Union.
General Secretary
Field workers, placed in our Union’s fund towards re
Orissa Sales Representa
distant places in the country lief operations carried on by
tives Union
and being eager to join their the member unions of the
Kesarpur. Cuttack-753001
comrades for the purpose of Cuttack City Co-ordination
job security and improvement
in service and working condi
FMRAI PUBLICATIONS
tions, often become victims of
such mischievous elements.
No. of copies
Some individuals, groups and
available on
vested interests extracted huge
Price
1-7-82
amounts from the field wor
kers in the name of union 1 FMRAI 12th G.C. Meeting
Documents
98
Rs. 6.00 per copy
and thereafter
disappeared.
Management also
started 2 Closure in drug industry
(a note published during
sponsoring such fake and nonNew Delhi Drug Convention)
346
Re. 0.50 per
existent organisation to isolate
the Company's medical repre 3 Constitutions of FMRAI
145
Re. 0.50 per copy
sentatives from the mainstream 4 27-Point C.O.D.
38
Re. 0.50 per copy
of the movement.
5 Multinationals in Drugs &
Pharmaceutical Industry
FMRAI coutions all field
(AICAPEF Publication)
28Rs. 3.00 per copy
workers to remain vigilant
jg
against these mischievous ele 6 Legal Notes No. 1
Re. 0.50 per copy
(High Court Division Bench judge
ments and not to join “any
ment in Andhra Pradesh holding
union or organisation” with
that under Shops & Establishments
out consulting FMRAI and
Act in Andhra Pradesh, Appellate
its units.
authority has the
jurisdiction
to adjudicate Medical and Sales
Representatives issues)
TERMINATION WITH
RETROSPECTIVE EFFECT
Chelsea, a small drug com
pany of Bombay, terminated
the services of a medical
representative by a letter dated
17 May with retrospective
effect of 31 March 1982.
opinion in respect of his pro
posals within 22 July, they
failed to do so indicating that
they are not interested for
amicable settlement.
FMRAI called emergent
zonal meeting of eastern zone
for effective mobilisation to
carry forward the struggle and
will take further decision in
an appeal
NO EXPLANATION
“No explanation whatsoever you give will be accepted.
Let me tell you clearly that if
the sales picture is not chan
ged within December, 1981 we
will all find ourselves in
difficulty.”
—Quotation from a circular
of the General Manager of
Raptakos Brett to the Medical
Representatives.
7 Legal Notes No. 2
813
(Meher Tribunal Award in
Maharashtra holding that Medical
and Sales Representatives are
“Workmen” under I. D. Act)
8 Legal Notes No. 3
(Kerala Tribunal Judgement
holding that the Medical Repre
sentatives are “Workmen” under
I.D. Act and Residences of Area
Managers are establishments of
the Company)
929
9 Legal Notes No. 4
928
Re. 0.50 per copy
Re. 0.50 per copy
Re. 0.50 per copy
(Judgement of Labour Court at
Patna holding that under SPE Act,
Labour Court jurisdiction is the
place where the employee works.
Scooter Allowances, Daily Allow
ances, Incentive amounts are not
part of wages)
Send requisition to FMRAI Publication, IE, Rajendranaga
Patna-800016 with advance payments including postage
’
FMRAI news
ORGANISATION
A^NLLA^ GENERAL BODY MEETING OF Maha-
At the close of the workshop a largely attended, general
meeting was held, which was addressed by the general
secretary of FMRAI.
a eS & Medical Representatives Association was
at Nagpur on 11 July iast. Large number of
delegates and observers from Ahmed nagar, Bombay,
.
olhapur, Aurangabad, Pune, Nanded, Solapur and
_ i arbha units participated in the meeting. Members
irom Akola and Anravati also came to attend this
meeting. The General Secretary’s report recorded rich
and ratied experiences from both national and inter
national events. The report noted the existing situation
in drug industry after 34 years cf independence parti
I
I, UPMSRA, AGRA UNIT ORGANISED a Special
Session of the General Body on 9 July last. The
meeting was attended by the General Secretary and
Zonal Secretary of Zone-II of FMRAI and General
Secretary of UPMSRA.
I
| ALL INDIA MEETING OF CONVENORS OF
SARABHAI field workers councils was held at Patna
on 6 July. Serious discussions took place and decisions
were taken to organise councils in unorganised areas.
Efforts will be made to organise councils in the Sarabhai group of companies.
cularly production of non-essential drugs and cut in
production of essential drugs, high profitability, multi
national strangle-hold, promoting banned drugs and
corrupt practices in sales promotion, sale of irrational
drug formulation, spurious and substandard drugs etc.
"Sjie report noted the rising voice of the workers of the
industry including the medical and sales representatives
against such a situation.
The cottference of All India Federation ofSarabhai
Group Employees was also held at Patna from 5 to 7
July. Large number of units from different parts of the
country participated in the Conference. The meeting
elected George Verghese, Secretary of FMRAI, as the
President of the Federation and re-elected S.R. Banerjee
of Kanpur office as General Secretary. The meeting
decided to publish a periodical journal “Sarabhai
Worker”.
The report recorded significant development in respect
of 19 January Strike and successful participation of
Bombay unit and the members of other places in the
strike. The report highlighted the demands of the
N.C.C., 27 point C.O.D. of FMRAI and participation
of members in pursuance of these demands.
On 6lh. evening a joint meeting with FMRAI office
bearers took place. It was decided to launch joint move
ment in pursuance of the demands of field and office
workers. The field and office woikers of Sarabhai will
submit memoranda separately in the respective divisional
office. The field workers of Sarabhai are demanding
recognition of All India Grievance Committee, statutory
bonus and reinstatement of George Verghese and
supporting the demands of the office workers. The
office workers are demanding cuangc in distribution
policy, settlement of their charter of demands and also
supporting field workers demands.
The report was adopted unanimously with all round
support of the members and resolved to make MSMRA
a stronger force. The office bearers of the Association
was elected unanimously with K.K. Chaturvedi as Presi
dent and R. S. Rane as General Secretary.
J
| ANNUAL GENERAL BODY MEETING OF MSMRA,
Bombay Unit was held on 13 June with record attenc^dance of members. The President in his address poin
ted out the deepening socio-economic crisis and the
necessity for the wotking class to unite and struggle.
The General Secretaiy of Warner Hindusthan Employees
Union, Secretary of AICAPEF (Maharastra Branch),
Secretary of FMRAI and the President of IMA
(Bombay Branch) addressed the members. A condolence
resolution was adopted on the demise of Com. Suresh
Ganguly. By another resolution the meeting supported
NPGCE Union in their struggle. The meeting elected
R. S. Rane as the President and Subhas Para as the
Jointly demonstrations will be held in front of all Sara
bhai offices in August and massive Dharna will be
staged on 6 & 7 September.
| AS ER DECISION OF THE ALL INDIA MEE
TING of Convenors, Vice-President and General Sec
retary of East India Phaimaceutical Works Employees
Union visited Lucknow and Patna. They attended and
reorganised EIPW field Workers council which was atten
ded by UPMSRA leaders. Successful council meeting
was also held in West. Bengal. The Annual Genei al
Body Meeting of the Union will be held at Calcutta on
15 August and the all India Convenors meeting will be
held on 16 August.
|
' General Secretary.
|------- 1 UTTAR PRADESH MEDICAL AND SALES REPRE
SENTATIVES ASSOCIATION organised two days’
•workshop for the trade union functionaries at Gorakh
pur on 2 and 3 July. Twentyfive cadres participated in
the workshop. Members discussed the historical deve
lopment of trade union movement in the international
and national level, the contribution of the working class
in the national independence movement and subse
quently in the post independent period and the tasks
before the working class.
Members also discussed
about the necessity to carry forward the struggle
objectively taking into consideration the subjective reali
ties. Discussion took place on the perspective of the
movement, sccterianism and the tendency of class colla
boration, democratic and collective functioning. While
discussing immediate tasks, emphasis was given to deve
lop programmatic unity on the basis of declared policies.
Discussion took place on the nature and forms of move
|
| ALL INDIA CONVENORS MEETING OF BOEHRI
NGER KNOLL field workers councils will be held at
Jabalpur on 13 August.
|
| WORKING COMMITTEE MEETING OF FMRAI
is being held at Madras on 29 and 30 July. Presidents
and General Secretaries of all affiliated units have been
invited to attend.
I
I SOUTH ZONE ORGANISATIONAL CONVENTION
OF FMRAI will be held at Ethiraja Kalyanmandapam,
Madras on 7 & 8 August in a massive scale. Zonal
meeting of the field workers of 46 companies have also
been called simultaneously on 7 August at 3.00 P. M. at
ment, labour laws etc.
The workshop noted that it is only a begining.of self
education of the cadres for converting the hetrogenous
mass organisation into a well-trained cadre based
organisation, unified with clear understanding of
declared policies and programmes of the organisation.
advances
the same place.
afternoon.
|
A Convention will be held on 8 August
| BIDDLE SAWYER Management had in the month of
April this year transferred Com. Ramanujam from
Madras City to Gwalior, Com. Daya Prasad from
The Workshop created much enthusiasm amongst the
participants.
Continued on Page 4
Abbott Signed Agreement
With Union tor Field staff
Consequent to reinstate
ment of R. G. Michel, General Secretary of Abbott Labo
ratories Employees . Union, a
settlement was signed between
the management and the
Union in respect of five medi
cal representatives.
M. A.
Faki and R. Behl of Bombay,
S. K. Roy and M. K. Roy of
Bihar and V. Ramachandran
of Tamilnadu refused to fall in
line under pressure of the
management and refused to
sign any agreement imposed
by the management through
Abbott management’s repre
sentatives council.
Clause 5 of the agreement,
signed by the Managing Direc
tor and Director Personnel on
behalf of the Company and
the President and General
Secretary of the Union on be
half of the five medical repre
sentatives, states that the five
inedical representatives will
get the revised service condi
tions as applicable to other
medical reprefentatives of the
Company with retrospective
effect.
The terms of the
settlement means that these
five medical representatives
will enjoy the financial and
other conditions of service as
applicable to other representa
tives, without any discrimina
tion, but their bargaining
forum shall be Abbott Labo
ratories Employees Union as
the union representated the
five medical representatives
and the management accepted
this position through this
agreement.
0 July Profesi Day
Successfull programme of KCC
After 19 January successful
strike, the workers of the coun
try responded in a massive way
to the call of National Cam
paign Committee to observe
Protest Day on 8 July, the
opening day of the Parliament,
to lodge the protest of the wor
king class against the anti
labour provisions in the pro.
posed amendments in Indus
trial Dispute Act, Pavment of
Wages Act, Indian Trade Un
ion Act and the Bill for hos
pital and educational institu
tion employees. A massive
demonstration was staged in
front of the Parliament and
gate meeting, street demonstra
tions and mass meetings were
held throughout the country.
In many places, workers wore
■ black badges. Thousands of
leaflets were distributed and
. massive postering was done
exposing the anti-labour poli
cies of the Central Govern
ment.
FMRAI units are already
the constituents of the state
and district campaign commi
ttee, Large number of field
workers participated in this
campaign in various parts of
the country.
FMRAI NEWS
NEWS IN BRIEF
Demonstration Against
Themis
On 12 and 13 July Themis
management called a sales
meeting of held workers at
Patna. On 13 July a militant
protest demonstration was
staged by BSSR Union mem
bers. A memorandum was
submitted.
Earlier, protest
demonstration was staged in
front of distributors’ office of
the Company on 28 June.
Themis field workers protested
against
increasing clerical
work; they formed a council,
endorsed FMRAI C.O.D. and
decided to
contribute to
the struggle fund of Themis
workers in Bombay.
opposed 19 January strike and
collaborated with the manage
ment
openly.
FMRAI is
determined to carry forward
struggle shoulder to shoulder
with the Union for common
interests of the workers.
Nggotiation in Rallis
Negotiation on charter of
demands of the field workers
of Rallis has started on 9
July between the management
and Rallis Group of Employees
Union. The next round of
discussion will lake place in
August. FMRAI extended
full support to the Union in
this respect.
Reinstatement in Services
Management of T. T. K.
terminated the services of a
probationer field workers in
West Bengal. WBCRU staged
’(a dcmcnsiration in front of
■‘U.ud vl
c
Bombay. AICAPEF, Mains ■ the place of Company’s con
rastra Branch started collec ference at Calcutta. Conse
ting fund in support of The quently management reinstated
mis workers. Emergent coun and confirmed him in services.
Madhya Pradesh Medical
Representatives’ Association
printed struggle coupons and
contributed to the struggle
cil meeting was held in U.P.
Government Refuses
Licence to Themis
On representation by AIC
APEF, Central Government
assured that no licence will be
granted to Themis. The appli,
cation of Themis to shift their
factory from
Bombay to
other part of Maharastra was
rejected. The Labour commi
ssioner of Maharashtra, con
sequent to the failure of his
effort for an amicable settle
ment for opening the factory,
sent his report to the ministry
for take over of the manage
ment of Themis by the central
govt, under Industrial DeveTopment Regulation Act. The
Government of Maharastra has
not sent any teport to the
Central Government, a high
official of the central Govt.
informed.
Latte Realisation by
Eastern Drug
Support to Steell £nd Coal Workers
Grievance Committee
Meeting in Bengal
Chemical
Subsequent to all-India
Grievance Committee meeting,
State-wise Grievance Commi
ttee meeting has started tak
ing place in Bengal Chemical.
One of such local Grievance
Committee meetings was held
at Patna on 5 July which was
attended by the head office
and local management, All
India, Zonal and State Con
veners, Joint Secretary of BSSR
Union and the Secretary of
the local BCPL Union. The
discussion took place objecti
vely. Such local Grievance
Committee meetings
took
place in West Bengal earlier
and is scheduled to lake place
at Jaipur and Cuttack. If all
public sector
undertaking
tlmaienea them,
terminated
their services and compelled
some to ‘resign from council.’
This infurated the members of
BSS4 Union and they decided
to wipe out the Company’s
business in Bihar. OSRU and
WBCRU
also
extended
support. Within few months
the mamgement realised this
situation and met BSSR Union
leaders several times. The
agreement was arrived at
Change in Leadership of
through discussions in the
BJ. Wortcers (Inion
BSSR Union office. The
In an election on 30 June, management gave assurance
the discredited leadership of to the Union not to interfere
Bengal Immunity Workers * in the union activities cf the
Union was d.le.uid by an members, reinstated the victi
mised employees and settled
overwhelming majority. Saroj ‘
other disputes. Union assured
Bhattacharya and Debabrata
the management that in con
Basu have been elected as
ducting their normal business
President and General Secre
activities they will get co
tary of the Union respectively.
operation of the Union in
The past leadership of the accordance with its declared
Union opposed
FMRAI, policies.
affiliated to the Central Trade
Unions in the National Cam
paign Committee, participated
in this convention. FMRAI
unit in Bihar extended all
support for the success of this
convention. Similarly,
big
prepration is going on at
Dhanbad for the convention
of coal workers. BSSR Union
is in the reception committee
and is contributing its might
for
the success of this
convention.
Histone Strike of University Teachers
Social forces arc throwing
all sections of democratic
people into militant struggles.
The recently concluded prolon
ged historic strike of the Uni
versity Teachers in Bihar
proves the point. On 79ih.
Day of their strike on 29 June
last 10,BOO University Teachers
staged demonstration in front
rain. The teachers werex.-n in
definite strike from 12™>pril
managements in drug industry
of t’.c Aaicaiblj. They walked
boi.jit— .v sp< *. —■.. I..
take such a positive stand, the
situation is bound to improve
in public sector.
in scorching sun and in heavy
of the country.
Settlement: of Pfizer
Workers
It became a common prac
tice of the management of
Eastern Drug, Calcutta to
recruit medical representatives
and thereafter terminate their
services after few months. The
field workers of the Company
in Bihar organised a council
to conduct their legitimate
trade union activities. Manage
ment called them in Calcutta,
National Campaign Commttee decided to hold industry
wise conventions of core
industries in public sector and
thereafter a general convention
of the public sector under
takings. Accordingly, a con
vention was held in Bhopal
forBHEL. The steel workers
met at Bokaro in a Convention
on 17 and 18 July. The assem
bly is the biggest in the history
of the united movement of the
steel workers. The unions,
After protracted negotia
tion and struggle with historic
Ill days indefinite strike, the
Pfizer workers entered into an
agreement with the manage
ment on 20 June last. Effective
from 1-1-1982 the rate of
yariable dearness allowance
has been raised to 5% from
2|4%. This is a major gain for j
t’hc .vorkmen in tile Company.
A final settlement is being dis
cussed and will be signed
shortly.
TOP 1© MONOPOLY HOUSES
13th. general council
MEETING OF FMRAI
AT
BARABATi STADIUM
CUTTACK
ON 8
9 OCTOBER 193S
. .
graphic
'
received
message
from
tele
All
India Convener of F. D. C. that
their C. O. D. and grievances
have been settled. Details arc
awaited.
,
O R G A NIS A TIO M A D V ANGES
COD of FD£ Fieidworkers
have
,
Continusd from Page 3
The second round of nego
tiations on the charter ofdemands of the F. D. C. field
workers is taking place al
Trivandrum on 23 and 24
July. The Grievance Commi
ttee meeting will also take
place simultaneously.
We
.*■--
1.
Tata, 2. Birla, 3. Mafat- dustan Liver, 13. Larsen Tom
lal, 4. J. K. Singhania, 5. Thabro, 14. Scindia, 15. Modi,
par, 6. TCI, 7. Sarabhai
16. TVS lyenger, 17. Mahin
8.
ACC, 9. Bangur, 10. Shri dra & Mahindra, 18.
Ram, 11. Kirloskar, 12. Hin gule, 19. Bajaj.
Negotiation in F. D. C.
Settled
and started courting arrests
from April 22. Never before
the teachers got such sym
pathetic support from all sec
tions of the people. The
teachers of Bihar are joining
the main stream of the democ
ratic movement
which is
Madras City to Jabalpur & Com, Aswani Kapur from
Delhi City to Nasik. Agitational programmes were
taken by TNMSRA & DSMRA. A massive demonstra
tion was held on 14th June at Delhi where the Com
pany’s conference was scheduled to be held, the Com
pany hurriedly shifted the venue of the conference to
Ludhiana. There also a mass deputation ’ met the
management and the Biddle Sawyer field workers
boycotted lunch and tea in protest. Later in the
joint conference of U. P. & Bihar field workers of the
Company held at Lucknow a memorandum was submi
tted by UPMSRA in a mass deputation and the field
workers of Bihar and U. P. boycotted lunch in protest.
Prior to this FMRAI had held discussions with the
management but the management retreated from the
agreed formula. Management retreated even from-the
commitment of the Grievance Committee which was
accepted on principle by them earlier.
It was unfortunate that when TNMSRA had taken up
the issue and when the negotiations were in progress
both the representatives of Tamil Nadu negotiated on
their own with the management. This encouraged the
management to retreat. However, FMRAI. W. C. will
be discussing the issue and take up future programmes.
Published by the General Secretary of the Federation of Medical Representa tive’s Associations of India from 1-E, Rajendranagar, Patna-16 and Printed by
Roy Printing Works, Langartoli, Patna-4
PANEL ON PRUDENT ANTIBIOTIC USAGE
IMA - 1990
ANTIBIOTIC -
I.
RESISTANCE
Microbiology
■
Briefly describe
antibiotics?
How
a
resistance
acquires
microbe
to
Pharmaco1ogy
«
»
How could we
limit the emergence of resistance? ' flo'i_c<VvZi<_ '
Fediatr ics
Medicine
What are the problem areas
sistance microbes?
in
current
practice
due
to
re
Pharmaco 1 ogy
■
How does clavulanic acid improve
and amoxycillin (Augmentin)?
the efficacy of
ampicillin
Medici ne
•
Can we use this combination in place of Ampici1 1in/Amoxyci1lin on a universal basis?
Microbiology
How has. staphylococcus responded
lactamase resistant penicillins?
to
our
efforts
at
beta
Pharmaco1ogy
What is the significance of MRSA
staph aureus) in planning therapy?
(methicillin
resistant
a
practical
Med i c i ne
Compare
sense.
and
contrast
Ampici11in/Amoxyci11in
in
Can Augmentin be used in MRSA infections?
Relative place
and Amikacin.
of
Aminoglycosides
Gentamicin,
Netilmicins
Medicine
Current place of NALIDIXIC ACID in therapy.
• ®
Pharmaco1ogy
Disadvantages of quinolone drugs.
Weakness of I I I gen. cephalosporins.
Med icine
How wouId you rate newer quinolone and
s in clinical practice?
Ill
gen.
cepha1ospo-
M i crob i o1ogy
»
What are the trends in microbial resistance to aminoglyco
side, quinolone and cephalosporines in the west and in
I nd i a?
II.
ANTIBIOTICS
1.
Upper Resp i ratory Infect ion
IN PRACTICE
With our limited LAB facilities, how can we prescribe anti
biotics rationally in URI - (Drug, Dosage, Duration)
- Pediatrics
- Medicine
• in children
• in adults
2.
How & when will
you use antibiotics
“ in chi 1dren
• in adults
9
3.
Acute UT1
■inmales
'W
-Medicine
4.
Prudent management of chronic or persistent UT1
- Med i c i ne
5.
Surgical lesions causing UT I
- Surgery
(What to look for & whom to screen)
6.
Skin infections
•
#
- Pediatrics
- Med i cine
-in females of reproductive age - group
- Obstetrics & Gynecology
. ”
®
in LRI
■
•
■
■
■
Impetigo
Recurrent furunculosis
Cellulitis & Carbuncle
Animal & Human bite
Traumatic wound
-
Pediatrics
Medicine
Surgery
Medicine
Surgery
7•
Surgical
a)
b)
c)
d)
Necrotising fasciitis
Diabetic foot infection
Compound fracture
Osteomye1itis/Septic arthritis
8.
GIT
a)
Does antibiotics reduce severity of diarrhea?
- Pharmacology
b)
Indications of antibiotics in diarrhea
- Medic i ne
■
c)
Antibiotic associated diarrhea
lesions
• Aetiology
• Therapy
d)
Surgery
Surgery
Surgery
Surgery
Ped i atr i cs
- Microbiology
- Medicine
Resistant typhoid
- Microbiology
■ adults
- children
- Medicine
- Pharmacology
e)
Is Campylobacter species
- Microbiology
f)
How will you diagnose it?
- Microbiology
g)
How will you treat it?
- Med i c i ne
9.
Meningitis
Organism not known or
• children
■ adults
10.
-
important in South India?
identifiable - How will you manage?
- Pediatrics
- Medicine
Antibiotic Prophylaxis
■ Surgical
■ Infective
Endocard i t i s
- Surgery and Obstetrics tx Gynecology
- Medicine
For further information contact!▼•luntary Health Association of India
C-14, Community
ABOUT DRUGS
New Delhi-110016.
Inspite of the green revolution, white revolution, industrialization,
modernization and development, the country's increase in CNP(Gross National
Profits), most of these things have not touched that man who hangs helplessly
below the poverty line.
The irony of all .our great development is that
the number of such people who are becoming destitutes is increasing.
Frcm 27 we can now boast of 229 Medical Colleges (Karnataka is planning' to
make a humble contribution and add/to that list).According to
VWs reco
mmendations our doctor population ratio is above the requirement. Cur
Pharmaceutical Industry is amongst the best in the Third World. The state
spends Rs. 9 per person per year on health. Why then do we still have such
a high incidence of malnutrition? high infant mortality?
Why are there
sti11 10 million IB patients when we have crores being spent on the National
IB Programme.? Why do 27 mil lion Indians get Typhoid every year? 6 out of
100 children, are in potential danger of becoming blind with Vit. A deficiency.
Why is it that the great majority
of our population has no access to basic
health care? 80$ of our doctorsSniOur health budget cater to the needs of a
..small minority.
Drug costs represent 40-60$ of the total health care expenditure in the
developing countries (compared ;wi!th 10—20$ in the developed ones).
The rural urban disparity when it comes to health man power allocation
expenses on drugs, vaccines and other health services is in simple words
UNJUST. Only a very meagre percentage of Rs. 9 alloted per person for
health expenditure reach him, who forms our 'Millions’.
VHAI believes in making health care available to those who need it most.
Orientation towards "appropriate use of drugs" and non drug therapies is not
merely for those who are given the prescriptions, but also for those who do
the prescribing.
A prescription written with the high medical standards in
mind, may be highly inappropriate in a social context where the patient
cannot afford to buy the drugs, or where buying these drugs for the family
memoers means being in and out of debt with money lenders.
Our prescript
ion practices have to-be modified according to the needs of the people, our
choice of drugs for stocking the pharmacy have to keep this in mind and
most of all the emphasis has to be on people taking self responsibility for
their health and avoiding these drugs as far as possible and using those
non drug therapies that have been recognized to have good therapeutic effect.
Education and awareness as to how to avoid disease and then how to handle it
appropriately at the lowest possible cost is the crux of our approach in
low cost appropriate health care.
*DRUGS:
The marketing of most brand named drugs specially by the multinational in the
Third World works against the Health of the poor: (l) Most critically because Health Care'priorities are distorted by pressure to buy expensive
inappropriate drugs/which cream off limited resources, and (2) Drugs freely
promoted in the absence of distribution controls can be dangerous.
(l)
*
-
The effect of promoting th expensive, branded drugs for which generic
equivalents are available 'at a fraction of the cost (semetimes as
low as 10$), is to drain limited Health Budgets unnecessarily.
OXFAM PUBLIC AFFAIRS UNIT (21.4.' 80) '
2/ ‘
2
(2)
-
Third World countries spend a disproportionate amount on Drugs,
often as much as 555“ of the total health budget (compared to 11$
of NHS budget on drugs here). Bearing in mind the very limited
. effectiveness of drugs and curative medicine in general in tackl
ing the major health problems - malnutrition, infectious and para
sitic diseases - public funds would be far better spent on prevent-ive health measures and the basic Primary Health Care infrastruct-ure. For this, WHO estimate that 200 generic drugs would be more
than adequate to meet
Health needs.
-
The promotional practices of drug companies, aimed at maximising
profits, run directly counter to the health needs of the poorest.
Drug company salesmen (Glaxo has 500 in India alone) concentrate
their promotion on encouraging doctors to prescribe the most
expensive, latest patented drugs, claiming they are great improve
ments on far cheaper, well-established drugs.
When Beecham's and
Vfellccme's antibiotics and antimalarials are prescribed at public
expense, instead of penicillin and chloroquine, the drug budget is
rapidly exhausted. Because of existing imbalances in the -he.alth
services, reinforced by marketing, the brunt of wasteful spending
invariably falls on the poorest, as the rural dispensaries run
short of vital life-saving drugs.
-
Apart- from promotion of unnecessarily expensive , but necessary
drugs, doctors are also encouraged into wasteful overprescribing
of non-essential tranquillisers, sympton-allaying drugs, and tonics.
Onceagain, the indirect effect on the poor, is that Valium being
doled out in hospitals on public funds, can mean shortages of first
line drugs in the vill age dispensaries. Where medicines have to
be paid for, (particularly when the doctor is remunerated for
prescribing rather than consultation) - sales talk may lead him
to prescribe unnecessary drugs e.g. several courses of antibiotics
and vitamins for a sick child, costing anything up to a months
wages.
-
Drugs freely promoted in the absence of distribution controls can
be dangerous.
- ' The Lr;’’c^-c-down effects of uncontrolled drug marketing in the ab
sence of an adequate health infrastructure, trained health workers
and controls cn over-the-counter sales can seriously endanger the
health of the poor. They are most vulnerable through ignorance of
dangers and the misconception that a medicine - any medicine - will
do the trick.
-
When under attack for unethical marketing practices in the Third
World, the drug companies argue that they stick to the letter of
the law. Quite true - But, they demonstrate a total lack of
social responsibility in promoting potent, potentially dangerous
drugs, in countries .where they know they will be freely available
over-the-counter,prescribed by local practitioners and traders
with little knowledge of medicine - let alone sophisticated drugs.
(Whilst deaths frcm adverse drug reaction go unreported in the
Third World - in the USA they are estimated at 30,000 per year.)
The net effect is that the poor are encouraged to buy drugs for
totally inappropriate uses and irrational self-medication - parti
cularly of antibiotics leading to serious problems of drug resist
ance - can be fatal. First line antibiotics given to children with
diarrhoea could mean they will die later if they get IB, because
there will be no way of obtaining or paying for a second line drug.
BRIEF OUTLINE OF VHAI’S IDLE 114 LOW OQST APPROPRIATE HEALTH CARE
Regarding Drug_rel^ted_LeQsslation„at nqiion^l_levelj.
-
Forming a lobby against unethical practices of drug companies.
-
Building awareness regarding WHO endorsed code of conduct as
against that drawn up by multinationals
-
Seeking information and analysing national policies which may
have detrimental implications, specially where drug market is
concerned.
-
Linking up with medical units of various consumer societies,
other groups and individuals working on similar lines: eg. Medico
Friends Circel, Centre for Studies in Science and Environment
etc. to form pressure group.
-
Use different seminars, workshops, medical and ncn-medical journals
to disseminate relevant information.
-
Questioning drug advertisements, giving incorrect information and
making false claims.
Re_ga£ding Production-of Generic name drugs:
-
Collect information of experience regarding production of drugs
and low cost health care from other -voluntary groups and pro
grammes: eg. Savar in Bangladesh, Guatimala, Philippines, SriLanka, Medicus Mundi/Intarnational Organisation and seeing
applicability in our Indian context.
-
Encourage or collaborate in production of generic name drugs.
-
Ccnscientize people regarding quality control and demanding it
to prevent involuntarily having turning to the sophisticated
drug companies.
-
To identify non allopathic drugs : eg. de Chanes, Homeopathic etc.
of cheaper and more effective to inform others.
Regarding Distribution of_ drugs.! (which is the biggest problem for develop-ing countries)
(See appendix-1)
- Encouraging bulk purchase at regional levels
-
Helping to organize distribution channels
-
Help collect background information based on epidermiological
studies, other field studies
Re_ga£ding MaQaS^ent-Of Pharmacies!
-
Encouraging formation of pharmacy and therapeutics committee
( See appendix 2)
-
Stocking with appropriate drugs - low cost, generic, avoiding
combinations trade names as far as possible
-
Ehcouraging local preparations of liniments, ointments, syrups
and mixtures (as done by compounders earlier)
2/
2
-
Helping in appropriate pricing of treatment (registration,
consultation and cost of drugs)
-
Availability of information on all drugs dispensed with.
Regarding Dispensing_of .drugs:
-
Limiting range of drugs in the pharmacy to essential
drugs
-
Use of formulary
Encouraging use of Physicians' Desk. Reference on extra
pharmacepea and not relying on the information given by
drug advertisements and drug representatives.
-
Helping in standardization of diagnostic and prescription
procedures ( to avoid unessential and limiting procedures
to the most appropriate)
Regarding ^Education_and_gaining of_Health Personnel:
-
Collection, analysis and dissemination of relevant inform
ation to health professionals ( and public) regarding use of drugs and their substitutes - role of drug industry
in health services - use of non drug therapies : eg.
massage, acupressure, acupuncture - investigation and use
of heme remedies and other indigeneous herbal medicines
known to be cheaper and giving good therapeutic results.
-
local preparations of commonly used ointments, syrups etc.
-
planting of medicinal plants in hospital vicinity with
specific therapeutic value.
Regarding Health_Education_ pf_Pgtients :
-
Enphasis on the concept of self responsibility regarding
health
Special coverage to methods of prevention of common
diseases, eg: those due to poor hygiene, sanitation and
nutrition.
-
Information about the various govt, health programmes:
- National IB Programme
- MCH & FP
For Blindness etc.
- Immunization Programmes
-
Information regarding functions of PHC doctor, sanitary
inspector, ANM etc. for people to know their rights.
Sharing information with the people about therapies used
by them
-
-
Encouraging medically sound customs and cultural practices
- eg. use of Dathun instead of Colgate tooth paste and
discouraging the harmful ones by giving appropriate
information. eg: branding a child on the abdomen, not
breast feeding a child for 3 days..
Giving information about the misuse of - injections tonics - steroids, bottle feeds.
3/
3
Other Activities to_decrease health_care costs:
-
Training of different levels of health personnel to be able
to handle common problems as effectively and as cheaply as possible
-
Investigate role of health insurance schemes in different parts
of India and their feasibility.
-
Preparation of recommended reading list of books and material
related to low cost appropriate health care.
-
Formation of linkages with groups working on the same lines
eg: MFC, Centre of Science and Environment
-
Collaborating with groups to do scientific field studies on local
remedies, their utility value and optimum methods of preparation
(Solidarity, SIRTDO, Ranchi)
This background paper is for discussion.
------------- cOo-------------
Appendix 1
Distribution of Essential drugs in Developing Countries
Drug distribution was identified as a critical factor in health care and the
accomplishment of a comprehensive national drug policy at the consultation
and WHO Technical Discussion in 1978.
It appeared that the types of distribution systems or patterns depend
largely on the political and economic system and the administrative system
under which the Ckivt. is operating, (effective distribution of resources
depends on nation's political will).
Following were the relevant factors to be considered for any system of
distribution of drugs:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Health Care System, Demography, Health Indicators
Morbidity pattern
List of essential drugs and medical equipment
Adequate storage facilities
Administration, personnel forecasting and inventory control
Transportation facilities and maintenance service
Packaging material standardization and labelling
Quality surveillance and inspection
Education and regular training of staff
Drug utilization studies
Appendix 2
The Primary purposes of the Pharmacy and Therapeutics Committee
a.
Advisory
b.
Educational
Functions and Scope
The following list, which is not necessarily comprehensive, is often
as a guide:
A.
To serve in an advisory capacity to the medical staff and hospital
administration in all matters pertaining to theuse of drugs.
B.
To serve in an advisory capacity to the medical staff and the pharma
cist in the selection of choice of drugs which meet the most effective
therapeutic quality standards.
C.
To evaluate objectively clinical data regarding new drugs or agents
proposed for use in the hospital
D.
To prevent unnecessary duplication of the sane basic drug or its
combinations.
E,
To recommend additions and deletions from the list of drugs accepted
for use in the hospital
F.
To develop a basic drug list or formulary of accepted drugs for use
in the hospital and to provide for its constant revision.
G.
To make recommendations concerning drugs to be stocked in hospital
patient units or services.
H.
To establish or plan suitable educational programmes for the profess
ional staff on pertinent matters related to drugs and their use.
I.
To recommend policies regarding the' safe use of drugs in hospital,
including a study'of such matters as investigational drugs, hazardous
drugs, and others.
J.
To study problems involved in proper distribution and labelling of
medications for inpatients and out patients.
K.
To study problems related to the administration of medications.
L.
To review reported adverse reactions to drugs administered.
M.
To evalutate periodically medical records in terms of drug therapy.
list of relevant reading material dealing with drug problem
1.
Drugs and the Third World
Anil Aggarwal
Earthscan
Publication
International Insti-tute for Ehvironment
& Development
10 Percy Street
London - August 1978
2.
There is Gold in them
tharpills
Alan Klass
Penguin Special
1975
3.
Poor Health-Rich Profits
Dr. Tom Heller
Bertrand Russel
Peace Foundation Ltd.
Bertrand Russel House
Gamble Street
Nottingham
1977
4.
Social Audit
Insult or Inyury ?
Charles Medawar
Social Audit Ltd.
9 Poland St.
London- W1V3DG
1979
5.
Social Audit
Drug Disinformation
Charles Medawar
Social Audit
Public Interest
Research Centre Ltd.
November 1980
6.
Medicus Mundi Internationales
International
General Secretariat
Organization for
of Medicus Mundi
Cooperation in
International!s
Health Care.
Mozartstrasse i960
Documentation of
D-5100
the General Assembly
Aachen, BRD
(17-19 May 1980)
7.
Essential Drug list
8.
Drugs and PharmaceuticalChapter from "Health for
All - An alternative strategy"
WHO Technical Report 1979
series No. 641
New Delhi
ICMR & ICSSR
August 1980
9.
Hathi Conur.i ssion Report
GOI
1974
10.
Food First
Lapp© Francis
Moore and Collins
1980
11.
Medical Nemesis
Ivan Illich
2/
2
12.
Confessions of a Medical Heretic
- Dr. Robert S. jMendelsohn
Contemporary Books
1979
- Vernon Coleman
Arrow Books Ltd.
Essex
1975
- Pharmaceuticals for
Developing Countries
National Academy of
Science, Washington DC
1979
Information Sources on the
Pharmaceutical Industry
- UNIDO Guides to Info.
Sources No.20
UNIDO, VIENNA
1976
Pills Against Poverty
(A Study of the introduction of
western medicine in a Tamil
village)
- Djurfeldt, Goran
Lindberg, Staffan
Oxford, IBH
Pub. Co. New Delhi
17.
In Search of Diagnosis
- Ashwin J.Patel
Medico Friends Circle
Gujarat
18.
Planning Pharmaceuticals for
Primary Health Care
(The supply & utilization of
Drugs in the Third World)
- Oscar jish
Loretta Lee Feller
19.
Drugging the Indian
(Article in"DebanoirM)
- by Shivanand Karkal
July 'SO
20.
The Ethics of the Drug Industry
(Article in "Business India")
- by Dilip Thakore
July '80
13.
14.
15.
l6.
The Medicine Men
Conference Proceedings
1976
1977
Group Discussion on Prescribing Policy - Groups Bl & DI
Questions to be ppndered about I
1.
Can a Hospital devise a formulary of good quality,
cost medicines?
low
Can this be common for all Voluntary Hospitals?
2.
Hou can prescribers 1 compliance be ensured or is freedom
of prescribing likely to make this impossible?
Can ue ensure Health Workers' compliance uith their
formulary (medicine list)?
Will doctors also prescribe from this list?
Is it possible to prevent prescriptions to medical shops
being given?
3..
Where simple lou cost drugs uill not be sufficient, hou do l
we subsidise to all or those who need help most?
Should all patients contribute to the cost of medicines?
-If-so, how?
4,
Will a Pharmacy Committee, including Doctors, Administrators
and Pharmacists help in implementing cost control or
quality control policy? (in most Hospitals medicines are
the second largest item of expenditure'.)
5.
Have we asked our pharmacists to research costs?
does he know hou to do so?
Have ue provided tools for the job?
If so,
If so,
uhat tools?
5.
Are bulk drugs purchases possible on a group of Hospitals-base?
What methods can ue devise for obtaining lou cost drugs
either for one or many Hospitals?
7.
Do ue consider proper stock control, record keeping and
auditing of medicines, purchase and distribution:
a) unnecessary expenditure
b) essential?
What are our reasons for our attitudes?
8.
In many Hospitals the Pharmacy is an important income
producing section.
Will a suitch to lou cost drugs raise
cost or make it instead a burden on the Institution?
9.
Is the production of medicines in the Pharmacy :
a)
too time consuming
b)
too costly in terms of personnel or equipment
c)
uneconomic?
(Broadly thinking of two types: non sterile prescriptions
and sterile prescriptions)
Hou uould you advise your
Hospital Management?
Voluntary Health Association of India
C-14, Community Centre,
Safdarjung Development Area,
New Delhi-110016
Telegrams : VOLHEALTH
New Delhi-110016
Phone : 652007, 652008
The Great Health Robbeiy
Dear Friend,
The theme of the discussions at the eighth General Body Meeting of
VHAI held in Ahmedabad in April 1982 was "The Great Health Robbery
The participants identified five groups of people who were deprived
of their right to good health viz., children, women, people who need
medicines and workers. They made some positive suggestions for action
to be taken at the individual, the State and the National levels.
VHAI will be grateful for your attention to these valuable suggestions.
Your collaboration in drawing up an action plan is indispensable.
AT THE INDIVIDUAL LEVEL
Children
Children are sensitive and perceptive^ therefore, we must practise
what we preach.
Women
a.
b.
Through introspection and meditation, women must become aware
of the full potential of their own strength and spiritual power.
Women must go in for vocational skills and education and tiy to
be economically self reliant.
People who need medicine
a.
b.
As an individual to respond sensitively to the need of another
for medicine in as many rays as our personal resources make
it possible.
The organisation of an area-wise information service to keep
upto date information on location or availability of scarce
life-saving medicines.
Workers
a.
b.
c.
Workers should be recognised as individuals capable of making
decisions for themselves.
Protect workers in our individual institutions against
occupational hazards.
Provide them with the facility to redress grievances.
AT THE STATE LEVEL
Children
a.
b.
c.
d.
e.
Adopt, adapt and carry out NANI plans vigorously.
Increase programmes for mother education in nutrition.
Projects to increase family incomes, so' they could have more
energy rich foods.
Education of doctors about the needs of children with protein
calorie malnutrition.
Promote education on the value of jaggery, against refined sugar,
as better food.
(P.T.O.)
2
Women
a.
b.
c.
d.
e.
Organisations must provide self-employment schemes for women;
greater economic freedom will bring.women greater social freedom.
Compulsory Primary Female Education, its strict implementation is
important to raise the status of women.
Since enhancing women's income improves her health, even part
time employment can begin the process of helping her become more
free. Society must make this possible.
Concerted drives and campaigns by voluntary organisations against
social evils like dowry, obscene advertising and films denigrating
the image of women, job and wage discriminations etc must be
encouraged.
The establishment of co-operatives or trade unions of working
women would help.
People who need medicine
a.
b.
To help purchase bulk medicines at regional and State levels;
where possibile from the government for the national eradication
programmes.
To provide ways and means to deal with the problems of spurious
drugs by
developing laboratory facilities where needed
improving the existing facilities
involving voluntary groups in the detection of spurious
and adulterated food and drugs.
Promote appropriate health and use of drugs through seminars,
literature, etc.
Demand code of conduct of marketing, for the pharmaceutical
industry.
Demand more facilities for research and practise of indigenous systems.
Build up public opinion for shifting the licencing and pricing of
drugs from petroleum to Health Ministry.
i.
ii.
iii.
c.
d.
e.
f.
Workers
a.
b.
c.
d.
e.
To press for the implementation of the minimum wages legislation
so that the worker is able to obtain the required volume of calorie
prescribed by the ICMR Study.
Creation of workers recreational outlets to minimize recourse to
alcoholism.
Press for the provision of adequately equipped cafetaria to provide
variety and nutritious foods to workers on a co-operative basis.
Establish stringent measures to survey work establishments for
study of conditions; to use this to prevent possible hazards to
which workers are exposed.
To develop continuous adult education process to keep workers
motivated; to meike them aware of their rights and responsibilities.
AT THE NATIONAL LEVEL
Children
a.
Explore cinema and television as an education- media.
(P.T.O.)
5
b.
c.
Work, upon strategies for controlling infections affecting
children
Medical curriculum must caution against unnecessary prescription
of drugs.
Vfonen
a.
b.
To give publicity to laws, which protect women from occupational,
social, economic and sexual exploitation.
To co-ordinate information on cases of injustice and seek redress
from authorities at different levels.
People who need medicines
a.
b.
Press for the use of generic names of drugs, wherever possible
and include then with the brand names.
To use the media for expression of public opinion for a shift in
the licensing and pricing of drugs cfrom the Petroleum to the
Health Ministry.
Workers
a.
b.
To give publicity to the laws, -which protect workers from occupational
hazards and economic exploitation.
To co-ordinate information on cases of injustice and present them to
the respective authorities at different levels.
..^JUt'.
'
vhai's role m drug issue
Almost all training programmes, publications
and other work of the Voluntary Health Asso
ciation of India, over the last decade have stress
ed the need for appropriate and low-cost health
care. In some VHAI workshops, at present, al
ternative forms of drug therapy and even non
drug therapies are discussed and practised.
The voluntary sector has a beautiful example
of how low-cost, good quality formulations are
possible in the Bangarpet Tablet Industry. Some
voluntary hospitals and institutions even have
some form of tablet formulation and/or solution
production units.
VHAI is currently negotiating an arrangement
with a tablet manufacturer in Ahmednagar,
Maharashtra. The objective is to make low cost,
essential, drug formulations available to the
voluntary sector under generic names.
Meanwhile feedback obtained from health
workers in the field (including a series of ap
propriate health care workshops conducted by
the Tamil Nadu Voluntary Health Association)
have helped in defining what needs to be done.
A brief outline of VHAI’s role in drug-related
issues follows. VHAI is already active in some of
the areas identified below:
1
drug related legislation at national level
Forming a lobby against unethical practices
of drug companies.
* building awareness regarding WHO endorsed
code of conduct as against that drawn up by
multinationals;
* seeking information and analysing national
policies that may have detrimental implica
tions, specially where drug market is con
cerned;
* linking up with medical units of various
consumer societies, other groups and indi
viduals working on similar lines: e.g. Medico
Friends Circle, Centre for Science and En
vironment etc, to form pressure groups;
* use different seminars, workshops, medical
and non-medical journals to disseminate
relevant information.
40
* questioning drug advertisements that give
incorrect information and make false claims.
2
production of generic name drugs
* collect information of experience regarding
production from other voluntary groups and
programmes: e.g. Savar in Bangladesh, Gautemala, Medicus Mundi Internationales etc.;
* encourage or collaborate in
generic name drugs;
production of
* conscientize people regarding quality con
trol and demanding it (to prevent involun
tarily having to turn to the sophisticated drug
companies).
* identify non-allopathic drugs e.g. de Chanes,
Homoeopathy, that are cheaper and more
effective and inform others.
3
distribution of drugs
(which is the-biggest problem for developing
countries)
* encouraging bulk purchase at regional levels;
* helping to organize distribution channels;
* help collect background information
based
HEALTH FOR THE MILLIONS/APRIL-JUNE 1981
Has Homoeopathy a treatment for all disea
eases? Yes, it has a treatment because it does
not treat diseases but only sick persons. But the
fact that the human organism is almost infinitely
subtle and intricate and each person is a unique
individual with no parallel, brings in limitations
in the treatment. Even so, it is possible to treat
all human ailments with the existing medicines
and availability of more and more new medicines
is sure to make the treatment easier. The most
difficult diseases to cure are those that arise
from indiscriminate use of non-Homoeopathic
medicines. Surgical cases cannot be treated
with Homoeopathic medicines alone. For exam
ple, the fracture of a limb or a strangulated
hernia need immediate surgical intervention.
Surgery is a separate branch of medicine, ind
ependent of any particular system. There is a
general saying that children are easily cured by
Homoeopathic medicines. This is a fact be
cause the bodies of children have not been
abused with drugs and stimulants and their
minds are free from trauma.
There is an essential difference between
Homoeopathic treatment and treating diseases
with Homoeopathic medicines in the line of other
systems of treatment. Homoeopathy aims at
individualising and treating each patient as a
person suffering under and from particular
conditions. There is no specific medicine for a
particular illness, there are . only specifics for
individuals. For example, ten cases of tuber
culosis may require ten different medicines
whereas ten different disease conditions may
require the same medicine. The Homoeopathic
approach to the study of diseases is from clini
cal standpoint. It regards clinical symptom as
those that render themselves perceptible to our
senses as a result of forces that are acting and
reacting in and through the human organism in
disease conditions.
popular in india
Most modern medicines create more problems
than they solve, especially with the general ten
dency of doctors to overmedicate. But the
medicines of Homoeopathy are comparatively
harmless and they are cheap too. The low price
of Homoeopathic medicines, their comparatively
harmless nature and the lack of a uniform policy
towards Homoeopathy throughout the country
until recently, have given rise to innumerable
quacks practising Homoeopathic medicine in
India. This has lowered the opinion about
Homoeopathy in the minds of many persons.
The damage is now being slowly undone.
India is probably the country where Homoeo
pathy is most advanced and popular today, and
the States of West Bengal and
*
Kerala come first
in this respect. There are nearly hundred insti
tutions teaching Homoeopathy. They are recogni
sed by various State Boards and Councils. Eight
of them are government-run institutions. There
is a Central Government Homoeopathic Advisory
Committee. Under the. Homoeopathic Central
Council Act of 1974, a Central Council of
Homoeopathy was set up on 8th August, 1974.
It determines the minimum standards of Ho
moeopathic education throughout India and
maintains a Central Register of Homoeopathic
practitioners. In the West, after experiencing a
period of decline, now there is an increasing
interest in Homoeopathy.
»
HEALTH FOR THE MILLIONS.APRIL-JUNE 1981
*
*
39
on epidemiological studies and other field
studies.
4
management of pharmacies
* encouraging formation of pharmacy com
mittees in voluntary health care institutions.
* stocking with appropriate drugs, low cost,
generic, avoiding combinations, trade names
as far as possible;
* encouraging local preparations of liniments,
ointments, syrups and mixtures (as done by
compounders earlier);
* helping in appropriate pricing of treatment
(registration, consultation and cost of drugs);
* availability of information on all drugs dis
pensed with.
5
dispensing of drugs
* limiting range of drugs in the pharmacy to
essential drugs.
* use of formulary.
” encouraging use of Physicians' Desk Refer
ence on extra-pharmacopia and not relying
on the information given by drug advertise
ments and drug representatives.
* helping in standardization of diagnostic and
prescription procedures (to avoid the inessen
tial, and limiting procedures to the most
appropriate).
* planting of medicinal plants in hospital vici
nity with specific therapeutic value.
* initiate new, short-term appropriate courses
for unregistered dispensers of medicines.
7
health education of patients
* emphasis on the concept of self-responsibility
in health.
* special coverage of methods of prevention of
common diseases, e.g. those due to poor
hygiene, sanitation and nutrition.
* information about various government health
programmes:
— National TB Programme
—MCH & FP
—Blindness
— Immunization programmes etc.
* information regarding functions of PHC doc
tor, sanitary inspector, ANM etc., for people
to know their rights.
* encouraging medically sound customs and
cultural practices—e.g. use of Datuns instead
of toothpaste and discouraging the harmful
ones by giving appropriate information.
* giving information about the misuse of injec
tions, tonics, steroids, bottle feeds and other
drugs.
8
6
decrease health care costs
education and training
* training of different levels of health person
nel to be able to handle common problems as
effectively and at as low cost as possible.
* collection, analysis and dissemination of re
levant information to health professionals
and public regarding use of drugs and their
substitutes, role of drug industry in health
services, use of non-drug therapies; e.g.
massage, acupressure, home remedies and
other indigenous herbal medicines known to
be cheaper and giving good therapeutic
results.
* local preparations of commonly used oint
ments, syrups etc.
HEALTH FOR THE MILLIONS/APRIL-JUNE 1981
* investigate role of health insurance schemes
in different parts of India and their feasibility.
* preparation of recommended reading list of
books and material related to low cost appro
priate health care.
* formation of linkages with groups working on
the same lines.
V
*
♦
41
voluntary initiative...
The Gonoshasthaya Kendra (GK), the Bangla
deshi voluntary organisation has been planning
to produce and distribute generic drugs at half
the price charged by the multinationals. Progress
Report No 7 of GK outlines their programme:
“Society cannot let this situation (about
drugs) go unchallenged. A Dutch friend, Jan
Willem van der Eb and GK have been planning,
since early on in our involvement in primary
health care, howto provide drugs under generic
names at low cost. It took three years to complete
the“footwork' of collecting the necessary Govern
ment approval, documents, etc. By 1978 we had
clearance in order and in November 1978 cons
truction began on our building. Today a factory,
one of the largest in the country, with 42,000 sq.
ft of floor space is ready to go into production
with a quality control and production develop
ment laboratory of the highest calibre.
“The building design central air-conditioning
installation and equipment set-up has been done
entirely by Bangladeshis. Specialized top manage
ment have heen recruited within the country and
sent abroad for refiesher courses. We have also
attracted highly qualified Bangladeshis who left
their jobs in developed countries to join the fight.
“The factory will be ‘different, not only in its
production of quality generic drugs at low cost,
but in keeping with GK philosophy, a large sec
tor of employees will be rural women. Some of
these have already been recruited for basic
training in their work and literacy as necessary.
Another distinctive characteristic is that all
labelling and explanatory literature will be in
Bengali. Gonoshasthaya Pharmaceuticals Limit
ed is organized under the Company's Act like
any other manufacturing industry in the country
with one major difference—there are no indivi
dual share-holders. It is 100% owned by the
GK Charitable Trust and by its charter. 50% of
the profits will be ploughed back for factory
expansion and the other 50% to help volunteer
programmes in the country with emphasis on
social sciences and indigenous herbal medicine
research.1'
This programme is funded by NOVIB of Hol
land, Bangladesh Silpa (Industrial) Bank, OX
FAM and Christian Aid.
aod making tablets
In 1977, a study was made by VHAIof25
items manufactured in the hospital pharmacy at
Fr Muller's Hospital, Mangalore. One of the major
conclusions that emerged from the study was it
is profitable to manufacture drugs and related
items in the pharmacy.
A VHAI study done later in 1979 also revealed
the same. Using the simplest of machines and
borrowed capital, the returns could be atleast a
minimum of 20% on capital investment per ann
um. Savings to the hospital as compared to
42
commercial products could be anything from
30%, to 70% on an average. A total initial investof Rs 2 lacs would be sufficient for a tabletting
unit. (Laboratory testing to be done elsewhere).
In fact, the hospital tabletting unit act as a
source of low cost medicines for other like-min
ded institutions in the sorrounding region. The
savings and benefits would be higher.
However, obstacles (like in Fr Muller's) could
be reluctance of medical staff to prescribe non
branded drugs.
HEALTH FOR THE MILLIONS/APR1L-JUNE 1981
CONSUMER ALERT - CONSUMER ACTION
- ravi narayan
'Ehe problem
THE INDIAN Council of Medical Research (ICMR) and the
/
Indian Council of Social Sciences Research (ICSSR)
haves in a joint study-group report entitled
All - an Alternative Strategy *
1 warned that
is required to ensur-
’Health for
’e t ern al vigilanc e
there the health cere 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-health’. This
warning is a serious indictment of the drug industry and
the medical profession in the country. It confirms the
growing evidence that drugs are being pushed on an unsuspecting
public by devious methods which masquerade as ’sales promotion'
of drug companies and 'professional prescribing practice •
by doctors.
A SPATE of reports have been appearing in our newspapers
and periodicals of late, on drug-related issues and a
review of these highlight that many of the following practices
are not at all uncommon in Indias
i) sale of drugs banned in other countries
egi Lomotil and Clioquinol preparations.
ii) Sale of irrational combinations and formulations
egs Hathi Committee has suggested weeding out of
atleast 23 such preparations.
2
I2t
i.i.3.)
Sale of drugs 'without adequate precautionery
product information
iv)
sale of drugs at a highly inflated costs
eg? It is reported that Analgin is being
sold at 20 to ?o times the cost of production.
v)
Promotion of drugs for indications that are
neither clinically proved and are often
potenti ally, d ang crous
eg; Promotion of HP forte combinations for
pregnancy testing and induction of abortion.
There is well documented scientific evidence
that the risk of foetal deformity is increased
by the use of these hormonal preparations.
vi)
sale of spurious| adult? rated or poor quality
drugs
eg; Turmeric powder in tetracycline capsules
and poor quality, reaction producing intravenous
fluid preparations have been reported.
vii)
sale of old i expired and unused drugs
There is the double danger of effects of
denatured drugs as also of inadequate dosage.
viii)
Over-prescription and misuse of tonics,
hiqh-protein foods, hormonal preparations
and baby foods
that are both superfluous and
a drain on the family economy.
3
3S
ix)
Sale of 6 rugs over the counter without doctor’s
prescriptions or the necessary statutory checks.
x)
Production of drugs for profits rather than health
needs of people~-egi The ICMR/lCSSR report highlights
that drugs for diseases like leprosy and tuberculosis
which affect millions are produced at one-third and
one-fourth of actual requirements while tonicss
vitamins and high protein substitutes are being
produced in wasteful abundance.
IT IS evident then, that what is needed in the country
today is a consumer awakening and av.areness building
process that will sensitise people to the realities of
the drug industry, mobilise public opinion, sensitise policy
makers, confront the medical establishment and challenge
the drug industry *>
This process will have to lead to the
initiation, promotion and sustenance of consumer action
to ensure that the drug policy in India is more ’people
*
and
’health
*
oriented, is there any evidence of such an
awareness?
consumer' alert’ 'ahc' 'ac't’i'o'n
BEGINNING IN the late seventies, there is an increasing
number of organisations, associations, projects and
action groups who have begun to create an av.areness of drugrelated policy issues. These groups are predominantly if
not exclusively urban-based, consisting of young professionals
and Intellectuals from different ideological backgrounds.
4
*4:
Since the Medical profession is the ’instrumental
*
consumer
ie., they prescribe the drugs, many of these
groups have directed their efforts particularly towards
them. Many others are health or development associations
science popularising movements and consumer associations
who are increasingly taking up drug-issues as one of their
many activities. The list of groups makes interesting
reading are Voluntary Health Association of India (VHAl), New Delhi;
medico friend circle (mfc), Pune;
Arogya Dakshata Mandal (ATM), Pune;
Delhi science Ebrum (DSF), Nev; Delhi;
Society of Young scientists (SYS), New Delhi;
Lok Vldnyan Sanghat an a (/<<m) , Maharashtra;
Kerala Sastra Sahitya Parishad (KSSP);
Concern for Correct Medicine (CCM), New Delhi;
Consumer Action Front (CAF), New Delhi;
Consumer Education and Research Centre (CERC), Ahmedabad
Centre for Education Development (CED), Bombay;
Federation of Medical Representatives Association
of India (emra); Patna;
All India women’s Conference (AIWC) and so on.
It is impossible to document all the efforts of these
groups but the main types of action they have been involved
in are 4-
5
«5«
1.
Public ations
rafc published too anthologies of their bulletin
articles 'In Search of Diagnosis ' (1977) and
’Health Care which way to go • (1982) which included
many articles on drug-policy related issues. VHAI's
special issue of the bi-monthly
Millions ' was entitled
'Health for the
Medicines, as if people
mattered' (1981). It covered many aspects of drug
use and abuse and tried to stimulate voluntary
initiatives from the public and the medical profession.
CED published an exhaustive, well-researched report
on 'Aspects of Drug Industry in India' (1982) to
stimulate further interest.
2.
Meetings
These were organised by many of the groups to bring
together people interested in the problem to share
views and discuss action plans. The Drug Industry
and the Indian People (DSF, SY’S, FMRA and others,
November 1981), Drug Issues and Feasible Alternatives
(VHAI, Pune, Jan.
Jan.
82),
*
Drug use and Abuse (mfc, Tara,
’82) were thr^e such meetings. The seminar on
National Health Policy (New Delhi, VHAI, AIWC, CCM,
April 1983) also discussed drug issues and stressed
the need for information dissemination and consumer
action.
«6*
3- Educational Campaign through letcers and media
AIM launched a movement called ’Operation Medicine ’
in July 197/ with letters to medicos and articles
in press requesting for a stop in prescription of
forte vitamin preparations $ irrational S~complex
formulations, tonics and tinned foods and boycotting
of certain drugs being sold at inflated costs.
VHAI launched a campaign in March 1982 (International
Women’s Day) against the misuse of hormonal preparations
for pregnancy testing. Letters were: sent to doctors
and chemists inform!; g them about the dangers and
requesting them not to misuse these products. Articles
were published in leading newspapers and periodicals.
The movement snowballed and the government decided to
ban EP forte combinations. The movement continues to
challenge government action gdsieg/^lag period of six
months to drug companies to move stock before ban becomes
effective.
mfc launched a campaign eaply this year about the
rational management of diarrhoeas in children with a
hope to prevent misuse of various available preparations
that have not much therapeutic value. Press releases,
informative articles and letters to drug controllers
have been major constituents of this campaign.
.7
:7 s
4. Newsletcer s/Bulletins
One of the best examples of continuing education of doctors
on drug issues is the Pune Journal of Continuing Health
Education published by ALM. Tills bulletin sensitises its
subscribers to the half-truths of medical advertising
apart from providing reliable information on latest drugs.
The Drugs Bulletin of Pharmacology Department of Post-Graduate
Institute, Chandigarh is another example, mfc bulletins
have also regularly featured articles on drug issues.
5. Information net-work anons voluntary action groups
To maintain this growing interest, VHAI has set up a
special cell on
•Low Cost Drugs and rational Therapeutics’.
This Cell has been keeping groups all over India informed
about new problems and follow up action of campaigns. Other
groups have also initiated informal network exchanges.
6 • Lov.-Oost Drug ventures
The Bangarapet Medical Mission Tablet Industry has been
a very successful small scale venture in providing low
cost, good quality formulations to a limited group of
mission hospitals in the country. Recently in Gujerat a
new project called LOCOST has been initiated. This is a
collective voluntary endeavour for rational therapeutics
through promotion of low-cost, quality, generic named
medicines. An important dimension of the project will be an
educational effort addressed to the voluntary sector for
minimum use of drugs and the socio-economic implications
of irrational therapeutics.
8
«8J
1 • Iteug issues ^2 Science Movements
With the growing interest on drug related issues well-known
science movements in the country like KSSP and PSM have
also decided to coordinate with other agencies in joint
campaigns. At the All India convention of the people’s
Science Movements at Trivandrum convened by KSSP in
February 19b3, a health group was formed which drew up
up a joint action programme having the following four
components.
a.
Ban on EP -K>rte combinations
TO oppose the wrong arguments of drug companies
being used to pressurise government to lift ban
order on these combinations.
b.
Campaign about Anemia in
,ar^l irrational
anti-an-emic drug preparations in the market.
PSM Maharashtra was including it as a topic
for their yatra in May 1983-
c.
Campaign against irrational Diarrhoea Management
in Children
mfc would initiate campaign from June 1983
*
d.
Campaign against Multinationals in Indian Drug
,ln3.u8.trly
A campaign lead by FMRA would be organized
in October 19b$ to coincide with the annual
Jatha of KSSP and to make people aware of the
role of Multinational Corporations in India.
9
:9:
*tbVartys a p'eo'pl'e *s movement
ALL THE above efforts are small steps towards a
much more wide-based consumer movement against drug
use and abuse and profit oriented drug policies. However,
it must be remembered that in a country like ours when
a very large percentage of people are below the poverty
line and when more than 75 person have little access
ydJ
to a basic health series a consumer action pgo'ramme only
A
on drug matters will continue to be cut off from the
needs and aspirations of the majority.
DR NORMAN BETHUNE, famous for his work in China
wrote,
'The best form of providing health care and
health protection would be to change the economic system
which produces ill health - to liquidate ignorance, poverty
and unemployment •.
ONE HOPES that eventually drug-related issues will
become part of a much wirier people *s campaign for
health development and socio-political change because
at the root of the entire problem of drug production
and availability lies what Ivan Illich has aptly described
as
’Social-iatrogenesis - ie., health policies reinforcing
an industrial organisation which generates ill-health
.
*
J JR - 3 3-7 L|
Report of Visit to the All India Missions Tablet Industry
Bangarapet - 563 114 Karnataka, India
From:
Wim Faassen, Special Field Consultant, Christian Medical Commission,
World Council of Churches, P.O. Box 66, 1211 Geneve 20, Switzerland
Visit Dates:
1-3 September 1984
Meeting with:
Emanuel J.D. Birnur, Superintendent
H. Rathnam, Production Manager, Assistant Superintendent
Stanley G. Jogin, Analytical Chemist
S.
Frederick Emmanuel, Analytical Chemist
Wilson Y. Nandihal, Treasurer
1.
Introduction
In the first quarter of l$84s Bishop Elias Peter, the chairman of the
Board of the All India Missions Tablet Industry, along with Major J.K. Michael
Director of CASA and Bishop Jonathan0 treasurer of CASA, paid a visit to CMC
and met with Dr. Ram in Geneva and requested the CMC to look into the
possibility of expanding the industry to meet the growing needs of the church
and voluntary hospitals and health works for essential drugs in India.
Dr. Ram had previously visited the Tablet Industry in 1981 and had already
indicated the possibility of further strengthening their very fine work.
Dr. Ram had used their products, which are of very good quality and available
at a very low cost, for 16 years of his rural health work in India and was
keen that others benefit from them as well.
The visit was thus formalised by Dr. Eric Ram, Director of the CMC/WCC, by
agreeing to the request of Bishop Elias Peter. CMC had their formulary
and the product list. The general question was: "If they want to expand,
do they need any support?"
The report will cover the following subjects:
2.
3.
4.
5.
6.
7.
History
Management and Personnel
Marketing
Production
Finance
Future
2.
History
"Dr. Hugh H. Linn, Medical Missionary", written by his wife, Minnie V. Linn,
2 years after his death in 1948, tells that Dr. Linn was called the "pillar"
of the church, because of his great Tablet Industry.
Dr. Linn started to produce tablets for missions in 1920 in Vikarabad, and
soon moved to Bowringpet, which is now called Bangarapet. The aim was to
enable the missionaries to help more people. Products were then sold to some
200 mission hospitals, and as many dispensaries, district missionaries and
managers of schools. Tablets went as far as Arabia, Burma, China and Africa,
and each package of tablets contained a tract which told about Christ.
Dr. Hugh Linn's booklet "Diagnosis and Treatment of Common Diseases for
Village Workers", Madras 1928, was translated into 6 Indian languages.
- 2
After his death in 1948, his son, Dr. (Pharm.) K.M. Linn took over. He
retired in 1981. The production manager, Mr. Birnur, then became the
superintendent.
3•
Management and Personnel
The management consists of the superintendent (who also does the sales),
the production manager (who is a pharmacist as well), the laboratory manager,
the treasurer and a pharmacy assistant for the packaging and additional
labour. There is a total of 19 people.
The company is registered as a small scale industry and charitable trust.
It would lose this status if the personnel consisted of 20 or more. The
consequences in such a case are that the exemption from income tax is lost,
the employess would be organized in the union, and government insurance
schemes would have to be followed, increasing the costs for the company.
The Methodist Church of India is the full owner of the Tablet Industry.
Bishop M. Elias Peter is the chairman of the board.
4.
4
Marketing
The range of products and the prices are given in the price list
of March 1984. It contains 55 tablets, of which 6 are patent and proprietary,
and 5 external applications. Furthermore, 57 formulations of other companies
are offered to the clients in order to complete the range. These items are
bought with 20% discount.
Prices are said to be interesting. Supplies are only made to mission
institutions and members of VHV. Packaging is free. For tablets, half of the
forwarding charges have to be paid by the customer, for ointments 100%. On
the patent and proprietary items, an excise duty of 15% has to be paid.
The present turnover is Rs. 3.8 million, of which 2.5 million on own products
(at Rs 11.5 for 1$, these amounts are $330,000 and $217,000). The main own
sales consist of 75 million tablets.
Ointment sales are about 4.5 tons a year at about Rs. 200.000 (8% of own
production).
Presently only 20% of the Protestant and 5% of the Catholic hospitals are
supplied. The Catholic clients are mostly from Kerala. Catholic hospitals
derive most of their drugs from gifts.
The marketing approach is rather passive. "Our customers are our representatives
Some advertisements are placed in mission periodicals. There are no travelling
salesmen. The only care available is the 1960 8 cylinder USA Plymouth left
by Dr. K.M. Linn, but to use it, the Tablet Industry needs a driver. Transport
of drugs to the railways is done by cart and bullock.
The first question they asked me was: "Are there any hospitals under your
control who could buy the double production?"
I said that CMC/WCC has no
hospitals under its control but works with more than 2,000 hospitals and many
more health centers and dispensaries around the world.
- 3 -
Mr. Jurgen Gotthardt of WEM-Hamburg visited Bangarapet early 1984.
has been made by him.
A report
The Government of India (GOI) spends about 1$ p.a./p.c. on health. Most
church-related medical institutions get no government grants, and have to live
from the fees of the patients. The Indian government owns 2 pharmaceutical
factories, the Indian Drug and Pharmaceutical Ltd. (IDPL), and the Hindustan
Antibiotics Ltd. Imported drugs would be cheaper than locally manufactured
ones. Customers pay 10% Central Sales Tax. WEM and CASA, according to the
report, are willing to channel orders through the Tablet Industry on the
"Deemed Export Scheme". Payments would be made from Germany in free foreign
exchange. The Tablet Industry could then import raw materials directly,
and WEM could even promote export to other countries. Also, new Indian
machines could be bought under the Deemed Export Scheme, with payment in hard
currency. The report also suggests that a separate production and distribution
unit could avoid the troubles of officially growing beyond the 20-employees
limit.
According to the people I talked to at the Tablet Industry, WEM's proposals
are not acceptable, since WEM would ask 6% for these services, and an increase
in the drug prices of 5% to the hospitals that are brought in contact with the
Tablet Industry by WEM. The Tablet Industry cannot use 2 different price lists.
Mr. Birnur did not know whether Bishop Elias Peter had already given a definite
answer to WEM. Contact with Mr. Gotthardt after my return to Europe about
this matter seems to be advisable, anyhow, since WEM has been thinking about
various possible solutions. The Tablet Industry also said they could not
afford 6% on the raw material prices, since their net profit is only 5%.
The Tablet Industry is afraid of an expansion into a separate distribution unit,
since some unwanted people might be manipulated into new jobs.
Talking about possible supplies for government tenders, the constraints
mentioned were:
the government is not a charitable organization (I do not
agree; government gives health care free; the mission hospitals are pretty
expensive for the patients), tender orders are only obtained through bribes,
and if payments are finally made after 1 year or more, this also happens only
if you give a considerable compensation. So government orders are out.
Export sales are negligeable.
From the answers given it was not clear whether the sales are limited by the
market or by the production.
It was said that the same number of people could
easily produce 50-100% more with better machines, and that limiting factors
were the non-availability of punches for the old tablets, machines and the
irregular supply of raw materials and electricity. On the other hand, one
gets the impression that the passive marketing is the limiting factor and the
acceptance of the "19-people limit".
Some employees are of the opinion that the Tablet Industry should produce only
tablets to remain loyal to the original aim of the founder of the company.
However, on the letterhead the command "Go heal the sick" is given without
limiting remarks.
There are no bad debts; sometimes it takes 1 year before clients pay, but
most pay within 1-2 months.
- 4 -
5.
Production
The building for production is sturdy and clean and certainly has possibility
for expansion. The roof is high and light, the space is cool, the floors are
of good quality.
Granulation and drying equipment is partially old, sometimes complete granulate
is bought on the market (aspirins). Tray driers are used. Tabletting machines
are:
-
Manesty double rotary 27 stations England 1958
Manesty single rotary 16 stations England 1958
Stokes single rotary 16 stations England 1955
Cad mach single rotary 16 stations India 1970
It is difficult, if not impossible, to get punches for the old manesty and
stokes machines; for this reason the second machine is already out of operation
It is clear that these machines would not be fully occupied for 75 million
tablets per annum, if punches were available. On the other hand, the first 3
machines are already over 25 years old and they become gradually difficult
to maintain.
Packaging of tablets is done by weight or by special counting devices. The
labels are clear, the glue, however, is so bad that all labels look dirty.
Containers are either square tins or round plastic jars.
The ointment department is hardly more than you find in a larger hospital.
The same people making tablets alternatively also make some ointments. There
would be room for capsule production, but the Tablet Industry is afraid to
surpass the 19-employees limit.
The laboratory has enough space and looks reasonably well-equipped; a
photospectrometre is lacking and wanted. Regular samples during production
are taken. The state drug inspector of Karnataka regularly checks the
production.
Working overtime is allowed up to 18 hours/week, at double pay.
The Tablet Industry has no license to import raw materials, so they have to
buy them in the local market, mainly from brokers. Often, items are out
of stock and have to be bought on the black market (mainly the imported
raw materials). Vitamin C and I.N.H. are in short supply. Even if the
Tablet Industry had an import license, supplies might be very irregular,because the government canalizes the raw material imports, and sets quantities
and prices. Payments have to be made in advance.
Of course, gifts of raw materials via CASA e.g. would be allowed, but then
the end products may not be sold, only donated.
Taxes on raw materials and packaging purchases are 4%, and if bought
inside Karnataka 9.6%.
- 5 -
6.
Finance
The Tablet Industry is owned by the Methodist Church. Per annum, Rs. 84,000
has to be paid to the church for rent for the buildings (sales department
and store of finished products. The newer production hall is owned by the
Tablet Industry. It seems that this rent is excessive and a source of
income for the church. Without this cost, the drugs would be 2.2% cheaper.
The money paid for rent to the SIRC (South India Regional Conference in
Bombay) is used to support village priests.
The Tablet Industry is obliged to transfer 75% of its profits to charitable
organizations to be exempted from taxes. In 1983, the net excess of income
over expenditure was Rs. 84,000, of which Rs 60.000 were donated to mission
schools and hospitals.
The total provision for machines and equipment as of 31-12-82 was Rs. 102.000,
not enough by far to replace the old machines. Total depreciation in 1983
was nearly Rs. 12.000. The provisions are used for working capital and not
even free for machinery purchases.
Of the Rs. 102.000, 60.000 was spent in 1984, so that Rs. 42.000 is left as
reserve for machinery and equipment.
The Tablet Industry has written to the government to obtain permission to
build up more reserves for machinery renewal.
Since the Methodist SIRC is the sole owner of the Tablet Industry and receives
considerable amounts yearly, one could say that they are responsible for
providing funds for any renewal of machinery. Donating amounts of Rs 60.000
annually to various charitable organizations at the cost of a sound depreciation
policy does not seem very wise from a financial point of view.
The Tablet Industry has no bank debts, since it is not allowed to borrow money.
The present stock is worth about 1 million rupees, of which Rs. 600.000 is
raw material. The Tablet Industry regards a stock of 1 million rupees as
"normal" for an annual sales of Rs. 3.8 million, so 3.2 months' sales as stock.
This is certainly modest and it is not unlikely that items will be out of
stock regularly on this basis.
Personnel costs amount to about Rs. 220.000 or 5.8% of sales, again, a very
modest figure.
Raw material and packaging purchases in 1983 amounted to Rs. 1,535.000, which
at a sales figure of Rs. 2.5 million would mean 61.4% of sales, assuming
opening and closing stocks would be equal. The factor sales divided by
raw material and packaging would then be 1.63, a reasonable figure for a
non-profit drug manufacturer.
The accounts receivable are about Rs. 524.000 or 1.7 months, a good performance.
Accounts payable are Rs. 166.000, again an excellent figure.
In total, the financial picture of the company is sound, apart from the amounts
spent on rent and charity (which could be used to build up reserves for
renewal and expansion).
Budget estimates for 1984-85-86 and the audit report 1983 were received.
7.
Future
The Tablet Industry would like to expand production without increasing the
staff. For that they need:
a.
2 double rotary tabletting machines, 27 stations, at about Rs. 100.000
each (Indian made) - Total Rs. 200.000 - Capacity each 1500 tabs/min.,
or about 35 h/week and 50 weeks/annum about 150 million tabs per annum
each total 300 million tablets. If the license for 6 additional tablets
is obtained, the Tablet Industry expects to be able to already market
200 million tablets.
b.
1 fluid bed drier, Indian made, Rs. 70.000 (The Tablet Industry says
the rest of the granulation department is adequate).
c.
1 diesel generator 100 KVA, estimated Rs. 100.000
d.
1 double beam spectrophotometer, import, Rs. 100,000
e.
1 single pan balance, Swiss, Rs. 10.000
f.
1 ointment vessel, double walled, 250 L, local made - Rs. 30.000
g.
1 standard 10 diesel van, 3 tons, Rs. 80.000
h.
1 capsulating section 20 million capsules per annum, with airconditioning,
fumigation, U.V. lamp, price from Italian manufacturer unknown - say
Rs. 100.000
i.
installation for expansion and various
Rs. 200.000
For an increased production, from Rs. 2.5 million, to say, Rs. 12.5 million.
(multiplied 5 times), the working capital also should be increased 5 times (so an
additional 4 times).
Assuming the present working capital (stocks, debtors and bank/cash less
creditors) is about Rs. 1.6 million, the additional need would be about
4 x Rs. 1.6 million = Rs. 6.4 million.
The total estimated additional capital needs of Rs. 890.000 would be for
machines, equipment and installations, according to the Tablet Industry
estimate (which might be on the low side), and for working capital.Rs. 6.4
million, total Rs. 7,290,000 (or at Rs. 11.5/$, about 634.000$).
Concluding remarks:
The Tablet Industry needs to formulate its own growth plans in a project
proposal with better estimates of prices, capacities, personnel, etc. for
submission to the donor agencies to obtain funds. My personal view is that
a different way of depreciation and use of funds is also needed so that
donations would not be needed after the initial grant of $634,000 for working
capital or machines. For working capital the use of bank loans and/or
soft loans should be investigated.
- 7 -
The complete address of the Methodist Church in India is South India
Regional Conference - Bishop M. Elias Peter - Medical Council No. 27
(old no. 315) - 1st Main road - Cambridge lay out Ulsoor - Bangalore 560 008
(Tel. 51087).
Acknowledgements:
I owe special thanks to the management and staff of the Tablet Industry for
arranging my appointment with CASA and VHAI in New Delhi, for the transport
between Bangalore, Kolar and Bangarapet and for all the frank information
provided. I am also grateful for the board and lodging at the Elkn Thoburn
Cowen Memorial Hospital in Kolar arranged by Dr. Kaye and Dr. Keith Streatfield
and Mr. Jaya Mitra, the administrator, and to Bishop Elias Peter, whom I had
the pleasure of meeting briefly at the airport.
SELF RELIANT HEALTH PROJECT
A N K U R A N
1.
PROJECT
INTRODUCTION
ANKURAN is a voluntary non profit making secular organization
registered in 1982 under Societies Registration Act 1860
*
It believes that health is an important aspect of development and
can act as a good entry point to overall development.
For the
present its work is carried on in four panchayats of Chatra
Sub
division in Hazaribagh District of. Southern Bihar but later it
should extend to a wider area.
2.
GENERAL
BACKGROUND
The World Health Organization has adopted the target of " Health
for all by the year 2000 ", but the present health services in
Third World countries
*
especially in rural areas, organized on a
western model are not adequate regarding the enormous problems to
deal with and do not meet the fundamental needs of the population
as a whole.
Realisation of this inadequacy has given rise to a new concept of
health care, called primary health care by the WHO, which consists
in doing away with classical schemes and replacing them with new
and very decentralised structures where the doctor is no longer the
central figure and treatment is milder and less expensive.
1
Ankuran is a registered Society under the Bihar act XXI of 1860, Office; Gudri Mahalla - CHATRA-825401-District Hazaribagh-Bihar-(INDIA)
OBJECTIVES
3
The aim of ANKURAN is to try out in rural areas a system of health
care accepted by all and accessible to all as far as possible, which
should provide appropriate treatment to the poorest as cheaply as
possible.
Thus in its area of operation ANKURAN proposes to set up a locally
run health network based on village pharmacies, village health
committees, a low cost drugs manufacturing industry, medicinal herbs
gardens and a pathological laboratory.
be put on traditional herbai
In this network stress will
medicine and preventive health with
community participation which means to educate and organize people
for community development, to accept the responsibility of taking
care of their health.
4.
ACTIVITIES
1.
Village
Pharmacies
The spear-head of the project is a network of village pharmacies,
one pharmacy for 2000 to 5000 people. These pharmacies will be run
by local retrained healers (Bare Foot Pharmacists, BFP) chosen by
the population and who are motivated and qualified.
Each pharmacy
should be involved in varying extents in research, production,
distribution and promotion. The BFP will have also to organize the
population so as to allow them to take in hand the defense of the
health of the community.
2)
village
Health
Committees
In each village, a village health committee (VHC) with 5 to 7 people
including 2 village Health Volunteers (VHV) is formed to be
2
responsible for the villager’s health and has to maintain everytime
the good health through education.
The 2 VHV, one male and one
female (dais), regularly trained, work as preventive health agents
and educate the people.
They will have to keep close contact with
the BE'?.
3)
Low
Cost
Drugs
Manufacturing
Industry
As an indispensible complement to the village pharmacies and in order
to provide low cost but quality drugs to the poorest section of the
community, one small-scale pharmaceutical industry is to be set up
in the outskirts of Chatra. This LCPMI will produce at low cost few
essential drug.' from chemical and some drugs from medicinal herbs.
The medicines will be distributed to the village pharmacies or sold
to surrounding hospitals or institutions. Besides giving selfreliance to the project and providing cheap drugs to the people,that
programme will increase also employment in the countryside.
4)
Medicinal
Herbs
Gardens
The supply of medicinal plants for the popular pharmacies and the
industry will come for ...
the most part from local resources.
.For
that, production gardens will be settled in the villages on a
community land. They will be managed by the village health
committee.
One demonstration, research and production garden will
also be settled on a land belonging to Ankuran at the outskirts of
Chatra and will be as a reference for village crops. By promoting
the growing of medicinal herbs, the employment in the countryside
should also be increased.
5)
Pathological
Laboratory
A pathological laboratory set up in Chatra is offering its health
services to the population of the subdivision. Prices adapted to
the economic situtation of the patients and mobile laboratory in
3
the villages allow the laboratory services to reach the poorest in
the villages.
5.
SPONSORSHIP
For the implementation of that original health network, ANKURAN is
helped and sponsored by Solidarity International (France) which
has started the project, by United Nations (Geneva), European
Economic Community (Brussels)
and other organizations.
6.
HOW
TO
REACH
THE
INSTITUTION
CHATRA is connected with Gaya (80 fcm) and Hazaribagh (70 Ian) by
frequent buses and with Patna, Ranchi, Rourkela and Daltenganj by
some direct buses. The premises of ANKURAN are located in the
middle of
town and can easily be reaches by rickshaw
Chatra
or by foot.
* A*
*
ft
4
A* A A* * k*A
A* A * * AA*A&*
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 oxyphenbutazonc 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 (AIgesin-0, Aristopyrin cream, Butacortindon, Butadex, Butaproxyvon, Disiflam, FlamarP., Ganrilon, Inflavan, Kilpane, Maxigesic, Oxalgin,
Oxyrin, Oxytri actin, 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?
^0 400 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
other 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.
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 failure'.
References
Interestingly in the last two years, three other
^Ion-steroidal anti-inflammatory drugs benoxaprofen,
indoprofen and zomepirac and a formulation of indo
methacin (osmosin) were also withdrawn. A review
of a current CIMS5 shows 20 formulations of oxy
1.
Hindu. 17ih May 1984.
2.
Pune Journal of Continuing Health Education, Issue 69,
May 1984.
3.
Lancet: January 2, 1984 (Non steroidal anti inflammatory
drugs — have we been spoilt for choice)
4.
Lancet. March 31, 1984 (phenylbutazone and oxyphenbut
azone: FDA considers petition for ban in USA).
5.
CIMS — Current Index of Medical Specialities, May 1984.
6.
Meena Kelkar, Anti-inflammatory Agents: Pune Journal of
continuing Health Education.
7.
World Health Forum. Vo! 4, 1983: Homeopathy today —
round table.
addresses of people who may be potential subscribers
and share our perspectives?
VOCAL FIGURES
r Our current state-wise break up of readers are
— Maharashtra (212); Gujarat (63); Karnataka
(36); Delhi (28); Bengal (27); Kerala (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 iBhavan, 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
mic bulletin: JULY 1984
Editorial
THE ICMR/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 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 drag 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 medicine3 is particulaly
relevant
in today’s drug situation.
The role
of doctors in acting as watchdogs is primary
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 probl^fc
needs to be tackled in the form of an organism
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. His
suggestions for a multi-dimensional
campaign of
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
Pllease note
1.
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
Editorial Committee :
karnala jayarao
anant phadke
padma prakash
ulhas jaju
dhruv mankad
editor :
ravi narayan
Regd. No. L/NP/KRNU/202
— 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 advertising1.
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.
2.
HEALTH FOR ALL — AN ALTERNATIVE STRATEGY:
ICMR REPORT, 1981.
NON-STEROIDAL ANTI-INFLAMMATORY DRUG™
Lancet Editorial, 21st January, 1984.
3.
FEED BACK ONJFRESCR1BING: Lancet Editorial, 11th
Febntary 1984.
4.
WHAT IS RATIONAL DRUG THERAPY?: Health for
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 S 4 for all countries
Air Mail : Asia — USS 6; Africa & Europe — US S 9; Canada & USA — US Sil
Edited by Ravi!Narayan, 326, Vth Main, 1st Block, Koramangala, Bangalore-560 034
Printed by Thelma Narayan at Ptuline Printing Press, 44, Ulsoor Road, Bangalore-560042
Published by Thelma Narayan for medico friend circle, 326, Vth Main, 1st Block,
Koramangala, Bangalore-560 034
D-10.341
§S:k/31.12.81
international federation of pharmaceutical
MANUFACTURERS ASSOCIATIONS (IFPMA)
CODE OF PHARMACEUTICAL MARKETING PRACTICES
Preamble
The Statute of the Federation article 3 states that one of the
objects of the Federation is "to promote and support continuous
development throughout the pharmaceutical industry of ethical
principles and practices voluntary agreed on and "to coordinate
the efforts of its members towards the realization of the above
objects ".
It is believed that in keeping with the pharmaceutical industry's
international responsibilities, the members of the Federation
will be prepared to accept certain obligations, insofar as their
marketing practices are concerned, and to ensure respect for
them.
IFPMA recommends a Code of Marketing Practices to its member
associations, recognizing the difficulty of setting out a simple
Code which will be applicable in all parts of the world.
It
seems clear that national and regional conditions and legal
restrictions will continue to vary to such an extent as to make
a simple world Code impractical.
Nevertheless, the Federation
believes that it has a duty to encourage its member associations
to either introduce such Codes of Practices or where such Codes
already exist, to continually re-examine and where necessary
revise them so that a voluntary system based on such a Code
keeps pace with modern medical knowledge and changing health
services and conditions.
It is recognized that many individual member associations of
IFPMA have laid down their own Codes of Marketing Practices and
this recommended Code is not intended to replace similar Codes
or instruments already in force by members of the
Federation.
The following voluntary Code is therefore put forward as a
model for IFPMA's member associations.
A Code of Marketing Practices of this sort should be the res
ponsibility of member associations who should also provide
guidance to their members on matters of compliance and inter
pretation .
Obligations of the industry
The obligations of the industry may be identified as follows:
The pharmaceutical industry, conscious of its special position
arising from its involvement in public health, and justifiably
eager to fulfil its obligations in a free and fully responsible
manner, undertakes:
to ensure that all products it makes available for
prescription purposes to the public are backed by
the fullest technological service and have full
regard to the needs of public health;
-
to produce pharmaceutical products under adequate
procedures and strict quality assurance;
to base the claims for substances and formulations
on valid scientific evidence, thus determining the
therapeutic indications and conditions of use;
,
D-10.341
SS:k/31.12.81
to provide scientific information with objectivity
and good taste, with scrupulous regard for truth,
and with clear statements with respect to indications,
contra-indications, tolerance and toxicity;
-
to use complete candour in dealings with public health
officials, health care professionals and the public.
Suggested Code of Marketing Practices
We hereby declare our intention to voluntarily conform to the
following Code, of Marketing Practices:
I.
General Principles
1.
The term "pharmaceutical product" in this concept
means any pharmaceutical or biological product
intended for use in the diagnosis, cure, mitiga
tion, treatment or prevention of disease in humans,
or to affect the structure or any function of the
human body, which is promoted and advertised to
the medical profession rather than directly to the
lay public.
2.
Information on pharmaceutical products should be
accurate, fair and objective, and presented in
such a way as to conform not only to legal require
ments but also to ethical standards and to
standards of good taste.
3.
Information should be based on an up to date
evaluation of all the available scientific evidence
and should reflect this evidence clearly.
4.
No public communication shall be made with the
intent of promoting a pharmaceutical product as
safe and effective for any use before the required
approval of the pharmaceutical product for market
ing for such use is obtained. However, this pro
vision is not intended to abridge the right of the
scientific community and the public to be fully
informed concerning scientific and medical
progress.
It is not intended to restrict a full
and proper exchange of scientific information
concerning a pharmaceutical product, including
appropriate dissemination of investigational find
ings in scientific or lay communications media,
nor to restrict public disclosure to stockholders
and others concerning any pharmaceutical product
as may be required or desirable under law, rule
or regulation.
5.
Statements in promotional communications should be
based upon substantial scientific evidence or
other responsible medical opinion. Claims should
not be stronger than such evidence warrants.
Every effort should be made to avoid ambiguity.
6.
Particular care should be taken that essential
information as to. pharmaceutical products 1 safety,
contradictions and side effects or toxic hazards is
appropriately and consistently ccmmunicated subject
to the legal, regulatory and medical practices of
each nation.
The word "safe" must not be used
without qualification.
p-10.341
ss:k/31.12.81
:
7.
II.
3
:
Promotional communications should have medical
clearance, or where appropriate, clearance by the
responsible pharmacist, before their release.
Medical Reuresentati ve
Mt dical representatives must be adequately trained
and possess sufficient medical and technical knowledge
to present information on their company's products in
an accurate and responsible manner.
III.
Symposia, Congresses and other Means of Verbal Communi
cation .
Symposia, congresses and the like are indispensable
for the dissemination of knowledge and experience.
Scientific objectives should be the principal focus
in arranging such meetings, and entertainment and
other hospitality shall not be inconsistent with
such objectives .
IV.
Printed Promotional Material
Scientific and technical information shall fully dis
close the
properti_s of the pharmaceutical product aj
approved in the country in question based on current
sbientificknowledge including:
The active ingredients, using the approved
names where such names exist.
At least one approved indication for use
together with the dosage and method of use.
A succinct statement of the side-effects,
precautions and contraindications .
Except for pharmaceutical products where use entails
specific precautionary measures, reminders need not
necessarily contain all the above information providing
that a form of words is used which indicates clearly
that further information is available on request.
Promotional material, such as mailings and medical
journal advertisements, must not be designed to dis
guise their real nature and the frequency and volume
of such mailings should not be offensive to the health
care professionals.
V.
Samples
Samples may be supplied to the medical and allied
professions to familiarize them with the products, to
enable them to gain experience with the product in
their practice, or upon request.
******
Voluntary Health Association of India
C-14, Community Centre
Safdarjung Development Area.
New Delhi-110016
Telegrams : VOLHEALTH
New Delhi-110016
Phone : 652007, 652008
D-10/545
LOW COST DRUGS AND RATIONAL DRUG THERAPY
INTERNATIONAL CODES AND DfOU J
Last year the WHO was instrumental in passing an International Code of
Conduct of Marketing Practice of Baby foods.
This not only focussed the attention of the public, the health professionals
on the baby food issue, but placed the concept of breast feeding from
a ’rustic, old fashioned practice' to scientifically sound and recommended
one. What this will do to the commercial interests of the milk food
industry is anybody's guess? It is up to the aware public, the consumer
associations, the journalists to ensure that the code of conduct of which
India was a signatury - is firmly adhered to.
The contents of this code are being circulated for awareness and action
of the health personnel and the public.
Along with it is a copy of the International Code of Pharmaceutical
Marketing Practice, proposed by IFPMA (international Federation of
Pharmaceutical Manufacturers Associations).
A copy of this provisional code was given to the participants of our
Drug Workshop at Poona, for discussion and comments.
The code is being circulated along with extracts from the discussion
document prepared by Health Action International on the code.
You are reguested to read it carefully, share it with your colleagues
and pass it on. Your comments and suggestions regarding the international
code of pharmaceutical marketing practice are requested.
You are request ,d also to bring to our notice, cases of malpractice by
drug companies which may be,by way of misinformation, selling of spurious
drugs, unethical marketing practices, commissions for prescriptions, cut
backs etc. Your participation is not only requested but is NEEDED for
us and other groups and organisations to take any legal action, for
malpractices to be curtailed before i ; is too late.
What is IFPMA ?
IFPMA is an International Federation of Pharmaceutical Manufacturers
Association, a Zurich-based trade organisation, set up and supported by
a nnmbpt of national associations of manufacturers of prescription drugs.
Altogether there are JO affiliated national associations plus 12
affiliated through the Latin American Association of the Pharmaceutical
Industry.
Why the IFPMA Code was introduced and what it aims to be?
"The Paris-based International Chamber of Commerce has published codes of
advertising and marketing practice - which are meant to apply to business
of all kinds. However, the IFPMA Code (which makes no reference to the
requirements of the International Chamber of Commerce) is believed to be
the first ever attempt to introduce an international code of marketing
practice for pharmaceutical companies.
...2/-
Ms-cb/25.382
- 2 -
The preamble of the IFEMA Code (Appendix) explains how its terms of
reference extend to the drawing up of a voluntary code of praCiice. Though
the IFPMA does not state why it decided to introduce a code at this timd,
the following factors would certainly have been importants
1. There has been considerable criticism of the activity of the international
pharmaceutical industry, anu. it appears to be increasing. The industry
has given little evidence tc suggest that it accepts such criticism - but
would certainly be aware, at least, that health-care professionals increasingly
find it legitimate and to the point. The relative success of the campaign
coordinated by the International Baby Food Action Network (IBFAN) has
demonstrated the potential for international action by media, consumer,
public interest and development and health action groups - particularly
where developing countries are concerned.
2. The need to avoid further statutory regulation of the industry at
either national or international level. The indications are that the
IFPMA proposed its Code in response to the threat of a move by the World
Health Assembly to work towards the setting up of a formal international
code of pharmaceutical marketing practice. In the event, the threat did not
materialise at the Summer 1981 World Health Assembly - but there remains
the possibility of future initiative, if not through the World Health
Organisation or UNCTAD, then possibly through the UN Centre on Transnational
Corporations.
/
3. The credibility of the industry - now clearly under threat - is a vital
commercial asset. Lack of confidence in the drug industry by those who
regulate, prescribe or use pharmaceutical products could be commercially
disastrous. It is clearly critical that the industry generally, as well
as individual drug companies, is trusted and seen to 'care'.
The IFPMA has responded to these (and perhaps other) imperatives by first,
issuing a statement of 'the obligations' of the pharmaceutical industry;
and secondly, by suggesting a number of 'general principles' by which
these obligations might be fulfilled.
It is important to recognise that, in doing so, the IFPMA is not trying to
introduce its own 'simple world code'. The IFPMA specifically says this
would be 'impractical' because of differences in local conditions. All
IFPMA as trying to do with its Code is 'to encourage' national member
organisations either to introduce or to revise their own voluntary codes
*
"
What stage of implejnentation is the Code in?
'The document has not yet been formally adopted or published: it is
reproduced here in the form in which it was circulated for comment to
IFPMA member associations, in March 1981. Since then-, the Code has been
agreed by the IFPMA Council and, by the end of. June 1981, it had been
approved also by all of the major associations within IFPMA."
What is the purpose of the discussion document circulated by HAI?
"The purpose of this paper is
1.
to draw attention to the existence and provisions of the IFPMA Code;
...3/-
MS-c'b/23.3.82
- 3 -
2.
to discuss briefly its significance in relation to controls that are
needed and which might be applied; and
3-
to suggest options for action by HAI participating groups. "
According to the discussion document, what are the three essential
ingredients of any code of practice omitted in this IFHVIA’s Code?
1.
Need for interpretation.
Reference to the need to ensure that the industry makes products which
have full regard to the needs of public health - appears a statement
so vague that it is hard to accept it as anything much more than an
advertising or public relations slogan.
2.
Need for monitoring
The question raised is 'what assurance is there,that the code will be
adhered to?' Is the Code to operate on the basis of a complaints
procedure? The mechanism for complaints handling and monitoring,
which are fundamental to a code have not been referred to.
3.
Need for enforcement
What happens if the Code is violated?
-
who judges? industry (through its association or otherwise) or
truly independent bodies.
-
whether enforcement decisions are published - or this is kept
a secret? Could it be possible to establish, on the basis of past
decisions, what practices are acceptable or unacceptable? And what
is the record of individual companies- where complying with the
Code is concerned.
-
what sections would be applied if companies break the provisions
of the Code?
-
what incentive is there for firms to observe the requirement of
the Code?
What are the implications and significance of this for the HAI groups?
This is useful to fefer to the obligations of the industry identified
by IFEMA;
Individual groups may think alternative or additional requirements which
might be needed to control abuse in pharmaceutical marketing, and to
consider how such requirements might effectively be enforced at both
national and international level;
...4/-
D-lO/545
MS-cb/25.5.82
-
4
-
Groups might also wish to collect exrnaples of apparent malpractice;
Collectively, groups may find it useful to exchange information or the
design and enforcement of standards under different voluntary (self
Regulatory) systems operating in their countries. Groups might also wish to
compare and pool the evidence they obtain about apparent malpractice
and to publish and publicise this evidence both locally and internationally
through RAI.
HAI would like to know whether it should press for introduction of an
international code of pharmaceutical marketing practice which ha^'teeth,"
and which can reasonably be expected to work through TOO/UNCTAD and
national governments.
YOUR RESPONSE IS NEEDED URGENTLY
2-4/378
k/16/7/84
Background paper for
DRUG ACTION NETWORK (DAN)
Core Group Meet, Wardha,
July 30-31/ 1984
From: Dr. W.V. Rane
Dr. A.R. Patwardhah
DRUG PRICING Ah) PRICING POLICY
Introduction and acceptance of generic names would solve all
the problems of pricing (barring a few accepted combinations).
But as long as generic names cannot be accepted, it is advissabic to adopt the stop-gap measures suggested hereunder.
Present system of indirect promotion of drugs to a common man
through the medical profession and eventual selling through
series> of middlemen (distributors, stockists and retailers)
brings direct and indirect burden on the consumer. The govern
ment, in order to safeguard the interest of the common man lias
introduced many directives - which have been ill-utilised by
the pharmaceutical industry.
1.
-CATEGORI3ATION OF DRUGS:
In order to make essential drugs
available at reasonabl e routes, the government formed
four categories of drugs.
Category I drugs were taken as
essential and a mark-up of 40% was allowed thereon.
In
order to cover the -losses if any, the government allowed
the manufacturers to charge any price on category III & IV
drugs.
The END RSSUlfl?: the essential drugs are not avail
able and that the tonics, multivitamins, cough syrups,
hormone combinations, anabolic steroids, ensyme etc.
products are heav..ly promoted and within a span of one
year the prices o:; these products have doubled or trebled
and that the sale; have increased. This is mainly due to
indirect promotion of 'not-so-essential1 drugs through the
medical profession. .More money and imagination is expended
by the pharmaceutical companies in promoting these pro
ducts. Eventual loser is the end consumer.
Hot? can this be remedied?:
a)
fixing leader prices of not-so-essential (Category III
products by grouping them irrespective
of various combinations.
These groups can be:
Multivitamins, enzymes steroids, cough syrups etc. etc.
Lt IV)
b)
Imposing price control on all categories of products
and even allowing higher mark-up (than the present) on
group I £.11 products.
c)
Imposing certain restrictions on sales promotion of
not-so-e:.sential products viz no samples, no presents,
no fancy packings, no lay-press advertisements and no
schemes or bonus offers.
d)
Banning bhe visual aids-charts and strictly checking
the medical literature.
■4/37 8
16/7/84
: 2 '
2.
DRUG PRICS CON£ROL AUTHORITY
Drug Price Control Authority was created to control prices
This authority should review the prices every two years.
No spacial facility should be given to any section of the
industry.
A few examples of gross discrepancies are given
hereunder;
Product
C om p os i t ion/
tablet
Rate
Cost
100 tabl
CorbutyK Roussel)
Dextrooropexyphene
65mg.
Paracetamol 650mg.
2.15/6
35.83
Norgesic( Cipla)
Dextropro
poxyphene
3 2.5
Paracetamol 325mg.
3.11/10
31.10
How can one justify virtu illy the same price for exact
ly half the contents?
Proxyvon
(Wockhardt)
Dextropropoxypheno
65mg.
Paracetamol 400mg. 4.68/6
Diazepam
'
2mg.
78.00
What justification there can pe for reducing paraceta
mol by 250 mg. and adding diazepam 2 mg. and taking
more than double the ruling (of Corbutyl) prices.
B.
Mictooyrin
(Nicholas)
Acetyl salicilic .acid 350mg.
78/10
Caffe in
20mg. U'/H/1U
7 80
'
Micro pvrin-C
Aspirin
Vit -min C
350mg.
25 mg.0.54/4
13.50
Merely dropping 20 mg. caffein and
has doubled the prices.
C.
idding 25 mg. Vitamin C
Esriidrex
(Giba -Geigy)
Hydrc-chlorthiazide
0.46/10
4.60
Arkamin-H
(Uriichem)
C Ionidine He 1.1 OOmg, 5
Hydrochlorr 9n/in
thaidine
20mg. 3’28/1°
Rn
52-80
Arkamin
Clonidine
Hcl.
100mg.4.20/10
42.00
i .u.
Hydfochl.orthiaziue
20mg. 1.08/10 10.80
25mg.
bow when 25 mg. tablet of hydrochlorthiazide (essidrex) is
available for less than 5 •paisa a tablets (cost of tablet
ing and packing included) mere adding of 20 mg. hydroch lo.rthiazide enabled the rnanpfe.cturers to charge 11 paise
fertile same.
There are many such instances and those should be
reviewed by the Drug Price Control Authorities.
1-4/378
V16/7/84
:
3.
3
:
MI DP j E' IE N A M D C GMMIS 31 ON
The unions and associ-itions of chemists & druggists have
become powerful end they are now demanding 10% wholesellers
commission -nd 20% retailers commission on new introductions.
Gradually they will make these terms applicable to existing
products as well which now give 5% wholes hie and 12.5%
retail commission.
Theirc present demand has naturally
increased the direct burden of 12.5% and indirect burden by
13.74%.
This increase is due to increased excise duty and
sales tax on increased prices. Take for example a product
presently sold for Rs.100/- (i.e. maximum selling rate) .
This price will attract rough 1 y Rs. 13.00 excise duty and
Rs.4.00 as sales tax.
For this price the manufacturer gets a minimum price (i.e.
realisabl e price) of Rs.34.65.
Now for getting the same
realisabi e price of Rs. 84.65, a new price structure will b..
as follows:
Trade rote
..
..
..
Rs.93.11
Maximum selling rate
..
..
Rs. 111. 74
which otherwise means that the and consumer has paid 13%
excise duty on increased price of Rs. 11.74 and he has also
paid 4% sales tax on this increased price.
That otherwise
means that by this new method, he is paying Rs. 11.74
additional to the middle men-Chemists etc. and Rs. 1.53 addi
tional excise duty to the central government and %.0.45
additional sales tax to the state government.
BENEFIT TO 3MALu—SCmJuE INDUSTRY
Benefit of price etc. offered to small scale sector has
been ill-used by the multinationals and big Indian firms.
Normally a multinations is not allowed to market a new
product or its combination - and even if marketted, it's
price is controlled by the government.
In order to bye
pass these difficulties, the manufacturers have created
their own subsidiaries as small-scale industries and are
taking maximum advantage of the benefits offered.
In most
of these cases the f?.ncy products
been marketted or that
new combinations of old products have been introduced nt
fancy prices.
For example
:
Walter-Bushnel
Met "ike If in
F,s. 5.4 7/1
Rs. 2 73.50/100
Chymoral forte
20.58/12
171.50/100
Amclox
10.25/4
256.30/100
Martel-Hammer, Montari, Jagson-Pal, Dolphin, Full Ford,
Blue-Cross are some, such firms.
Normally the products •manufactured by a small-scale indus
try are marketted by the parent multinational. The govern
ment should now allow the multinationals and other big
firms to market the products of such small firms.
Before
making any of their new product available to their own sub
sidiary, it should be made available to any other smallsc-iL"! industry. The r tes of all such new products should
be controlled and fixed by the government.
AT LEAST ESSENTIAL DRUGS TO BE MADE AVAILABLE IN GENEP.I'.-'
NAMES
Anti-leprotic, anti-malarial, anti-tuberculour, anti-biotic-.
anti-filarial, analgesic drugs -it least should be m-irk tted
only in generic names and their prices reduced.
Once these
products are converted into generic forms, these will not
attract excise duty and the state governments can wave off
the sales tax.
The whole.—sale md r tail margins on these
generic products should be fixed only at 5% and 12.5% res
pectively.
These measures will make these essential drugs
available at virtually half the present prices.
Leader
price should be fixed and any.addition of anything should
not enable to increase or cross the leader price.
<1
DIARRHOEA AND DRUGS*
IN the rich world, where the treatment of diarrhoea
aims to relieve inconvenience rather than save life,
a variety of drugs is used.
SINCE there are so many passible causes of diarrhoea,
it is often not possible to identify the cause, let
alone attack it directly with drugs. This is particularly
true in poor communities, where there are few, expensive
diagnostic laboratories.
IN the Third world, drugs are therefore of limited value
in tackling diarrhoea.
WHO, in a Manual of the Treatment of Diarrhoea, warns
“A number of medicines which are of no value and are
even dangerous, are often given to treat diarrhoea. Money
and time are wasted in their use".
THIS advice sometimes conflicts with the hard sell of
the rich world *s drug companies. American pharmaceutical
firm G.D. Searle has encouraged its
representatives
to claim that its product Lomotil has "an important
role in the treatment of such diarrhoeas to help
prevent dehydration."
The WHO manual on the other hand dismisses the drug
as of "no value".
----------------------------
*
♦source
......2
PRIMARY HEALTH CARE: Earthscan Press
Briefing Document No 9, July 1978 pp 3a-39
2
IN Britain and the USA, it can only be obtained with
the prescription of a doctor- Yet in some poor countries,
Lomotil is freely available
over the counter without
warning of possible dangerous side effects, particularly
to children.
G0VEKM2NT health services still spend money on such
products. In Tanzania, for instance, a doctor found recently
that i>25,0OO (6 35,000 shillings) a year was being spent
on Lomotil and other anti-diarrhoeal drugs of doubtful
effectiveness. The WHO’s list of essential drugs is intended
to exclude this sort of wasteful purchase.
mfc ms
TOWARDS RATIONAL THERAPEUTICS
Extracts of a letter from a young doctor in a small rural
hospital in Madhya Pradesh.
Dear Friend,
............ About drug prescribing practices in our hospital—
in the first few months of my work I had ordered many new drugs.
Later I realised mainly because of financial conditions of the
patients that only important essential drugs and a minimum
possible list should be adopted.
Antibiotics
We use commonly Procaine Penicillin and Penidure.
They used to use a lot of Streptopen, which I don't. I mainly
use procaine penicillin. Then I use a lot of septran when
there is double pathology, like respiratory tract infection
with urinary tract infection or otitis media. We use tetracyclines
very rarely. Injection Terramycin I don’t use at all. So also
Chloromycetin. I never use chloramphenicol. Xf I doubt enteric
fever, I start with septran. Then we have streptomycin only for
TB patients. Crystalline penicillin I use only in new boms.
At present I feel very confident regarding the usage of antibiotics
and I don’t use two drug combinations,so I have stopped using
chlorostrep.
Diarrhoea
This is usually controlled with rehydration salts and plenty
of oral fluids.....Slowly discontinuing lomotil and other drugs.
Cough syrups/Tonics
When I joined there were lots of varieties of cough syrups,
cough/cold tablets and also lots of variety of tonics. It took me
nearly a year to cut down many brands. We had 11 brands of cough
syrup and 10 brands of tonics.
Now we make cough mixture in the hospital for free patients
and we have 3 other brands of cough syrup
About tonics—it takes a lot of patience to convince patients—
they don't need tonics—they can get the same benefit with proper
food and milk/eijgs. Now-a-days very few people ask for "Thakath
ka sissi”
and we have only two types of tonics....
I have kept multivite tablets, fersolate and calcium tablets.
Not a single brand of costly vitamin capsules or tablets are
stocked. They used to use a lot of varieties. Slowly I stopped
even B-complex injections...
For TB patients we have pyridoxin. For children we have
Vit A & D and multivite drops. Vit C.
I hardly use—nor do I
use calcium injections except in tetany.
Antacids
We had lots of brands before. Now we use Belladinal and two
brands of antacids only.
..One thing I have succeeded in proving here is that you
can run a small hospital and treat patients successfully with only a
handful of drugs which are cheap and good quality. Why do we insist
on each doctor or specialist having his own petty brand of drugs
in our large hospitals and even the medical college hospitals?
Yours sincerely.
L.M,
ORAL REHYDRATION - which method is most appropriate?
Diarrhea is one of the main causes of death in small children.
However, most of these children actually die from dehydration—the
loss of too much water, It is generally agreed that the most important
way to manage diarrhea is to replace the liquid that the child is
losing. But there is less agreement about how to do this.
A few years ago, most doctors treated even mild dehydration by
giving intravenous (l.V.) solution. But this was expensive, and
many children died in diarrhea epidemics because there was not enough
l.V. solution, or not enough skilled workers to give it.
Today, most health planners recognize that oral rehydration—or giving
liquid by mouth—is the best way to manage most cases of diarrhea and
dehydration. Even in clinics, where l.V. solution is available, it
usually makes more sense to replace liquids by mouth. This way parents
learn how to prepare and give liquids so they can begin treatment early,
at home, the next time a child gets diarrhea.
A Special Drink or Rehydration Drink can be made from water mixed
with small amounts of sugar and salt. It is even better if the drink
contains a little baking soda (bicarbonate of soda) and a mineral
called potassium—found in orange juice, coconut water, banana and
other foods.
* The salt in the special drink replaces the salt lost through
diarrhea, and helps the child's body to keep liquid.
* The sugar provides energy and also helps the body absorb liquid
more quickly.
* The baking soda prevents 'acid blood', a condition that
causes fast, heavy breathing and shock.
* The potassium helps keep the child alert and willing to drink
and eat,
2
2
The amounts of sugar and salt in the Special Drink do not
have to be very exact. In fact, there is great variation in the
amounts recommended by different experts. However, too little
sugar or salt does less good, and too much salt can be dangerous.
P To
—He^ptog'-HeaLtl’i ^Jo.tkers--Lea-rn''-s---David_Werner~-and~_BiIi-~Bower
THE RANGE OF REHYDRATION METHODS FOR CHILDREN WITH DIARRHOEA CAN BE
DIVIDED INTO TWO BROAD GROUPS:
Group ‘A1
1. Intravenous solution (l.V.)
2. Factory prepared oral solution
3.
Factory prepared packets of rehydration salts for mixing
in water
4.
Bags with salts, prepared at the health centre for mixing
in ’water.
,
Gha'racteristic-:— •Mdre‘-.ldependency-i-:„cont-roL—i-ntrthfe’ hands' -oi institutions
and pro fes s i on e 1 s ’.
Advantages and Disadvantages
Control and responsibility mainly in the hands of professionals,
institutions, and drug companies
Measurements more precise and 'controlled
*
(atleast in theory)
More magical; acceptance may be quicker but with less understanding
More dependency—on high technology, on outside resources, on
centralised services, and on local and international politics
More expensive
Easier to gather data on, and prepare statistics about
Reaches fewer people; supply often uncertain and inadequate
Sometimes causes delay in treatment, because special materials have
to be obtained; effect is more curative than preventive
Focus is on materials and supply (so cost goes up each year)
May give better (safer) results for individuals treated in time,
but has worse results overall since many children never receive
the liquid, or are given it too late.
2
Group 'B'
1. Homemade drink made with plastic measuring spoons
2. Homemade drink made with spoons found in the home
3,
homemade drink made with homemade spoons
4.
homemade drink with salt and sugar measured with the
fingures or by another traditional way
Glacier i-s-tic's s
More
elf—suf:
cif
family
Advantages and Disadvantages
Control and responsibility mostly in the hands of the family
Measurements less precise, less ’controlled’
More practical and easier to understand
More self-sufficienty; uses local resources (whatever is
available in the home or in stores)
Cheaper
Harder to gather data on, and prepare statistics about
Reaches more people; supply is local and almost always available
Treatment can begin at the first sign of diarrhea; more preventive
than curative.
Focus is on people and on education, so the people’s capacity
for self-care increases over the years (cost goes down)
May be less safe in individual cases due to the possibility of
errors in preparing or giving it, but it probably saves
many more lives—since it reaches more children more quickl
Helping Health Workers
David Werner and Bill Learn
Bower
Page 1 of 1
Main identity
From:
To:
Cc:
Sent:
Attach:
Subject:
"Dr Daoade" <drdaoade@sanchamet.in>
<drugactionindia@healthyskepticism.org>
<psaumya@vsnl.net->
Sunday. November oO. 200o G:zo PM
ATI 00051 txt
Re: [drugactionindia] Hepatitis B vaccination in India
'of ecbngs.
Thanks for your comment. Can i request you to throw more light on Hepatitis C.
Thanking you
Goos!
57 'Sonv
-91 836 2461554
drdabade@sanchamel.in
12/2/03
12/2/03
District Health Action Forums (DHAF)
jS- pp REA MB A.
Whereas infections and diseases are on the rise,
W hereas the government machinery fails to address
adequately the problem of ill-health,
hereas the voluntary organizations and non-gov
ernmental developmental organizations (NGDO),
thougn to some extent networked for advocacy on
he.r 'h related issues at national level, are yet to be-
The District-level Health Action Forum could com
prise the following:District-level Health Officers of the government
or their representatives, like District Medical and
Health Officers. District TB and Malaria Officers,
District Education Officer, etc.
Members of Voluntary Health Association of
cowre^i jomViorce at the district level,
India
Members of Catholic Health Association of India
MJ hefeis medical institutions, left to themselves and
Members of Christian Medical Association of
m :atr'.:l\, cannot measure up to the immense chalke'fltje of heaitli for all in the district,
health calls for a multi-sided response from
India
Voluntary organizations intersted in health
environment and development.
. ar ' us
irons,
MtVeWvpresentatives of people loo need to be
District level consumer movements.
'■■■
n a commitment to integral health.
WhereivShe WHO and related initiatives have been
ifsesSvr^'on the district as a viable unit for health plan-
Representatives of Diocesan Social Service
Societies.
N't reretf: njbr reasons mentioned above, it is benefi-
into one forum the various health-related
c«T\oems m the district - whether of governmental or
'TitffV^O'Jernmehtal or community-based organizations.
1.
2.
it ‘s oropossed to set up a district Health Action Fo
rum n each district of India.
Obiecti\es :
1
2
3
4
5
6
7
_________
To identify the major health needs and issues in
the district.
To plan together and initiate joint campaigns.
To pool resources together to bring health to all.
To join forces to involve people in planning and
acting for health.
To promote health resource-mapping by people .
To build infrastructures for participatory action
for health by people at the grassroots.
To promote a district-wide network of people
for concerted action for health.
Health Resource Mapping by people and health
planning from below.
4.
5.
6.
7.
8.
9.
10.
Organizing people at the grassroots into
neighbourhood health communities and net
working them through representative sructures
at the levels of the village/ward, panchayat,
mandal and the district.
Taking up district-specific health issues.
Preparing an action plan for a definite period of
time, say for five years, and preparing annual
plans accordingly.
Cleanliness and environmental protection.
Celebrating health-related days.
Consultation on participatory action for health (PAH)
Demystification of medical knowledge
Getting people to be growingly less and less ex
pert-dependant.
On the basis of the internal changes taking place for collaborators as a result of collaboration
and tho typo of response of the collectivity to external scenario, These are two factors
important In respect to DHAF. I would like to classify tho different typos of Intor-agoncy
collaborations given in annexuro 2 and the vaiious perceptions of the DHAF given in annexure
3 into four major groups and I would prefer to call them major approaches to inter agency
collaboration. Summarized and tabular statement on these three approaches Is given as
annexuro 4. These are the ‘conventional networking' approach, joint programming approach,
engulfing approach and political approach. (The third one is not relevant for our discussion
here). These are not mutually exclusive categories but are different stages of development In
a continuum. The level of understanding of the present socio political scenario, the extent of
commitment to effecting a real change in the living conditions of the poor and the degree of
capability of the actors are the factors that help an organization or an Individual to make their
choice on approach.
The first approach is the easiest and tho least burdensome one. This is the most commonly
found type of inter-agency collaboration. It does not need a higher level of commitment and
capability. In our experience, most of our DHAFs show lenience towards this direction. It Is
this approach is easily acceptable ono bocauso it Is Immediately rewarding and a politically
neutral one or "harmless" one. It Is non-throatonlng too. It Is a floating approach without any
proper direction.
The second approach is the one envisaged by the concept paper published by CHAI. It
involves more understanding, commitment and capability. It is a burdensome business and a
time consuming process. The DI lAFs look at DI IAF in this way. Il is surprising to see that
moot of our collnborotoro including our members ore not very much interested in this approach.
And those who are interested are mainly excited by the possibility of getting coopted by
undertaking "contracted out" schemes of tho governments and acting as contracted vendors of
government services.
The third is a political approach. Here a critical analysis of the emerging socio political
scenario must be tho starting point. It will provide role clarity to collaborators. The critique of
social reality will help the emergence of different types of responses within the DHAF, which
may later develop into specialized efforts or offshoots of the DHAF. Then the DHAF should
always get linked up with the emerging and now movements to safeguard Interests and rights
of people. A good example Is tho possible linkage with tho PI-1 A. Very few collaborators of the
DHAF understand it in this way.
1^ choice of Approach:
The choice of approach depends mainly on the challenge one faces from the emerging
scenario and one's resolution to address thorn in a specific manner. Hence, In the current
context, If one wants to make a choice from among the above approaches, one has to analyse
the current scenario and try to position oneself. Lot us tiy to do this and understand the ideal or
the desirable approach to collaboration that tho DHAF may need in the present context.
The current (external) scenario is largely shaped by globalization. The direct impact of
globalisation on health is a well-discussed subject. Now for the purpose of this paper, we shall
turn to some other impacts of globalization. Shrinking of the state, decentralization of power
and crisis in democratic practices are the important political impacts of globalization.
The state in India after globalization is not as powerful as it was earlier.
The state lost its
power In terms of both autonomy and sovereignty to tho market. This leads to
1. Giving up many of its conventional functions in favour of the market. Decentralization and
devolutions takes place in a great way at his point of time.
2. Market forces and the rightist, reactionary divisive forces rush to occupy the spaces
formerly occupied by the state as soon as the latter makes the withdrawal.
WChaiiif'chdiiibtinlccl-dlial’.ik'c
-2-
3.
The democratic practices that shaped the state gradually become outdated and a crisis
appears there. The organised political forces that try to control the state will have either to
become mouth pieces of the market or to compromise with it and with that representative
democracy will be in very serious crisis. Search for new models become inevitable.
The only hope is civil society. Activating civil society and promoting different types of civil
society organisations to capture the new spaces and to pilot new democratic practices is a real
solution. But civil society is virtually non existant or remains fragmented, if at all, It exists, Not
only that the factors such as caste, class and so on which tho segmentation of civil society
takes place are also affected by globalisation and undergoing changes.
It suggest that
conventional organisational stratogios will also become Inadequate and inappropriate. On the
other hand tho new organisational strategics such as NHGs and SHGs proposed under
globalization are proposed to make people in different to such changes but can be seen as
double edged weapon.
The above anlaysis tells us that the desirable or ideal approach to collaborations in DHAF in
the political one. Unless the DHAF intervenes in the political situation, the networking and joint
programmes will neither bo able to make any impact on tho lives of the masses or be
sustainable. And equally Important Is the Implication that most of our collaborators are not
adequately aware of the real nature of emerging situation.
Tasks before us:
Tho following aio tho important tasks before us.
o A well designed policy on networking and collaboration. (Networking and collaboration is to
»
•
be seen separately from advocacy and lobbying. Both are not ono and same. The former
can bo a tool for tho latter; but not a tool only for tho former. It has other functions too.
Spoil out those also In policy statement).
Building up tho capacity of our members and other collaborators Is very much Important.
The capacity building activities of the CHAI has to address tho now and emerging needs
also. The ongoing capacity building activities needs a thorough revision.
Opening up ourselves is very important. The leaders of tho R.U.s and the D.U.S may have
to be made aware of the inevitability and desirability of being open.
WChauittchdurb.'ui'cd-rlliaf.doc
-3-
Annexure - 4
THE DIFFERENT APPROACHES TO DHAF
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1.’ " Conventional
network aporoach
2.
Joint
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Approach
Nature
A mere platform (sharing and
discussion on heath issues
and concemes celebrations)
watchdog
And "excursion"
Join planning.
Joint programming
Convergence
Addresses the issues of long
term has s
Extension
Internal change
No internal change
Extent of involvement is
limited, (for a change or
variety or seeking support
and gaining confidence)
Internal changes takes
place (policy, planning
etc)
Network priorities
influences internal
priorities
Response to external
situation
No serious response to
the external situation.
Superficial responses
Symbolic responses
Not deep
Curative and partly
preventrve in nature
Result
No effect on the fa-scars
creating tne scenario.
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4.
Engulfing
Acprcach
Pcliricai Aporoach
Efficiency increased
Help the actors to ecjusi
to the scenario
Compromising
Getting coooted
No influence on •‘actors
creating the str1.
3 to p-ga o a rrer gem en r
NOT RELEVANT TO OUR CONTEXT
DHAF becomes a forum
promoting varying responses
including ail the above.
Flexible to accommocate
different interventions at
different levels.
Promoting offshoots
Dynamic and chancing
Internal change take place
■'perspective, vision)
'Eom again" feeling.
Strategies of operation
shall also be changed
Deep
Seek the real causes
influence the decicirg
factors
Open to all movements
catering to the interests
and needs of the poor.
_________________________
DIFFERENT PERCEPTIONS OF DHAF
Project or additional programme
Simple network of NGOs
Full-fledged organisation
Platform of all stake-holders in health
Civil society rosponco to globalisation
New paradigm of participation
Strategy to mediate with power and governance
Means to bring PHO back to forefront
Forum for advocacy and policy lobbying for health for all
Watch-dog arrangement
Instrument changing the style of functioning and
Perception of actors
Means to promote community action for health and
Hence community involvement in health
Disaster management mechanism
Arrangement for convergence of resources and hence
For cost i eduction
Mechanism to help government in carrying out its functions
Political intervention in health
Joint programming forum
Arrangement for sharing of resources and responsibilities
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Fixed Dose Combinations of!
Drugs Banned
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Fixed dose Combinations of Drugs Weeded by the Drug Controller of
India.
1.
2.
Amidopyrine.
Fixed dose combinations of Vitamins with anti
4.
inflammatory agents and tranquillisers.
Fixed dose combinations of Atropine and
Analgesics and Antipyretics.
Fixed dose combinations of Strychnine and
5.
Caffeine in tonics.
Fixed dose combinations of Yohimbine and
3.
Strychnine and Testosterone and Vitamins.
Fixed dose combinations of Iron with
Strychnine, Arsenic and Yohimbine.
7.
Fixed dose combinations of Sodium
Biomide/Chloralhydrate with other drugs.
8.
Phenacetin.
9.
Fixed dose combinations of anti-histamines with
anti-diarrhoeal.
10.
Fixed dose combinations of Penicillin with
Sulphonamides.
11.
Fixed dose combinations of Vitamins with
6.
Analgesics.
Fixed dose combinations of Tetracycline with
Vitamin C.
13.
Fixed dose combinations ofHydroxyquinoline
12.
group of drags except preparations which are
used for the treatment of diarrhoea and dysentery
and for external use only.
57. Fixed dose combinations of Haemoglobin and fixed
dose combination of Pancreatin or Pancrelipase
containing amylase, protease and lipase with
another drug (stayed by Government with effect
58.
59.
60.
61.
from October 20, 1999)
Bl, B6 & B12 combinations.
Astemizole.
Terfanadine
Multi - ingredient products that contain Astemizole,
Terfanadine or Phenformin are also banned.
Drug Controller of India,
Nirman Bhavan.
New Delhi 110 001.'
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Fixed dose combinations of Cortocosteroids with any
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15.
Fixed dose combinations of Chloramphenicol with
any other drug for internal use.
16.
Fixed dose combinations of crude Ergot preparations
except those containing Ergotamine, Caffeine,
Analgesics, antihistamines for the treatment of
migraine headaches.
17.
Fixed dose combinations of Vitamins with Anti-TB
drugs except combinations of Isoniazide with
Pyridoxine Hydrochloride (Vitamin B&).
18.
Penicillin skin/eye ointment.
19.
Tetracycline liquid oral preparations.
20.
Nialamide.
21.
Proctalol.
22.
Methypyiilene, its salts.
23.
Methaqualone.
24.
Oxytetracycline liquid oral preparations.
25.
Demeclocycline liquid oral preparations.
26.
Combinations of Anabolic Steroids with other drugs.
27.
Fixed dose combinations of Oestrogen and
Progestrin (other than oral contraceptive containing
per tablet Estrogen content of more than 50 mg
(equivalent to Ethinyl Estradiol) and of progetin
content of more than 3 mg (equivalent to
Norethisterone Acetate) and all fixed dose
combinations injectable preparations containing
synthetic oestrogen and progesterone.
14.
28.
29.
Fixed dose combinations of
Sedatives/hypnotics/anxiolytics with analgesic -
3
antipyretics.
Fixed dose combinations of Pyrazinamide with other
anti-tubercular drugs except combinations of
Pyrazinamide with Rifampicin and INH as per
recommended daily dose given below:-
Drugs
Minimum
Maximum
600 mg
450 mg
Rifampicin
300 mg
400 mg
INH
1000 mg
1500 mg
Pyrazinamide
30. Fixed dose combinations of histamine H2 - receptor
antagonists with antacids except for those
combinations approved by the Drugs Controller,
India.
31. The patent and proprietary medicines of fixed dose
combinations of essential oils with alcohol having
percentage higher then 2% proof except preparations
given in the Indian Pharmacopoeia.
32. All Pharmaceutical preparations containing
Chloroform exceeding 0.5% w/w or v/v which ever
. is appropriate.
3.3. Fixed dose combinations ofEthambutol with INH
other than the following:_________________________
INH
200 mg
Ethambutol
600 mg
300 mg
800 mg
34. Fixed dose combinations of antihelmerithic with.
cathartic/purgative except for Piperazine.
Fixed dose combinations containing more than one
4
antihistamine.
36.
Fixed dose combinations of Salbutamol or any other
bronchodilator with centrally acting anti-tussive and/or
antihistamine.
37.
Fixed dose combinations of laxatives and/or anti spasmodic drugs in enzyme preparations.
38.
Fixed dose combinations of Metoclopramide with other
drugs/or anti-spasmodic drugs in enzyme preparations.
39 Fixed dose combinations of centrally acting anti-tussive
with antihistamine having high atropine like activity in
expectorants
40. Preparations claiming to combat cough associated with
asthma containing centrally acting anti-tussive and/or an
antihistamine.
41 Liquid oral preparations containing glycerphosphates
and/or other phosphates and/or central nervous stimulant
and such preparations containing alcohol more than 20
percent proof.
42.
Fixed dose combinations containing Pectin and/or
Kaolin with any drug which is systemically absorbed
from GI tract except for combinations of Pectin and/or
Kaolin with drugs not systemically absorbed.
43.
Chloral Hydrate as drug.
44.
Tooth paste/Toothpowder containing Tobacco.
45.
Dover’s Powder/Dover’s Powder Tablets.
46.
Antidiarrhoeal formulations containing Kaolin or Pectin
or Attopulgite or activated charcoal.
47.
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Sulphathiazole or Sulphaguanidine or Succinyl
35.
Sulphatjiiazole.
5
Antidiarrhoeal formulations containing Phthalyl
Sulphathiazole or Sulphaguanidine or Succinyl
Sulphathiazole.
48
Antidiarrhoeal formulations containing Neomycin or
Streptomycin or Dihydrostreptomycin including
their respective salts or esters.
49
Liquid oral antidiarrhoeals or any other dosage form
for paediatric use containg Diphenoxylate or
Lopermide or Atropine or Belladona including their
salts or esters or metabolites Hyoscyamine or their
extracts or their alkaloids.
50
Liquid oral Antidiarrhoeal or any other dosage form
for paediatric use containing halogenated
hydroxyquinolines.
51
Fixed dose combinations of antidiarrhoeals with
electrolytes.
52
Fixed dose combinations of modern drugs with
Ayurvedic drugs belonging to any other system of
47
medicine.
Fixed dose combinations of Penicillin and
Streptomycin.
54
Fixed dose combinations of
Oxyphenbutazone/Phenylbutazone with any other
53
drugs.
Fixed dose combinations of Analgin with any other
drugs other than antispasmodics.
56
Fixed dose combinations of Dextropropoxyphene
with any drug other than non-steroidal antiinflammatory drugs (NSAID).
55
57. Fixed dose combinations of Haemoglobin and fixed
dose combination of Pancreatin or Pancrelipase
containing amylase, protease and lipase with
another drug (stayed by Government with effect
from October 20, 1999)
58. Bl, B6 & B12 combinations.
59 Astemizole.
60. Terfanadine
61. Multi - ingredient products that contain Astemizole,
Terfanadine or Phenformin are also banned.
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