MEDICAL SERVICE VOL. 42 No. 1 JANUARY-1985
Item
- Title
- MEDICAL SERVICE VOL. 42 No. 1 JANUARY-1985
- extracted text
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i^w^ww^w
BMHH
rat<onaf d rug therapy < Iocost r good q ua 1 ity? 1 ow cost generic medicines ♦ :
^swse in surgical practise S fofe df traditional medicine in primary health care
January 1935
official house journal
of the catholic
hospital association of India
medical
service
''the love of Christ
urges us" 2 cor 5 :14
vol 42
jahuary 1985
no 1
contents
editorial board
dr c m francis
dr ravi narayan
dr prem chandran john
dr daleep mukarj’i
mr augustin veliyath
fr george lobo sj
prof george joseph
dr paul neelamkavil ■'
fr edwin mj
1
editorial
2
2
rational drug therapy
dr mira shiva
3
locost: good quality, low cost generic medicines
s srinivasan
9
workshop recommendations on towards a people
oriented drug policy
13
what/why the problem in our hospitals and
dispensaries
16
comparative study of brand name drugs and
generic name drugs
a john berchmans
18
drug use and misuse in surgical practise
dr srinath dore
19
role of traditional medicine in primary health care
dr t n manjunath
22
the drug action network a people's response to
the drug's issue, vhai's role and responsibilities
dr mira shiva
25
3
4
5
editor
fr jphn yattamattom svd
6
7
cover design
p m Isaac bangalore
8
9
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
10 chai news and notes .
31
"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india'*
EDITORIAL
Big task ahead
With this issue of our Journal, most of the convention and the welcome
workshop proceedings are made available to our readers. According to the
opinions expressed by the participants of the convention and workshop held
at Bangalore last November, that was a very useful convention. Such remarks
were made by the participants regarding conventions in the past too. Every
convention ends with a number of resolutions and recommendations. During
this convention too there were resolutions and recommendations. In the
previous issue we had already given the concern expressed by the delegates
over the health situation with particular reference to the drug issues, and also
the resolutions. In this issue we are giving the recommendations at various
levels as a result of the workshop discussions. From all these one thing is very
evident i.e. the task before the health care institutions in the future is a very
big one.
We have been very prompt in making recommendationsand resolutions
during convention after convention. However^ when the question of imple
mentation comes we fall back. If we go through the recommendations and
resolutions of our last convention, we can see there are a number of very
practical suggestions to be carried out from individual level to national (CHAI)
level. Let us make a deliberate attempt to do something concretely and posi
tively on this.
The basis of all these proposed activities and action programmes is
our motto, i.e. "Love of Christ Compels Us". It is in the field of health care
that this love can be manifested in the best way. There should be an urge
from within us to come to the aid of the sick, the poor, the oppressed, the under
privieged etc. It is not enough for us to provide certain services even in the
most efficient way or even free of cost for those who can not afford to pay.
We need also to analyse the situation in which majority of our people are.
We are treating millions of sick people through our institutions every
year. On analysis we may find vast majority of them are suffering from infec
tions, diseases due to malnutrition, lack of safe drinking water, proper sanita
tion, etc. Yet we know most of thesis could be prevented. The requirement is
proper nutrition, sanitation, safe drinking water facilities, increased purchasing
power of the common man etc.
Thus we see the task ahead of us is a gigantic one in our country and also
a challenging one. Let us all summon our courage and pool our resources to
gether and go ahead as we have no other option because "Love of Christ
Compels Us".
Rational Drug Therapy
—DR. MIRA SHIVA
Rational Drug Therapy is use of effective.
— safe
— reasonable cost
— quality control standard drugs
— for there is a specific therapeutic need.
in right doses, for right duration, for the
right patient with effective communication
of the right information which is followed by
rational consumption of drugs.
Main actors involved
Policy makers — who can allow flood the
market with irrational and hazardous drugs in
the name of scientific and pharmaceutical
progress at the cost of essential drugs.
Drug producers— Interested in producing
and selling drugs not necessarily filling health
needs having high market value, with in
adequate or biased drug information, drugs
which ensure irrational drug use.
Pharmacists—The first point of contact
for many consumers buying OTC drugs 46%
according to NIN studies with majority of
pharmacists being untrained and unqualified.
Health personnel—- who form the major
components of the medical industry complex
and who have to rely on the drug industry
for samples, ongoing education, sponsoring
of their conferences, grants for research etc..
Consumers — mainly ignorant, illiterate, poor
and sick with preventable health problems.
They often believes in the modern day supers
titions i.e. Western medicine is scientific and
developed and therefore at alone has the ans
wer 'There is a pill for every ill'.
January 1984
While talking of Rational Drug Therapy
the questions cannot be addressed to the
prescribers along since its all the various other
dimensions that makes Rational Drug Therapy
possible or not. To ensure rational drug use,
the matter has to be dealt at all levels.
Believing in and implementing Rational
Drug Therapy requires a certain philosophy
i.e. practice of humane ethical, medically
sound medicine which puts 'people' before
'profits'. Alleged belief in rational drug use
and commercialization, profitering from medi
cine don't mix. Theoritical knowledge of what
Goodman Gillman 'Martindale' and all the
medicine Text books say in absence of the
above attitude cannot ensure rational use.
Like anything else requiring swimming against
the current, rational drug therapy requires
knowledge of the principles of Rational Drug
Therapy and an attitude which permits its
implementation.
Principles of Rational Drug Therapy
Appropriateness and
Relevance— Use
drugs which fulfil the main health needs of
your people.
Prioritization— Give priority to essential
over non essential these drugs providing our
symptomatic relief.
Cost Consciousness— Avoid costly brands
if cheaper drugs therapeutically equivalent
drugs are available.
Boycott and challenge— Boycott
nal and hazardous drugs.
irratio
Communication of information— Provide
patient with adequate information about the
drug use.
3
Healing and caring — Communication of
concern— Let your
interaction having a
healing effect.
Use drugs that :
— Offer significant therapeutics benefits
— meets real medical needs
— have a satisfactory risk-benefit ratio
i.e. low risk and greater benefit.
— provide acceptable therapeutic value
for money.
Avoid using drugs which
— may be therapeutically sound but not
needed
— drugs with one or more ingredients of
no value in sub therapeutic doses.
— the drug or its ingredient
unacceptably high risk
have
an
— in a particular formulation not permitt
ing effective and appropriate intake
— which doesn't allow the most appro
priate route of intake or work as effec
tively.
e.g. Buscopan (hyoscine butyl bromide)
is used to relieve stomach spasms—
poorly absorbed from gut according to
some experts. It is effective only as in
jection (Turner P Volanse G N 1980
pg. 3) Oral B— (Cynacobalamin or
hydroxycabalamin is futile (BNF No. 5
1983 pg. 275) Painkillers, antihista
mine, creams are more effective when
taken ’orally.
Many paediatric syrups medicine con
tain about 60% sucrose and not child
ren's teeth if taken in long doses.
Avoiding avoidable risk-
— side effects are predictable and un
avoidable
4
— adverse reactions are unexpected and
unusual
— certain drugs may be risky for children
eg. Paediatric tetracyclin, cholomphenicol for infants.
— certain drugs may create problems if
used for long (therefore need to be used
only for a short period)
— some drugs are particularly prone to
abuse and can be dangerous when
abused (Pethedine, exytocic steroids)
— certain drugs have a low therapeutic
margin eg. lomotil for infants, digexin
— risks may be created due to inadequate
provision of information (eg. phenylbu
tazone, oxyphen butazone, amidopy
rines, pain killers and their impact on
BM anabolic steroids)
Certain ingredients in formulation increase
risk. eg. fixed dose combination of steroids,
■analgesics, tranquillizers. Risks when certain
drugs are formulated in certain ways. Certain
ingredients lead to sensitization to certain
products leading to reaction when used in
greater doses, e.g. neomycin and Betnovate,
antibiotic ear drops.
Fixed dose combinations are justified in
WHO's-250 drugs, only 7 are FDC—
1.
if the ingredients enhance each others
action
2.
combination and cost
3.
if willingness of patient to take the drug
improves significantly, therefore of a
single preparation.
Many combination drugs are like Swiss
Army penknieves. They are exotic and ver
salite, very convenient and compact their only
real disadvantage apart from cost is that they
are very inefficient.
Medical Service
Some irrational combinations
1.
antibiotics as only diarrhoeals—chlorostrep, STMP
2.
expectorants and cough— suppresents
together
3.
Steroids
NHS Sainsbury Report *1967
2200 prescribed drugs categorised.
Innovation
Effective drugs 50% of the total
Rational Combinations 8%
Unclassified 7%
(Pharmaceutically active but of
therapeutic value or safety)
unproven
Undesirable irrational, ineffective, 'supersed or absolute drugs or preparations.
U.K. joint formulary Committee recently
identified 20-24% of 2000 and branded drugs
as less suitable for prescribing BNF No. 6
1983.
Why are fixed dose combinations made?
1. Extension of product range
2.
Can get patent protection
3.
reduces price competition
4.
Convenient
5.
May be cheaper.
I remember a study* involving chickens.
It was a carcenogenesis study—a study to
determine whether or not the drug caused
cancer. The report to FDA said the test drug
caused cancer no more often than placebo,
or a sugar pill and in fact that was true. What
they failed to tell us was that half the chieckens
died of heart failure. That's putting your best
foot forward.
VIC Department of Health and Social secu
rity—204 new chemical entiters studied which
were granted license between 1971 -80. NCE's
were mainly for disease—common cronic and
and occur principally in Western Society.
Only I was a new C.E. For treatment of odristogomases, oxamniquine (guffin JP, Diggle
GE '81.)'
NCE's in U.S. 1982, 28 new drugs approved.
Class Degree of thera
peutic gain
No. of
NEC's
%
K
Important
4
14
B
Modest
5
18
C
Little or none
19
68
Analgesis of product licenses between
1973-77 done by Drs. Guffin and Diggle.
Fully innovative
In 1982 £ 150 million spent on drug pro
motion. In U.K. about £ 4000—£ 5000 on
each G.P. i.e. 50 drug advertisements/day
1 : 20
1 : 3—4
4 NCE's
4%
Semi innovative
32
31%
Non innovative
67
65%
(D HSS- Department of Health <& Social
Security)
provides professional, political support, spon
soring, research, journals, conferences, free
medicines.
Greenfield report 1982— Informal working
group on effective PRESCRIBING.
Drug
information—Panorama
series 17-1-83.
Sainsbury 1967— Medicines Commission—
Association of British
January 1985
BBC-TV
5
Pharmaceutical Industry
no control of medication
no confidence in product quality
decreased patient compliance and con
fidence
loss of support for errors and problems
loss of information and technical services
U.K. based medical research discourage
Placebo effect
Beecher 1982 patients. Placebo effect in
angina, rheumatoed and degenerative arthri
tis, pain hay fever, headache, phtic ulcer and
essential hypertension.
Psychiatric • patients
anxiety— psycho
therapy, (Benson 4 Epstern M 1975)
Causes of overprescribing
— to play safely and legally if unsecure
— to terminate consultation when busy
tired or bored
— to impress or mystify
— patients or role play as a proper doctor
— prescribing on instruction from superiors
— compliance to patients demands
— recognition of the desirability of not using
drugs when not needed.
Sources of information which most influence
general practitioners prescribing habits.
percent
Source
Drug firm representatives
29
Recommendations from consultants
27
Articles in journals
12
Drug firm literature
10
Professional contacts with doctors
8
Advertisements in journals
1
Drug firm meetings
1
Other sources
10
Dont know
2
(Source Sainsbury Committee enquiry. 1967)
Quality of prescribing
Of 25 most prescribed drugs in U.S. 1976,
8 were authoritatively considered to be phar
macologically and therapeutically questio
nable (Knapp. D E 1978)
Realizations about Drug therapy
Prescriptions for children random samples
72 GPs in Wessics 1% i.e. 80/6331 could
legitimately be called into question on the
basis of current .modern specialist leading
42% of doctors used drugs that have recently
been considered hazardous or undesirable
(Calford J 1980)
— Different patients respond differently to
drugs
750,000 leading hospital prescription indi
cated over one in 8 was over medication.
— need to avoid drugs in pregnancy
Recognition of ingredients
— sheet habit
— justify consultation and make it official
— to impress the patient and keep him
hooked.
— recognition of catrogenise and nature
of drug interaction
— recognition of the role of suggestion and
therapeutic effect of the prescribing
process
6
Best known 23 combinations correctly
identified by only 2/3 prescribers, 7/23 not
even one physician answered correctly. (Re
port of plot survey among 60 Montreal physi
cian in DTB, '80) Over half of repeat pres-
Medical Service
criptions were in appropriate for
Report 1967
Sainsbury
1/4 prescriptions for painful osteo arthritis
were for Butazolidin. About 20% of prescrip
tion were for drugs with no anti inflammatory
effect eg. codiene, paracetamol. Antidiarrheals—about 40% of prescriptions were for
antidiarrheals, now discredited or considered
hazardous.
should receive from £ 5 note after purchasing
single article. Nearly 1/3 cannot handle multi
plication, division or percentage (News item
Numeracy week Guardian 1983).
Royal college of G P's 1977.
Typical GB seeds
— 600 people with cough and colds
— 300 suffering from depression and anxiety
Consumer compliance
— 100 with chronic rheumatism
Two out of 5 patients never take prescribed
drugs as directed (Parish 1982 pg 10).
— 50 with High B P
Over 200,000 tablets were collected by
chemists during a 3 week medicine amenesty
in Dudluy in 1976. 3 years later —300,000
tablets turned. In 1982, 140,000 tablets col
lected. (Source Inglis B in Health Services-'82)
4/10 cannot read railway time table. One in
4 adults cannot work out the change they
ALAHS/N
from
— 8 with heart attacks
— 5 with chronic appendicitis, strokes.
Campaign poster—be prepared to leave this
clinic chamber empty handed. The doctor
may not give you a prescription. His advice
may be all that you.need. You can be sure that
is you really need one you'll get one.
pioneers of Ayurvedic research in-Medical’Dental •Veterinary fields
-'•> in management of DENTAL patients ■'
Safe; Simple drugs^c curative aspects
etklcoL pnxrctucts
for • GUM • DENTAL • ORAL Hygiene
as Gum massage. Dentifrice, Rinse & Gargle
52
ALARSIN
Relief in 2-3 applications
Remarkable improvement in 2-3 days.
in easily crushable tablet form
GUMS Gingivitis: Bleeding, swollen, spongy, painful Gums
TEETH: Painful, Aching, shaky & Hypersensitive:
prevents plaque formation.
ORAL hygiene : in disease or drug induced conditions,
where oral hygiene has to be improved & corrected.
G32 is an excellent supportive &■ follow up treatment:
to consolidate the gains of Surgical & Systemic management
of Gum & Teeth conditions and ORAL Hygiene;
.
R. COMPOUND V/c ’ Oxyphehbutazone
Aspjrih
as Anti-inflammatory, Analgesic & Antibacterial
Quicker relief without side effects Complete relief within 5-7days
in all Inflammatory & Painful conditions of Oral cavity:
after teeth extraction. Trismus, Odontitis, Dental Pulpitis.
Cellulitis. Periapical abscess. T. M. Jt. problems.
DOSE: 2 tablets tds for 7 days.
January 1985
AYAPON
Oral Herbal Haemostatic & Coagulant
in all Bleeding Conditions of Gums, where
the patient needs systemic heamostatic
Pre-operative: as prophylaxis to minimise
bleeding.
Dosage can be adjusted according to the
severity of bleeding (up to 6-12 tabs a day
In divided doses)
SOOKTYN
for immediate & lasting results in
• HYPER ACIDITY • ORAL ACIDITY
relief within 5-15 minutes even in severe
cases with 3-6 tabs at a time
Masticating trouble leads to: Indigestion.
Flatulence, Constipation, Hyper-acidity
syndrome (nausea. vomiting ptyalism)
SOOKTYN helps assimilation, degestion,
morning evacuation
DOSE: 2 tabs tds between or after principal
meals.
for Rx all available in 50 & 100 tabs PACKS at Chemists
lor Hospitals & Clinics: Supply from factory only.
1000 tabs PACKS except G32.
for latest research data.
Therapeutic fade* Pjice List
Please write for ser-D
ALARSIN MARKETING P. LTD.
12. K. Dubash Marg. Fort. Bombay-400 023.
7
Locost: Good Quality, Low Cost Generic Medicines
—S. SRINIVASAN
Our former Vice President, M. Hidaytullah
once made an interesting observation:
"Why have milk prices gone up so much?
In the olden days, the mothers milked the
cows, the daughters set it out in pans to
separate the cream, one of the sons sold it
in the market.
Today, the agricultural department is mobi
lised, the cow sheds are sterilised, the cows
are immunised, the milk is homogenised,
the supplies are- motirised, the dairies are
organised, the milkmen are unionised, the
milk exports are subsidised, the political
leaders are energised.
The result? The Indian consumer is victimis
ed."We, in LOCOST are not exactly in the milk
business but we have been concerned with
the drug (medicines) problems in our country
and decided to launch out a small project
called LOCOST, to distribute generic based
medicines that are not only cheaper but
scientific in their constitution and specifica
tion.
Our small effort has had its initial problems,
obstacles, and challenges. There were even
moments of anxiety. But we cannot deny that
the support LOCOST received from interested
health and management professionals, from
partners or purchasers has given us cause to
look forward.
LOCOST (Low Cost Standard Therapeu
tics) is a collective voluntary enterprise for
rational therapeutics. LOCOST aims to pro
mote low cost, scientifically tested medicines
January 1985
under generic names. LOCOST is a response to
a growing demand and challenge of the vo
luntary health sector to meet the needs of the
deprived sectors of society for not only low
priced, but also good quality medicines.
History of LOCOST
In the last few years, voluntary agencies
have been sensing an urgent need for a ratio
nal drug therapy structure. Some of the main
reasons that led to this sense of urgency
were: widespread irrational prescription prac
tices with no social accountability; the un
ethical practices of the drug industry; the lack
of a formal structure and network for low cost
and quality medicines.
Despite seminars, commissions, research
studies and journalistic expose's, there was
no adequate implementation as a response
compared to the magnitude of the problem.
Interested voluntary health sector members
discussed the issue and finally sowed the first
seeds of LOCOST in a nebulous form. In 1982,
a team of experienced professionals in the
field of community health got together and
drew up a list of the essential drugs based on
the Hathi Commission, the WHO recommen
dations and other such documents. A search
for competent and dedicated personnel finally
led to a modest infra-structure for LOCOST.
The initial bottleneck LOCOST encounter
ed was the problem between prices and orders.
Small scale manufacturers, whose credibility
was not doubted, refused to quote a price
unless they had firm orders. The partners
(or target purchasers from small health cen
9
tres) did not want to place orders until the
prices were quoted. LOCOST was badly in
need of finances for its working capital runn
ing expenses and non-recurring capital re
quirements.
Taking a plunge however, LOCOST secured
a few loans from individuals to the tune of
Rs. 55,000/- and asked OXFAM for a grant
of Rs. 40,000/- to explore the viability of the
idea for the first few months. Fr. M.A. Urrutia,
was able to raise a further grant of Rs. 55,000/and LOCOST was launched.
Registered as s public trust at Baroda in
November 1983, the first supply of LOCOST
drugs was despatched in October 1983.
Subsequent visits to health institutions only
underscored the need for rational therapeu
tics. LOCOST is now well on its way to es
tablishing a small step, but in the right direc
tion, in the field of social justice in health.
How LOCOST Functions
1.
Procurement : LOCOST has contacted
a number of reliable low cost drug manu
facturers on the Bombay-Thane and
Ahmedabad - Baroda - Surat regions
whose integirity and credibility have not
been doubted.
LOCOST plan ultimately to distribute 72
drugs based on the WHO and Hathi Com
mission recommendations
which will be
added on to the LOCOST price lists as the
financial base gets more secure. One of the
options of LOCOST is to increase its nominal
profit margin and or to cater to private profit
making institutions. However LOCOST feels
this will vitiate and hamper its original aims
and objectives, namely to cater to the rural
poor and urban slums.
Educational Efforts
LOCOST tries to create an awareness about
the unethical and irrational practices of both
the health professionals and the drug industry
through visits, literature, seminars, etc. This
enhances the scope for rational drug therapy.
A rational drug therapy cell has been formed
under the auspices of LOCOST. The cell con
sists of interested physicians, academicians
and practitioners from the field of medicine,
pharmacology and management from Bombay
and Baroda. The cell has had to two meetings
to date—one at Bombay and one at Baroda.
The cell will, among other things, do the fol
lowing :
1.
• 2. Some of these manufacturers supply the
drugs specifically ordered by LOCOST.
3. Quality testing and control : LOCOST's
responsibility is to ensure a regorous
quality control of these drugs before
despatch.
4.
All the drugs distributed by LOCOST
are under generic names and adhere to
the principles of rational drug therapy as
chartered by the World Health Organisa
tion, the Hathi Commission and other
authentic studies.
LOCOST's range of products has increased
from the initial 19 to 25 to 45 at present.
10
Critically review and examine existing
drugs* and therapeutic agents available
in the Indian market with respect to their
scientific constitution, the claims' made
by their marketing agents, and the harms,
uses and misuses in the light of actual
experiences in India.
2.
3.
Pool in adverse drug reactions.
Conduct research and study wherever
needed.
4. Find ways and means to educate users
at various levels and act as a guide to
users especially in rural areas.
5. Start publications and educational mate
rials to support the rational drug therapy
effort.
Medical Service
Conclusion
Annexure I
Why LOCOST?
LOCOST is slowly taking off towards more
stability not only in services rendered and in
management functions but also in awareness
building of rational drug therapy. It would be
appropriate here to thank all the partners for
their support and involvement without whom
this venture would not have reached where it
is today. LOCOST thanks each one of its part
ners and hopes that a constant dialogue will
help both parties fruitfully.
Several independent studies have revealed
the following facts:
1.
There are approximately 30,000 formu
lations going on in the market under
various brand names. Most of these are
unscientific.'
2.
All these formulations can be reduced to
about 200 in number. Their compositions
can be simplified thus enhancing the
relevance for rational drug therapy.
3.
Marketing them under generic names can
further reduce their costs to the consumer.
Postal Address
4.
The Coordinator
LOCOST
GPO Box No. 134,
Vadodara 390 001
Granting a reasonable profit margin, the
present on going rate of profits can be
lowered considerably.
5.
It is possible to ensure a high quality
of drugs at low costs.
For price list and for further information,
please contact :
Office Address
LOCOST
Arunoday Building (top floor)
Opp. Lakadi Pool
Shivaji Road, Dandia Bazar
Vadodara 390 001
Tel : No. 55 84 81
January 1985
it was widely believed that quality drugs
cannot be made available at low costs. Yet
there was a pressing need from health profes
sionals working with the poor and marginalis
ed sections of society for low cost. quality
medicines.
LOCOST was launched as a response to the
above situation.
11
Annexure //
Comparison between LOCOST prices and prices of cheapest brands/generics cur
rently at Khushalchand Charitable Drug Store, S.S.G. Hopsital, Baroda
Form &
Ampicillin (LOCOST)
Ampicillin (Lyka)
2. Ampicillin Syp (LOCOST)
1.
3.
4.
5.
6.
7.
8.
Ampicillin Syp. (Cipla)
Chloramphenicol (LOCOST)
Reelor (Sarabhai)
Chlorpromazine (LOCOST)
Chlorpromazine (Intas)
Cotrimexazole Tab. (LOCOST)
Septran (B.W.)
Bactrim (Roche)
Codein phosphate (LOCOST)
Codein phosphate (Indon)
Chloroquine phosphate (s.c.) (LOCOST)
Lariago (IPKA)
Cotrimexazole Syp (LOCOST)
Septran (B.W.)
Bactrim (Roche)
9. Diazepam (LOCOST)
Tancoiorim (Torrent)
10. Ferrous sulphate (LOCOST)
Ferrous sulphate (Roopes)
11. Frusemide (LOCOST)
Lasix (Hoechst)
12. Mebendazole (LOCOST)
IDIBENA (IDPL)
13. Metronidazole (LOCOST)
Metrogyl (Uni.)
14. Paracetamol (LOCOST)
Paracetamol (Paran)
15. Prednisolone (LOCOST)
Deltacortil (Pfizer)
16. Salbutamol (LOCOST)
Bronkotabs (Biddle Sawyer)
57.00 per 100
80.00 per 100
4.00 per 40 ml
6;20 per 40 ml
30.00 per .100
43.00 per 100
0.36 per 10
2.00 per 10
2.76 per 10
6.20 per 10
6.20 per 10
1.10 per 10
2.30 per 10
2.04 per 12
3.80 per 12
3.00 per 50 ml
7.00 per 50 ml
7.00 per 50 ml
0.57 per 100
5.25 per 100
7.20 per 1000
6.00 per 1000
0.69 per 10
2.00 per 10
0.69 per 6
1.75 per 6
0.84 per 10
2.00 per 10
0.66 per 10
1.00 per 10
1.00* per 10
2.00 per 10
0.80 per 10
2.75 per 10
strength
250 mg Cap
-do125 mg Syp
5 ml
-do250 mg Cap
-do25 mg Tab
-do80 + Tab 400 mg
-do-do10 mg Tab
-do250 mg Tab
-do404- Syp 200 mg
per 5 ml
-do-do5 mg Tab
-do200 mg Tab
-do40 mg Tab
-do100 mg Tab
-do200 mg Tab
-do.500 mg Tab
-do5 mg Tab
-do4 mg Tab
-do- ■
N.B.
1. Khushalchand price data courtesy Raju Gaekwad.
2. Please note that Khushalchand gets discount at a special rate from the drug companies.
Their actual prices to the public could be anything from 40 % to 100 % higher.
12
Medical Service
Workshop Recommendations on
Towards a People Oriented Drug Policy
at the CHAI annual convention in Bangalore
from 23-26, Nov. 1984
[Following are some of the important
suggestions made, by various groups of parti
cipants at the above mentioned workshop.
Each group had given a number of valuable
suggestions. What is given here is only a sum
mary of them which I hope will reflect the
thinking of the various groups. The sugges
tions were at four different levels i.e. Indi
vidual, institutional. Diocesan and National
—Editor]
8.
Use of audio-visual aids in educating
people on various illness, their possible
prevention, simple remedies etc.
9.
Doctors and others concerned should
avoid any unnecessary investigations, even
if this will lead to a cut in the income of
the institutions.
10.
Study of the local social and cultural
practice of the people.
11.
Sharing of the informations and knowledge
received at the workshop with others
connected with the health care services,
such as, doctors, nurses, administrators,
pharmacist. Parish Priests, etc.
12.
Write in journals like "Medical Service"
etc. about your experiences, case studies,
good or bad effects of drugs etc. for the
information and benefit of others.
Individual Level
I.
1. All health care personnel should be aware
of drugs which are essential, banned,
hazzardous etc.
2.
Prescription of drugs'should be rational in
every respect. Doctors should take special
care in this.
3.
Prescription should be legible and explana
13.
tion should be given in vernacular.
> 4. When dispensing medicines clearcut ins
truction should be given in vernacular re
garding dosage, use, timings, etc.
5.
Educate the patients by explaining to
them about the side effects of certain medi
cines, advantages of natural food over
tonics etc., rational use of injections etc.
6.
Not to fall prey to the salesmanship of
medical representatives in ordering sub
standard drugs and sometimes even spu
rious ones. No gift in any form should be
accepted in this regard.
7.
Promote herbal medicines and home re
medies and also promote non-drug therapy
like yoga, exercises etc.
January 1985
Be a good listener to the patients and
others and spend time in explaining to
them the various aspects of illness and
their remedies.
14.
Be a promoter of rational drug therapy
by joining hands with anyone who is
working in this line. „
15.
Promote the use of drugs with generic
names.-
16.
Attend refresher courses, workshops, etc.
on matters pertaining to better health
care in a rational way, as a part of conti
nuing medical education.
17.
Cultivate the habit of reading.
18.
Avoid over/under/self/multiple
tions.
prescrip
13
Share informations, journals etc. with
others concerned in the institution.
19.
9.
Promote Community Health Programme
and non-drug therapy.
Help in the preparation of a formulary 10. Identify and review the goals and objec
and follow it strictly.
tives of the institution.
21. The good of the patients should be kept 11. Inter personal relationship should be built
as priority number one by all concerned.
up in the institutions.
20.
Adhere strictly to the principles of medical
12.
ethics.
23. Have respect for other systems of medi 13.
22.
cines and promote the use of them when
ever necessary, more useful and possible.
24.
Promotion of Inter personal relationship
with all the health care personnel in the
14.
institution.
II. Institutional Level
1. Every institution should have a drug formularly to be strictly followed.
As far as possible build up a good library.
Request CHAI for organising courses for
health care personnel in the member ins
titutions (administrators, nurses, doctors,
pharmacists and other paramedicals) on
various topics.
Medico Legal Cases should be attended to
in our institutions even if this would in
volve some inconveniences as human
life is more important than any inconvenciences.
2.
There should be a pharmacy committee 15. There should be fixed time for meeting
medical representatives.
in each institution (hospital) comprising
of the administrator, pharmacist, medical 16. Imparting health education on topics,
officer etc. The number of members in
like oral rehydration, NFP, prevention of
this committee will depend on the size
illness etc. should form an integral part of
of the institution.
our institutional activity.
3.
Drugs should be dispensed only on pres
cription.
17.
As far as possible institutions should co
operate with government at various levels.
Certain common medicines should be 18. Every institution should have a qualified
prepared in the institution itself to en
pharmacist.
sure quality and make it cheaper eg. pre
19. Primary health care should be taken on a
paration of carminative mixture etc.
priority basis by all our institutions.
5. Have a pharmacy budget and preference
interaction
should be given to life saving and essential 20. Healthy inter-professional
should be promoted.
drugs.
4.
21.
Avoid unhealthy competition among ins
titutions and to be stopped at all cost in
doctor-snatching.
6.
Remove all the banned drugs from the
pharmacy.
7.
Stock sufficient quantity of life saving
22.
drugs.
8.
Display a list of essential drugs and banned
drugs at the dispensary arid at the OPD 23. Join hands with other institutions and
of hospitals to educate people.
professional bodies to create public opi-
14
Medical Service
Positively promote other systems of medi
cines and nondrug therapy.
4.
If need be even to initiate.action against
doctors who go against institutional for
mulary and policies.
CHAI should eventually go for production
of essential and life saving drugs for the
benefit of all. Consult Lisie hospital, Ernakulam, LOCOST, Baroda and Bangarapet Tablet Factory for this purpose.
5.
Send informations to CHAI Central Office
on new -experiences, initiatives, innova
tions etc. to be published in our journal
"Medical Service" for the information
and. knowledge of others.
Continuing medical education should be
taken up by CHAI which should include
other systems of medicine. Our journal
"Medical Service" could also be used for
this purpose.
6.
CHAI should take initiative in reorienta
tion of Medical Education also in terms of
value formation. A start could be made
with St. John's Medical College itself.
7.
CHAI should organise training of Com
munity Health workers at a reasonable
cost.
8.
Informations on compounding drugs
should be provided through our journal
"Medical Service".
9.
Information materials on drugs and other
such subjects should be made available
in regional languages either directly by
CHAI or by diocesan/regional unit of
CHAI.
10.
Collaborate with and support other likethinking organisations at the national,
regional and local level.
11.
Use counter advertisements.
12.
An evaluation through a survey regarding
the follow up of this workshop should be
done before the next convention.
13.
CHAI should provide a list of pharmaceuti
cal firms producing drugs with generic
names.
14.
CHAI shall mobilise public opinion and
approach the central and state govern
ments to solve problems related to pro
duction, distribution etc. of drugs at all
levels.
(Contd. to p. 17)
riion and pressurise the Government to
change policies for the good of the people
at large.
24.
25.
III.
Diocesan Level
1. There should be a coordinator in every
diocese to coordinate various efforts in
the health field.
2.
Orientation, workshop etc. should be
organised in the diocesan level (sometimes
also regional level) on various topics con
nected with a rational health care. .
3.
Institutions in a diocese, or even in a
region, should come together to form
certain common policies based on the
situation of their area.
4.
They should also organise bulk purchase
of drugs and other materials.
5.
There should be regular flow of communi
cations between the diocesan units and
CH Al. for better service and efficiency.
IV.
National (CHAI) Level
1. CHAI should prepare list of banned drugs
(preferably with reasons for banning), and
essential drugs for the use of various types
of institutions.
2. CHAI could prepare a model formulary
for different types of institutions.
3.
CHAI should establish a quality control
lab as soon as possible on a priority basis.
January 1985
15
What/Why the problem in our
Hospitals and Dispensaries
(A summary of the FactorslProblems identified by 15 groups through small group
discussion)
National
Life saving drugs not available
sufficient quantities.
Too many formulations.
Lack of a rational drug policy.
Lack of quality control.
Inadequate price control.
Essential drug prices rising.
Unnecessary taxation.
in
Institutional (Professional)
Belief in standard companies.
Highly individualised prescribing.
Improper communication with both
patient and pharmacist.
Habit to prescribing powerful drugs.
Not open to other systems or non-drug
therapies.
Lack of continuing education.
Lack of knowledge of banned drugs or
policy issues.
Professional associations do* not advocate
rational drug policy.
No encouragement to local compounding.
Struggle for existence.
Institutional (Pharmacy)
Have become income generating unit of
hospital.
Decrease in local compounding.
Use of expired drugs.
Continued use of English in labels and
instructions.
Lack of bulk purchase.
16
Cost only criteria in drug selection.
Buying
from
local,
substandard
companies.
Institutional (Administrative policies)
Lack of communication and team work.
(between administrators, doctors and
pharmacists)
Lack of rational drug policy.
Lack of standardised formulary.
Profit motive and commercialization.
Charging for donated medicines.
Selling of vaccines obtained free from
Government.
Inefficient administration.
Building mania and institution develop
ment.
Refusal of emergency or medico legal
cases.
Inter institutional competition.
Doctor/staff snatching from one church
institution to another.
. Lack of involvement with government
agencies or health services.
Screening of drugs/policy issues by
untrained superiors/administrators.
Lack of institutional goals.
Lack of understanding of peoples needs.
Lack of commitment to christian/human
value system in the institution.
Medical Companies
High pressure advertising.
Misinformation.
Package deals of inessential drugs.
Medical Service
Expectation of free treatment.
Ignorance about drugs.
Poor purchasing capacity.
Over the counter purchase.
Self-medication.
Psychological dependence.
Increasing drug culture.
Inadequate consumer awareness
or action.
Offer of unethical 'perks' or 'discounts'.
Offer of resources to institutions.
Drugs treated as an industry.
At the level of people/patients
Pressure for injections and tonics.
Faith in costly medicines.
Faith in foreign medicine.
(Contd. from p. 15)
15.
CHAI should prepare/make available au 19. CHAI should organise a strong National
dio-visual materials for educating the
Drug Committee for research on drugs,
health care personnel and the public.
study on harmful effects of drugs etc.
16.
A signature campaign could be under
taken by CHAI demanding from the drug
controller. Supreme court and others con
cerned for a speedy implementation of the
existing legislation on drugs and also for
bringing further legislation to ensure
availability of life saving and essential
drugs and also banning of hazzardous
drugs.
20.
Research should be undertaken into the
systems of medicines other than Allo
pathy for better and cheaper health care
more in line with the values and culture
of our people.
[The above mentioned suggestions are of
great importance for all of us concerned with
the health of our people, particularly the un17. CHAI should work in closer collaboration derprevilaged. Hence I request all concerned
with other national organisations like at various levels to go through them carefully
VHAI, CMAI, All India Drug Action Net and seriously and try to implement them. As
work etc.
suggested we shall try to make an evaluation
18. CHAI should help resolve problems in before our next convention.
various hospitals which may emerge when
*— Executive Director]
they start implementing these policies.
January 1985
17
A Comparative Study of Brand Name Drugs and Generic Name Drugs
(on the basis of cost and efficacy)
A. John Berchmans
Introduction
The study was conducted at the Ozanam
Free Dispensary, located in the camps of St.
Joseph's College, Tiruchirappally-620002,
Tamil Nadu.
A Brief History
The Oznam Free Dispensary was opened
on 23, April 1978 with a motto to give
Medical care to downtrodden and forsaken
section of the society without any discrimi
nation of caste or creed and is run by the
Tiruchirapalli Particular Council of the Society
of St. Vincent De Paul. It is open between
4.30 p.m. and 6.30 p.m. on Mondays, -Wed
nesdays and Fridays. One Lady doctor and
two male doctors visit our dispensary on the
above said days on the honorary basis. Regi-
stration fee of Re. 1/- is collected for administening. injections and 50 paise for oral
medicines from the patient. Apart from this,
donations are collected from the generous
hearted local parishners, viz, business men,
professors, etc. and sometimes financial aid
from CHAI, which help us to keep the dis
pensary afloat.
The Study
Till a year ago only brand name drugs
were prescribed and dispensed in our dispen
sary. Then on the suggestion of Medical
practitioners who prescribed generic name
drugs we began to purchase, prescribe, and
dispense generic name drugs but quality
drugs in our dispensary and studied the cost
and efficacy of the generic name drugs and
brand name drugs. Here we present the
result of our study.
Brand Name
Price
Generic Name
Price
1.
Tenamycin, Inj
(Pfiza)
For .
10 ml Vial
Rs. 3.45
Cexytetracycline
Microbe
Gufic
2.
By Inj.
Alembic
Cyanocobalamin
3.
Neurobion Inj.
Merck
For
10 ml pack
Rs. 3.25
For
2 ml pack
Rs. 2.50
40ps per Tab
35ps/Tab
35ps/Tab
8ps/Tab
Metronidabole
200 mg
Paracetamol
Ascorbic acid
For
30 ml pack
Rs. 4.70
Rs. 4.75
For
10 ml pack
1DZ Rs. 7.00
For
10 ml pack
Rs. 4.00
14ps/Tab
25ps/Tab
Sulphadiazine
4.
5.
6.
7.
Flagyl 200 mg
Amezole
Crocin, Metacin
Cel—100 mg
(Vit. C)
Sulphadiazine
(^i+Bq+B^)
Zobromin
10 ps/Tab
3ps/Tab
18ps/Tab
As the above study shows the generic name drugs are less costlier than brand name
combination drugs none the less they are as efficacious as the latter. In the future we
shall purchase, prescribe and dispense generic name drugs, but quality drugs for all the
essential drugs and help the poor by giving necessary medical care for a lesser charge and
give the medical care freely for those who really deserve it.
18
Medical Service
Drug Use and misuse in Surgical Practise
Dr. Srinath Dore
There are about 1,600 officially recogni
sed drugs and drug combinations listed in
the mothly index of Medical Specialities a
monthly publication which is a Pharmaco
logical index used in most hospitals as a
source of' reference to the Medical Profes
sion. Out of this long list probably only 50
drugs are essential and in use in Surgical
Practice at this Hospital. At the outset it
brings to .light the gross discrepancy between
the number of essential drugs reuqired and
the number available for the practitioner to
use.
In the Analgesic and Antipyretic group of
drugs there are about 54 brand names of
drugs which are basically combinations of
Paracetamol, Analgin etc, starting from
Actimol, Avamol to Zimalgin. Among the
huge list of 54 we use only 6 drugs which
are Baralgan tablet and injection, Novalgin
tablet and injection. Fortwin tablet and
injection, Crocin tablet. Injection Mol,
Injectine Pethidine and Injection Morphine.
The Companies marketing these drugs vary
from known companies to relatively unknown
companies with no proper quality control
and testing^
In the
Sedative
and Tranquilliser
group there are 25 brand names with
common names like Calmpose to drugs
like Nervo Vitamin 4
being
advocated
for Cardiac Sexual Neurosis and psycho
Neurosis. The price, range varies from 7
paise a tablet to 40 paise a tablet. In this
long list we use only Calmpose tablet and
injection.
In the Non Steroid Anti Inflammatory
groups, most brand names are combinations
January 1985
of Phenylbutazone, Oxphenbutazose, Ibuprofan and other derivatives, all drugs with
potent side effects if misused. Indications
listed vary from inflammatory conditions like
Rhematoid Arthritis, Non Traumatic inflamma
tions and inflammations associated with
Obstetric and Gynaecological conditions.
In the list of 35 drugs.we mainly use Brufen
and Dolocaps.
Antibiotics:
These group of drugs forms one of the
most important list of vital drugs which are
essential at the same time there is a gross
tendency for misuse. Misuse of Antibiotics
has led to the hospital resistant infections
which are fast becoming a problem in most
hospitals and Peripheral Centres. The policy
of to shoot a fly with a double barrel gun
has unfortunately become the trend. The
drugs used are Ampicillin, Gentamhcin,
Crystalline Pencilling Strepto Pencillin, Eroythromycin, Septran, Cloxacillin, Cephalexin
and Metranidazole. Each of these drugs are
marketted by 15 different Companies under
their own brand names with varied combina
tion and price ranges. The Industry churns
out different antibiotics as their profit margin
is high. A course of Ampicillin for seven
days would cost Rs. 40/-whereas the same
course with Streptopencillin having similar
range of properties would cost half
as much. Thus most essential antibiotics are
quite out of reach of the common man.
Drugs acting on the Gastro Intestinal
System:
Ranging from Antacids to Laxatives and
Antispasmodic agents we use ten drugs in
19
the list of 80. The prominent ones are
Gelusil, Dygiene, Cimetidine, Buscopan,
Perinorm, Dicyclomine,
Dulcolax, Liquid
Cremaffin and Glycerin Cuppository. These
group of drugs are most commonly prescribed
and hence one needs to view them with
seriousness. Apart from the essential drugs
we have a long list of enzyme preparations
like Zynebio, Molzyme, Merizyme, Enzar
which have relatively minimal utility but
pushed and sold in the market because of a
high profit margin.
The Endocrine preparations used in
Surgery are mainly in Thyroid disease where
Eltroxin and Potassium Iodide is used and in
Diabetes where Insulin and Lente Insulin
are used.
The Anti Tuberculosis and Anti Leprosy
Agents are the essential group of drugs
namely
INH-, Thiacetazone, Rifampicin,
Etnam Butol, Streptomycin, Pyrizinamide,
Dapsone and Clofazime. There are very few
companies marketting these essential drugs
as compared to the Companies, marketing
tonics and vitamin's. The reason is obvious.
These drugs don't form a very big financial
and commercial prospective.
Tonics, appetite stimulatants mineral and
nutritional additives. This is the money
spinner of the pharaceutical industry and has
unfortunately a most prominet place in drug
therapy. These fortn the least important
group of drug from a therapeutic point of
view. The conditioning is so deep rooted
that the first medicine the patient wants for
his ailment is a tonic rather than drugs for
January 1985
Tuberculosis. In a prescription of five drugs
the patient may first buy the tonic and leave
out the rest for want of money. We have a
record of two hundred and forty brand names
of drugs with exotic names like Glutomalt
Tonomalt, Tenophos, Bitahext, Bitopheral,
Berin, Sclerobich. The list is endless. The
listed indications vary from general tonic,
general debility, stressful conditions, noctur
nal muscle cramps to nervous exhaustion.
They come in varied palatable flavours and
attractive containers with complimentary
gifts. Price range is limitless. We have
thus have a list which is relatively non essen
tial but with so called maximum range of
indications to suit our large population. The
ones really used are tab. Macrofolin with
Iron Tab. B.C. glaxo, and Berocin C.
In conclusion it seems that the drug
industry is fast reaching a stage where
essential drugs are being side lined to make
room for the relatively unessential drugs.
The new Practitioner is faced with a long list
of drugs and indications that he is unable to
prescribe and choose the right drug. With
the drug industry bringing out different com
binations of drugs using technical jargons
like increased efficacy, better patient comp
liance it becomes imperative for the practitio
ner to be aware of the list of drugs which
are essential and of proven efficacy.
Finally I would like to emphasise that in St.
John's Medical College Hospital (which is
one of the largest hospital in the Catholic
Hospital Association of India) out of a list
of 1,600 drugs available, in our Dept, of
surgery we use only 50 which are essential.
21
Role of Traditional Medicine in Primary Health Care
Dr. T.N. Manjunath
Traditional system of medicine are deeply
rooted in the civilization of Asian region and
India in particular has recognized systems of
traditional medicine which have continued to
flourish upto modern times. Practitioners of
traditional systems of medicine in like manner
have remained a part of the community they
serve. Being sensitive to the traditions,
believes and customs of the people they
exert considerable influence within the
community in relation to health and health
related practices.
Recognizing
this health man-power
potential in the delivery of primary health
care services the joint UNICEF/WHO study
recommended to mobilise and train practi
tioners of traditional systems of medicine for
primary health care services.
Traditional medicine is the sum total of
all the knowledge and practices, whether
explicable or not, used in diagnosis, preven
tion and elimination of physical, mental or
social imbalance and relying exclusively on
practical experience and observation handed
down from generation, whether to generation
or verbally in writing. 2.
The traditional systems of medicine prac
tised in our country recognised by the Gov
ernment include the Ayurveda, Sidda, Unarii,
Yoga and naturopathy systems.
In our
country today there are 4,50,0003 tradi
tional practitioners out of which, 3,41,408
are traditionally trained.
This includes
herbalist, bonesetters, spiritual healers and
traditional birth attendants and there are
another 1,08,592 institutionally qualified
practitioners in various systems of traditional
medicine.
It is unfortunate that a large number of
these practitioners are in the field but largely
working outside the National Health Service
system. The manpower potential available
may be utilised for primary health care
services for achieving the goal of health for
all the year 2000.
A comibation of traditional healing and
modern medicine appears to be the most
promising and appropriate for the health
problems facing the developing countries.
Ayurveda or the ‘'Science of Life" countributes much in this direction as majority of
the Ayurvedic preparations are cost-effective
non-toxic and can be prepared locally.
It is well known that in many aliments of
functional origin like consitipation dispepsia,
indigestion and cases that have proved
refractory to modern medical treatment good
result's have been produced by the Indige
nous system. Yoga practice and meditation,
forms the part of the indigenous system.
They were once considered only as a subjec
tive experience. These practices have been
objectively assessed and their physiological
effects and possible clinical application in
many anxiety disorders are being recognised.
The practitioners of Ayurveda normally
prepare the medicines needed for the patients
in their own clinics from simple decoctions
to powder. The physicin also advises the
patient to prepare them in their own homes,
from locally available herbs. For example
Paper Presented by Dr. T.N. Manjunath, Assistant Medical Officer, (ISM) CHAD Programme, CMC Vellore
at the workshop on “Towards a People-oriented Drug Policy" at St. John's Medical College, Bangalore
from 23rd to 25th Novembe, 1984.
22
Medical Service
in villages combination of Thulasi leaves
juice, pepper powder and honey for cough
is used which is inexpensive, effective and
also easily available in rural areas. However
in urban areas the practitioners give prescrip
tions tor patent drugs which are available
at Chemists and Drug shops. The large
scale production of Ayurvedic drugs is now
undertaken by many pharmaceutical compa
nies like Himalaya Drug Company, Baidya-nath Company and Indian Medical Practi
tioners Co-operative Pharmacy and Stores
Limited (IMCOPS) Madras using modern
* pharmaceutical technology. These products
include patent, proprietary and classical pre
parations. Every state has got its own drug
standardisation centre which supervises and
maintains standard of Ayurvedic drugs.
There are as many as 4500 pharmacies which
produce these drugs in South-Eastern Asia.
Statutory controls over the manufacture of
Ayurvedic drugs are also enforced in some
countries.
Ayuredic pharmacopers contains 8000
receipes.
Besides these there are large
number of receipes which have not been
documented but which are used by the
community in every-day practice.
Ayurvedic medicines are prepared in
the form of distiletes (Arka) fermented
preparations (Asava, Arishta) linctus (lehya)’
incinerated minerals, shells (bhasma) powder
(Choorna) ghee (Ghritham) Tablets, pills
(vati) decoction (Kwatha).
The Community Health and Development
(CHAD Programme of the Community Health
Department of Christian Medical College) is
studying the feasibility of incorporating the
traditional practitioners in the Primary Health
Care. The CHAD Programme provides
services for the entire block of Kaniyambadi
with a population of 80,000. This study is
being conducted in a population of 15,000.
January 1985
Availability of Ayurvedic, Allopathic and
Accupuncture treatment under the same
roof is a unique feature of the CHAD health
programme and is a definite step towards
integration.
The objective of the study is to identify
the constraints which prevents the effective
involvement of practitioners of traditional
medicine in primary health care programme
and evolve strategies for their greater
involvement in promotion of Family Planning.
Maternal and Child Health (MCH) and
immunization programmes. It also includes
their orientation, training, monitoring and
supervision and identify areas where integra
tion is possible. It also aims to identify
possible linkage between the practitioners of
traditional systems of medicine and national
health care system.
11 Practitioners have been identified in
the 15,000 population. These practitioners
were interviewed, and their willingness to
practicipate in the programme determined.
The practitioners are visited by the Assistant
Medical Officer of Indian Systems of medi
cine of the CHAD Programme and their
activities are supervised every week. During
which he tries to establish a good rapport and
get their participation
in the health
programmes.
Initially they were reluctant to share their
knowledge and practices. After gaining the
confidence in the programme through the
repeated visits of the health team they
slowly started sharing their knowledge and
techniques. They were also afraid that their
practices may be asked to be stopped or
controlled.
This overcomes by assuring
them that their practices which are good and
helping the community will be maintained
and strengthened. They were also informed
of the unhealthy practices like branding and
persuaded to discontinue them.
23
They had misconception that vasectomy
affects their general health and makes man
very weak and he is suspectible to diseases.
This was removed by continued education
by all categories of health workers of the
programme.
Initially they were treating even those
conditions which were not responding to
their treatment and after education they are
convinced that certain conditions like' high
fever, of 3 days duration, bleeding should
be referred for modern medical care.
There was no proper reporting system re
garding the type of cases treated. They were
asked to maintain a record in which they have
to register the Name, Age, Sex, Complaint,
Treatment, Response and referral. This will
be scrutinized and supervised.
In the early stages there was over report
ing of case by the practitioners. This was
cross checked by surprise visits when they
were asked to show the cases. Following
this over reporting came down.
It is observed from the preliminary studies
that the traditional practitioners by virtue of
their close association with the community
plays a key role as educator and change agent
on matters relating to health and family
welfare. He, as a part of health team, acti
vely involves himself with national health
programmes both as a practitioner and as a
commnnity leader they are heavily used in the
Tuberculosis, bilariasis, RF/RHD, Malaria
eradication programmes.
Diarrhoeal diseases which causes high
morbidity and high infant mortality needs
promotion of oral rehydration therapy, which
would make an impact particularly on the
infant mortality. The traditional practitioners
have been educated on the correct use of
oral rehydration salts and its practical appli
cation in the treatment of actue diarrhoeas
with the ultimate goal of making oral rehy
24
dration therapy for treatment of diarrhoeas a
routine practice in the community.
ORS packets are distributed to them
repeatedly and they are taught to prepare
ideal oral rehedration solution in the abscence
of readymade packets in which they have
shown a definite improvement in the manage
ment of diarrhoeas.
These traditional practitioners are educat
ed on various health and health related
problems in their own village and in their
own language. Oral hydration for the child
with diarrhoea has also been accepted with
enthusiasm in preference to the crude caute
risation or branding. This is really a change
brought about by their education,
helped changing their attitude regarding some
beliefs which does not have any basis
The high cost of drugs and inability of
many developing countries to purchase such
drugs have prompted several countries to
look forward for local products in the form
of medicinal plants and herbal medicines that
have proved to be effective, safe, in expen
sive and culturally acceptable.
In this direction a herbal garden is grown
in .CHAD Campus as a means of home
remedy for common ailments and also encou
raging
traditional practitioners to identify
locally available an d commonly used medici
nal plants and herbs and make use of them
in their treatment. The community is being
educated regarding herbs in the Mahila
Mandal (Women's Group) as a means of
home remedy to make people become more
self reliant and make herbal medicine as
people's medicine.
A few low-cost effective remedies taught
at Mahila Mandal (Womens Club) meeting
and used by the community.
1.
For cold inhalations of eucalyptus
oil in boiling water helps much relivi-
(Contd. p. 29)
Medical Service
The Drag Action network a people’s response to the
Drag’s issue, VHAI’s role and responsibilities
—Dr. MIRA SHIVA
VHAI’s very inception was as a response to
the health care needs of the majority. With
a handful of visionaries, VHAI attempted to
propagate the concept of community health
and primary health care in late 60’s. VHAI
did provide a leadership role in alternative
health care with a very clear commitment to
its philosophy of reaching out to the best
deprived sections of society. Initiative alone
.with professional expertise was the strength
of VHAI. This loose federation of about 3500
membership of non profit making non govern
ment health institutions did represent a signi
ficant part of the Voluntary Health sector which
provides 20% of the primary health care in
India.
VHAI and Drugs
The Drug cultures and modern myths
April-June 1981 special issue of HFM
'medicines as if people mattered' was on
Drugs. Long before that some of us had begun
to realize the negative impact of the 'Drug
culture' or the 'Drug Pollution' of the mind of
an increasing number of a. literate, illiterate,
urban and rural health personnel and con
sumers alike. We felt that this unshakable
faith and implicit trust in drugs was being
created skillfully and being taken advantage of
by the medical industrial complex. The myth
that there was a pill for every ill was a modern
day superstition, a medical myth which was
being created, fed propagated by vested inter
est. There was just no reason why irrational
useless costly and often hazardous drugs
should be flooding the market, and find place
January 1985
even on the shelves of our service oriented
voluntary health institutions and be dispersed
and prescribed without any one questioning
the rationality of their very existence.
Our initial efforts have been geared to our
own VHAI members and in our various train
ing programmes whether they were clinical
assessment workshops, community health,
OD seminars school health workshops or ho
listic health workshops, misuse of drugs and
the issues involved have been discussed.
By the end of 1981 itself we realised that in
a society where giving of long prescriptions
with the latest 'wonder drug' had such a
value. It was difficult for health personnel in
the voluntary sector to bring about a signi
ficant change in the preception of rational
drug use in loolation. Even though many
health institutions and health
personnel
accepted the concept of essential drugs, and
rational drug therapy, they found the market
pressures very difficult to deal with.
By this time we were beginning to recognize
the shortages of essentia! and life saving drugs
eg; for TB and leprosy in the field. We also
realized that most of our health institutions
were not very well informed about the drugs
and health policies. Had.they been they would
never allow some of the decisions which
would not be in the interest of the public
to be passed so easily. The need for health
personnel, the people and consumers to parti
cipate and force their participation in decision
making in matters affecting them and their
work was strongly,felt.
25
On 8-1 Oth January in Pune, VHAI organized
an intense workshop 'Drugs issues seeking
feasible alternatives' when representatives of
consumer organizations, health organizations,
socially conscious doctors, pharmacologists,
journalists met. The objective was to-take stock
of the existing drug situation, the trend, identify
our own roles and responsibilities and coordi
nate our efforts.
It was here that the decision to take on the
issue of EP drug on campaign basis for Wo
men's day was taken. EP drugs were being
prescribed for pregnancy testing inspite of their
not being recommended for such a purpose
because of foetal malformation. In the case
of the EP campaign women's groups, jour
nalists, other peoples organizations started
coming together. A net work was spontaniously being built.
In August '82 at Jaipur many of the drug
enthusiasts met again, the focus this time was
'Hazardous drugs'. Handouts providing the
unbiased drug information from medical about
Amidopyrines, Paediatric tetracyclines, EP
update, hormonal preparations, clioquinols,
anabolic steroids were specially prepared by
us and circulated;
'false drugs information' that the drug was
not absorbed from the gut. Dr. Hanssen had
gone as a witness to help support the SMON
victims in their legal battle against Ciba Geigy
Takable Tanable the manufactures of clio
quinol (hydroxyquindine products) and the
State. He had led the boycott of 3000 doctors
and in Sweden against Ciba Giegy. Their
continued sales of clioquinols in third world
of Dr. Hanssen's inset was a big boost to us,
his public meeting at Al I MS later with the
Drug Controller of India, leading neurologists
of Delhi, various journalists etc. proved one
point—to fight against Drug colonolism, sup
port would have to come from people's orga
nizations and socially conscious individuals.
Expecting medical associations and medical
persons to fight for peoples cause was really
expecting too much. Drugs issues were a
sensitive issue and a strong stand by VHAI
has meant treading on many toes, occasio
nally on the toes of some of our own insti
tutional members.
Fighting against myths, superstitions and
malpractices of a highly organized medical
industrial complex is a task that demands
committment creativity and courage and con
sistency. Eventhough the legal dimension
of the drugs issue has been long recognised
January and MFC annual convention at the need to be involved in public litigation
against the vitimizers on behalf of the people
Tara was held with drug use, misuse as a
is long overdue. Today the matter related to
theme and the anti diarrhoeal campaign was
generic
names, the banning of EP drugs, and
launched with the various groups pooling in.
In February '83 KSSP for its bianneal 'peoples some of the other durgs in DCI's gazette
notification multivitamines etc. is in the High
science movement conversion focussed on
Court or Supreme court. It is no longer being
drugs'.
fought or therapeutic and rational grounds
In April '83 Dr, Olle Hanssen visited us. We
but on legal grounds, existing legal cases eg.
were aware of his contribution in fighting
Vincent Panikulangara's case against DCI,
SMON while preparing the clioquinol material
DGHS etc. for allowing sales of banned and
in ‘82 itself. He was the first medical doctor to . hazardous drugs have succeeded in creating
report the association of optic neutrits with
public consciousness about the matter. Drug
clioquinol (Mexaform, enterovioform etc)
Action networkers who have organized re
please note this was in Sweden and not
gional seminars and public meetings in Bom
Japan; he had fought single hanpedly against
bay, Trivandrum, Madras, Bangalore, Baroda
the powerful Ciba Giegy, challenging their
and Delhi.
Medical Service
26
Mr. Etsuro Totsuka's of Japan a socially
conscious lawyer from Japan who had fought
for the SMON victims and who was been
actively involved in informing other 3rd world
groups about mexaform Drug toxicity and legal
action, also visited us in '83. A meeting with
alternative health workers, public litigation
lawyers and journalists was held—to discuss
health issues urgently requiring legal inter
vention. During the one day National Health
Policy seminars organized by VHAI a drug
sub group met, discussed and gave some re
commendations.
In December '83 Dr. Zafrullah visited India
for the paediatric Conference in Pune, VHAI
coordinated his tour so that Dr. Zafrullah could
meet the State VHA's. A Drug Action Forum
has emerged drug action networkers in Pune,
Bombay, Trivandrum, Madras, Bangalore, Delhi
and Baroda where public meetings, discussions
and seminars were organized. This sharing of
experience at Gonosasthya Kendra of the
Bangladesh drug policy helped in getting
numerous others concerned and involved
with drugs issue.
A lot has happened since then, AP VHA
organized its General Body meeting with the
theme 'misuse of Drugs' in February '84
16-20th November '84, AP VHA organized
a workshop on 'Rational Drug Use' for health
personnel. In their G B meeting where health
and consumer groups as well as the state
Drug Control authorities attended the seminar
on drug misuse which has met with the Go
vernment authorities in their planning sessions
for the 7th five year plans.
WB VHA organized a public seminar with
Maximiller Bhavan in March '84 on 'Drugs
Vs People'. WB VHA has initiated the Central
Bulk Purchase Unit to make essential quality
generic drugs at reasonable price. The second
catalogue giving price lists is an educational
tool, providing the essential drug list; list of
banned drugs as well as principles of rational
January 1985
drug therapy. WB VHA's contribution in the
WB epidemic has been dealt within HFM.
Gujarat VHA along with other individuals
and organizations has initiated the bulk
purchase initiative called LOCOST (low cost
Standard Therapeutics). Drug education forms
an important part of drug supply. MP VHA
since past 3-4 years has been organizing clini
cal assessment workshops for upgrading of
diagnostic therapeutic skills of middle level
health personnel.
Kerala VHA organized a seminar on 'Low
Cost Health Care' and another meeting on
drugs is being planned for February.
Orissa VHA is planning its Drug meet
sometime next year.
During Dr. Zafrullah's visit, some of the Drug
Action network Core group members met in
Delhi and also attended a meeting with the
Policy makers organized by NISTADS on
'Health Pharmaceutical Policies'.
A one day meeting of Drug Action networkers took place in CINI on 31st January
'84 to discuss certain specific issues eg. dilu
tion of Fera companies and their impact,
Vincent's case and out stand. Banning of
Drugs etc.
On 30-31 st August at the Drug Action net
work Core group meeting in Wardha, the All
India Drug Action network formed and its
organizational structure formalized.
Representing Organizations Profile of
All India Drug Action Network Coordi
nating Committee.
ADM
CGHS
DSF
FMRAI
KSSP
MFC
VHAI
CERC
CHAI
. SAF .
FRCH
LOCOST
Log Vigyan Sanghatna
27
Material produced by VHA1 and Drug Ac
tion network members in course of Drug and
DAN meetings.
. .
' — Strong medicine
— Prescription for change
— IOCU Anabolic steroids
— Bitter Pills
— Hathi Committee Report
— Recommended reading
—. Photostat cover of
Pharmaceutical
Policies—Andrew Herxheimer
— Contact
.— Wrong Kind of Medicine
— Drug hand outs—eg. Essential drugs list.
Banned Brand drug list, Essential drugs—
a prioritization, E P update, Banned,
Bannable, hazardous drugs etc.
National — National Drug Policy—Techni
cal Expert Committee.
— M. P’s questions in Parliament about
banned drugs.
State — State VHA's
Members — Seminars, Workshops, train
ing programmes on Rational Drug use, clini
cal assessment and rational therapeutics.
International — G.K. Drugs & Health Po
licies— 1982 January. Drugs & Pharmaceuti
cal Policies—IOCU — HAI Sweden.
On 25 - 26th November an emergency
core group meeting was called for to discuss
All India Drug action network's stand for the
Technical Expert Committee meeting on 29th
November.
Many VHAI members have contributed to
wards drug work in various ways. Kurji Holy
Family Patna after much internal dialogue
amongst its senior doctors and management
has slashed down the number of drugs in its
formulary.
28
Morning Hope Addikavidu has taken a
policy decision not to stock irrational and
hazarious drugs in its Pharmacy. It has also in
corporated various non drug therapies in its
routine medical work.
From several places reports have come of
dialogues, discussions, counter questioning of
the medical representatives many of whom are
found to be totally unaware of some known
facts about the drugs. (A Number of medical
representatives have been reported to have
quit their jobs after realizing how they are
being used as puppets, fed with half truths, to
push down the throats of their people—drugs
mat need to be thrown in the sewage.
Padhar Hospital, a 200 bedded hospital in
Betul district during a 'Diagnostic study' con
ducted, there was found to be using around
100 drugs, the average number of drugs pres
cribed from the OPD ranged between 50-60
drugs. This hospital provides padeiatric, mater
nity, surgical, eye, orthopedic and rehabilita
tion services; besides community health work
and socio economic, programme.
Deen Bandhu, Tamilnadu has pioneered
the use of herbal medicines and has been
conducting several training programmes for
grass root workers in community health train
ing programme and its community health
work.
Bengal Rural Welfare Society is running a
community health programme in various vil
lages outlying Culcutta based on homeopathy.
It has now moved into provision of integrated
medical services from different systems of
medicines from under one roof.
RAHA had been bulk purchasing drugs for
it 30 or more health centres for being to cut
down costs. RAHA health centres today com
bine some aspects of traditional medicine in
their community health work.
Medical Service
WANTED
The Voluntary Health Association of India needs an Executive Director:
I.
The main goals of the Association are community health for the lowest economic levels
of society, with emphasis on health education, promotion and maintenance of health.
Applications or information helpful toward finding a suitable person, will be appreciated.
There is a staff of thirty people plus related State level associations.
Write to:
The Executive Director
Voluntary Health Association of India
C-14 Community Centre, SDA
New Delhi 110 016.
II.
Retired Christian doctor MBBS 60 yrs. looking for wholetime job in small mission Hospital/Health Centre.
Kindly address:
D.M. Saha
69 Defence Colony
Alto Porvorim
Bardez, Goa 403 521
III.
Dr. A.K. Mitra, 74 Sree Ram Dhang Road,
Salkia, Howrah 711106
Seeks suitable employment. Those institutions interested may contact directly.
(Contd. from p. 24)
fumes
turmeric
7.
For intestinal worms seeds of papaya
works effectively.
2.
Pomergranate skin dry powder in
buttermilk helps in certain cases in
reliving dysentry.
3.
9.
Clove oil application for tooth ache.
for certain diabetic cases in the community bitter gourd has helped much
3.
Decoction of oman seeds helps.in
reliving tummey ache in case of
idigestion.
4.
For fresh cuts and wounds fresh
ginger paste with Jaggery helps
much in healing and stops
formation.
5.
Scabies paste of margosa leaves
mixed with turmeric helps much.
6-
For scorpon stings rubbing a piece of
onion on the site of the sting and
refer to hospital.
nig could
powder.
or
of
. in bringing down blood sugar level.
References;.
1.
January 1985
2.
3.
Primary Health Care : Report-of the
International Conference on Primary
Health Care, of WHO Geneva
Health for all series No. 1,1978
,
Promotion and development of Traditional medicine, WHO Geneva Technical reports series 1978,
Gunaratna V.T.H., Voyage towards
health, New Delhi, Me Grawhill,
1980.
29
NEWS
CHAI
NOTES
Recommended Journals
During the last convention of November 1984, at Bangalore many of the participants
asked to publish a list of journals pertaining to Health and Development. Following is the list
of few of them with addresses.
Journals
1.
Social Welfare
2.
Swasth Hind
3.
Medical Friend Circle bulletin
4.
Contact
5.
Centre Calling
6.
Health for Millions
7.
Assignment Children
8.
Herald of Health
9.
Home Science
Address
Central Social Welfare Board, Jeevan Deep,
Sansad Marg, New Delhi - 110 001
The Director,
Central Health Education Bureau (Directorate
General of Health Service),
Kotla Marg, New Delhi- 110 002
Dr. Mrs. Thelma Narayan,
326, Vth Main, 1st Block, Koramangala,
Bangalore - 560 034
Christian Medical Commission,
World Council of Churches,
150, Route de Ferney 1211 Geneva 20
Switzerland, through VHAI, New Delhi.
The Editor,
'Centre Calling' Temple Lane,
Kotla Road, New Delhi - 110 002
Voluntary Health Association of India,
C-14 Community Centre,
SDA, New Delhi - 110 016
UNICEF,
Palais des Nations, 1211 Geneva 10,
Suisse.
G-S Peter Son for the Owners Oriental Watch
man Publishing House, Box No. 35,
Pune-411 001
The Editor,
Home Science, Directorate of Extension,
Pratap Bhavan, 5, Bahadur Shah Zafar Marg,
New Delhi - 110 002.
The Naturopathic Monthly
1. Health Herald
2.
Swasta Jeevan
January 1985
Institute of Naturopathy and Yogic Science,
16th Thumkur Road, Bangalore - 560 073
All India Nature Cure Federation Rajghat Colony
Delhi - 110 002.
31
HOSPITAL SUNDAY CELEBRATION
Sunday, 17th March 1985
Theme : "Towards a People Oriented Drug Policy"
All our institutions are requested to celebrate this day with due importance as a follow
up of our convention in Bangalore last November and as per the recommendations and guide
lines.
— EXECUTIVE DIRECTOR
Seminar cum Retreat
on
Spiritual and Personal Growth through Clinical Experience
Date :
For Sister Nurses
April 15—22, 1985
Date :
For X-ray, Lab Technicians etc.
April 23—30 1985
Course I.
Course II.
For Hospital Administrators
Course III.
May 2—9, 1985
Fr. Felix Podimattom OFM (Cap) and his team.
Date :
Resource Persons :
Venue (for all the 3 courses)
Amarjyothi
Portiuncula Capuchin Ashram
Kattappana PO 685 508
Idikki Dist, Kerala.
No. of seats :
Only 30 for each course (Apply soon)
Last date to receive registration form :
Course I
March 31, 1985
April 8, 1985
Course II
Course III
„
April 15, 1985
For further details and registration form etc. Please write to :
The Executive Director
Catholic Hospital Association of India
CBCI Centre, Goldakkhana
New Delhi - 110 001.
32
Medical Service
Management Seminar for
Pharmacists
Venue :
All India Institute of Medical Sciences, New Delhi.
Date :
6th— 13th April 1985
Participants :
Qualified and/or registered pharmacists, pharmaceutical che
mists, Drug Inspectors, Chemists and Druggists, Medical
Store Keepers etc. from Government or Voluntary Sector.
Tuition fee :
Rs. 250/-
For Further information please write immediately to :
Dr. P.N. Ghei
Indian Hospital Association
C-ll/72 Shahjahan Road
New Delhi - 110 011.
Tel : 382602
Only 14 out of 59 analgesic preparations found scientifically justified
Dr. Jamie Uhrig and Dr. Penny Dawson of
Medico Friend Circle have analysed 59 pre
parations listed as analgesics and antipyretics
in the July '84 issue of MIMS, India and found
45 of these 59 preparations to be irrational on
some ground or the other.
Basing themselves on the latest authentic
text books. Dr. Uhrig and Dr. Dawson rigo
rously studied each of these preparetions
and graded them into the following catego
ries :
Fortagesic,
Malidens,
Optalindon.... etc.
Micropyrin,
C.
The combination has been proven to be
inferior to single ingredient preparation
and should be withdrawn........ 11 pre
parations. For example—Apidin, Carbutyl, Dolopar Plus, Norgesic, Parvon-N
Parvon-P, Proxyvon, Spsame-proxyvon, Sudhinol-N C............... etc.
D.
The preparation contains analgin and
should be banned.... 17 preparations.
For example—Codosic, Dolopar, Novalgin. Ultragin, Sedyn-A forte, Spasmizol etc.............
A.
Use of the product is justified-14 pre
parations for example: Plain paraceta
mol, Aspirin etc....
B.
Medico friend circle appeals for socially
The combination is not proven to be
superior to single ingredient preparation conscious medicos to ask for withdrawal of all
and hence not recommended.... 17 the preparations belonging to category B, C
preparations. For example—Equagesic, and D.
January 1985
33
Five Viral Diseases Discovered
by Indian Scientists
Five Anthropod—borne viruses
1.
Kyasanur forest disease (KFD)
2.
Ganjam
3.
Chandipura
4.
Wanowire
5.
Bhanja
US $550 Billion A Year is
Spent on arms Whilst
2,000,000,000
people do not have safe
water to drink
450,000,000
people suffer from hunger
or malnutrition
250,000,000
people live in urban slums
or shanty towns
babies die every year
before their first birthday
130,000,000
children are unable to
attend primary school
870,000,000
adults cannot
write
January 1985
people are unemployed or
underemployed
42,000,000
people are blind or nearly
so
Information, VHAI
A Brighter Future
have been identified for the first time by
Indian scientists. Till 1952 only two dengue
and sandfly fever were known from India,
but today 41 arboviruses have been identified
In India, of which 28 are new to science.
Major arboviral diseases in India are those
spread by mosquitoes and ticks.
Information VHAI
12,000,000
500,000,000
read
and
Predictions at a recent World Health Day
ceremony indicate that the next ten years
will.likely to see the most dramatic break
throughs of all time for the health of people
of the Third world. Among developments
anticipated :
* Availability of an
against malaria.
effective vaccine
* Development of an effective vaccine
against leprosy.
* Widespread use of oral rehydration the
rapy which will have the. lives of mil
lions of children through reduction of
deaths from diarrhoea.
* Massive immunization programs against
the six major infectious diseases from
which children die in the developing
world : measles, polio, diptheria, whoo
ping cough, tetanus and TB.
* Global eradication of guinea worm.
* Dramatic increase in the availability of
clean water and sanitation especially
in Asia.
* Implementation of widespread programs
to reduce the preventable blindness
caused by. vitamin A deficiency, onchocreciasis (river blindness) and trachoma.
Information, VHAI
35
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