Fixed Doze Combination Drug Ban in India: An Unbiased Analysis!

In a surprise move on 10th March 2016, the central government of India has banned about 340 combinations of orally consumed drugs produced and marketed by modern pharma companies in India for various ailments such as cough, allergy, fever, cold, influenza, etc.(See this report) Many of these so called medicines have been in common use for quite some years and have been used by the common folks as over the counter (OTC) medicines without the prescriptions by any medical doctor.

The following gives the list of the banned  combinations- also called fixed dose combination (FDC) drugs - of medicines that are banned in accordance with the powers entrusted with the government under section 26A of the Drugs and Cosmetics Act 1940 and the Drug Rules 1945 of India:

 

  

  

I do not know whether this sudden action by the government is the right initiative or not. Apparently, the government has done this to safeguard the citizens health. However, all industry experts and users may not agree to this (Click here to read this!). I too am of the same opinion, as governmental decisions are mostly seen as governed by political or extraneous considerations and not always based on well informed and logical reasoning! (Also read my earlier blog on 'the politics and strategy of bans') 

The India government combination drug ban is estimated to cause the immediate disappearance of nearly 1500 popular prescription and over the counter English medicines from the medical shops across the length and breadth of India which is likely to cause much difficulties for the patients, doctors, the drug retail shops and the pharmaceutical companies. The problem would have been less severe, had the government did this in a planned manner with due diligence and planning!

The following are some of the very common medicine brands that would disappear:

Anti diabetic drugs : Tribet, Gemer P, Gluconorm, Triexer
Cough syrups : Phensedyl, Tossex, Ascoril, Zedex
Fever, cold, pain relief: Sumo, Vicks Action 500, Zerodol-P

There are hundreds of others for other kinds of ailments!

The governmental action is reportedly on the basis of several research studies which suggest possible adverse effects of using such fixed combinations of more than one drug. However, all these research findings are debatable issues as there are other research studies which support alternative views.

The authorities have been telling the pharma companies and the medical community not to use brand names while prescribing medicines. Instead, they were advised to use the original chemical name (generic name). However, the pharma companies and the medical doctors have just ignored these guidelines for quite some time now.

The pharma companies have been making huge profits from the medicine business. Most of the medicine suppliers are not original manufacturers of the basic drug. Many of them import or buy the basic medicine in bulk fro original drug producers from India or abroad and convert it into very small tablets, capsules, injectables, oral syrups, etc containing few milligrams of the original drug and market those in various kinds of fancy trade names. 

The sales representatives of these pharma companies, called the medical representatives, go to the hospitals and the medical doctors and educate them about the method of use of these so that the doctors remember these names to prescribe them to the needy patients. There exists an unholy nexus in this business and this is known to all concerned. The companies have devised their own systems wherein the prescribing doctors and the medical shops get good rewards when a particular brand of medicine gives good sales returns to the company.

There is nothing very surprising in this. Doctors, hospital managements, the medical shop owners and the pharma company people are all humans and they are all in this business for making some profits or earning a livelihood. 

But the markets operate in a competitive environment. The government allows so many drug makers to start business and operate. They simply cannot exist, unless they make profits. So they too are compelled to device marketing techniques of various kinds.

Fixed combination drugs are essentially a kind of marketing technique. In this method, more than one drug combination allow the pharma company to market a drug combination product under a brand name different from that of its competitors and reap better benefits and returns commensurate with its own marketing efforts.

While the law of the land has been in existence for decades, the drug enforcement authorities have never been publicly against any pharma company as the pharma companies know pretty well how to take care of the statutory authorities. It has been a win-win situation for every one. Even the poor patients too benefited to some extent as many had the choice of buying the medicines over the counter without actually being in the crowded lines in front of the hospitals and the medical doctors for small ailments like cough and cold that is so common. Their experience with the drugs have been better than many of the doctors!

And India is no USA, Canada or the European Union. In the latter, the prime responsibility of the citizens' health vests with the government and the government and the medical systems reportedly work pretty well unlike in India.

So India has been different so far and we call it as the Indian way of working. Even the foreign companies understood how to work in India. They work differently in India as compared to their own mother nations. So they make and market drug combinations that they do not make and sell in their own countries.

When we consider all these, the sudden ban of the combination drugs looks a bit absurd and perhaps even motivated with agendas other than citizens' health. What will happen when all these common remedies vanish from the medical shops? What will the common man do? Rush to the already overcrowded hospitals for seeking alternatives? Will our doctors be competent to prescribe non-combination alternative medicines to manage an ailment in such a short notice? We should consider the fact that they have been in the practice of remembering mostly trade names of common combination drugs!

Will this cause a sudden shortage of all kinds of life saving drugs and medicines when the pharma companies retaliate with their own methods?

Muhammad-bin-tugluq thought of many good things to give better administration to his people of his time. But all those good ideas became miseries for the people and this ruler has never been admired for his good ideas and deeds!

Is the present government doing such a thing by the many bans that it has initiated in the name of good governance?

Only time will tell!  

Allopathic Medicine Labelling : Forcing the People Swallow the Wrong Pills !

Today morning I was searching for the the tablet that I am required to take regularly to keep my blood pressure within limits. I keep all those pills the doctor prescribe for me for various health problems in a small box which functions as my medicine chest.

Without my glasses I cannot read even the small letters of the newspaper. But my glasses are of no help to read the fine prints on the shiny metallic strips that hold most of my pills. I doubt the existence of  any one in the world who has such a marvellous vision to read those things printed on the tablet strips !

So normally I rely on my sense of touch and guess to identify the tablets that I am supposed to swallow every day to live !

As usual I was about to swallow a white tablet which I guessed as the one needed for my BP. But then as if from a premonition, I thought I should check it and make sure. So I tried to read the name of the medicine. With so much effort with my glasses at different angles, I came to the conclusion that the one I was to swallow was not the one that is needed for my BP. This one was some tablet left over from some previous prescriptions ! I could perhaps be an anti allergic tablet that the doctors consider as a panacea for all kinds of acute illnesses !

Typical  Allopathic medicine tablet pack labeling

Image courtsey: Google 

Being a person who is some what comfortable with reading and writing and the internet, I check the details of the medicines by searching the world wide web. Experience has taught me that I should not rely fully on what the doctor's say when it is a matter of swallowing their pills ! So I do satisfy myself before deciding to swallow any allopathic medicine. These medicines can do more harm than good if you swallow those like an idiot !

Today's incident somehow caused me to think. What would have happen if I swallowed a drug that is not safe having side effects instead of the drug which I was supposed to take ? What if the drugs in question have serious effects if taken or not taken ?

Then I notices another thing. None of these drugs have any legible writings on them to warn the patient about its side effects or its probable uses. What they have instead is a faint warning label : 'To be taken under the guidance of a medical practitioner only !'

So far in my life I have not come across a doctor who had told me all about the pill I was supposed to take ! The chemist is the one who interprets the doctor's code writing and tells me what, how and when !

But even that can not solve the problem that I faced. If I have many tablets to swallow at different times, I am at a loss to identify these tablets. Most of them look similar. The brand name is prominently written and does not make any meaning and no one is going to remember such complex made up names. The generic names again are written in micro prints that one needs some microscope to make out the spellings for a possible check with the google search !

How can an illiterate person identify the drugs when it is not easy for even a literate one to do that ?

No wonder then that the drug induced illnesses are on the rise. [Read this !]

Drug companies all over the world operate as a big cartel and this fact is now getting more and more clear to the public. Drug companies have their own reasons. But I think they should consider packing their products with readable information that the patients can easily understand.

While retaining the authority of prescribing the drugs kept with the medical practitioners, information about the possible uses, generic name, precautions, etc could be printed on the medicine packs in legible form.

Drug controlling authorities and the law makers also should think about it.

I think you would agree with what I wrote !

My Experiences and Encounters with Modern Medicine !

I do not know how the present day system of medical treatment got official patronage in most countries to be labelled as 'modern medicine' . What we know now is that this system of medicine is named allopathy which was named so by the German doctor who while practising the same found it not so good for alleviating the sufferings of the common people. [ You may brush up all about the history of allopathy here !]

Doctors and all those supporting people who serve in any field of medicine are special people who need to be admired by all for their services that they provide to other human beings in alleviating pain and sufferings due to illness or injury to body or mind.

So medicine men and women have been treated with great respect by all others. Those who have experienced the horror of illness and injury can never forget these visible gods who helped them to come out of the dread of death or pain or utter helplessness caused by their failed bodies and minds. If they could, they would be too happy to do anything for their doctors in return. This high regard and respect of the patients towards the doctors caused the doctors gaining a high position in the society, both in stature and wealth.

Very soon the modern medical field became the arena for all those who want to become rich and famous in the easiest manner by encashing the fear and helplessness of the sick, wounded and the dying.

There are unscrupulous people in all walks of life. Medical service field is no exception.

When there was not much opportunity for big money making, but only scope for earning the respect of the people, those who opted for learning medicine and becoming medical professionals were driven by the passion of service and empathy towards those suffered.

But some unscrupulous business people with the help of ignorant and complacent law makers soon made medical service field a goldmine of opportunity for making quick money from the helplessness of people suffering from diseases, malnutrition, genetic disorders and man made disasters.

The modern medicine branded as the allopathic system of medicine took the lead in transforming medical service into a money making business. Regrettably other systems of medicine too are are going forward in the allopathic way now.

Sufferings of mankind have become the market potential for those who didnot find anything wrong with making the human body a commodity of immense opportunities ! They are worse than the wild animals who might occasionally kill a human for their food !

This transformation is taking place in my beloved country too. This must be stopped. Unscrupulous elements must be prevented from taking the ultimate control of the medical services field.

To do that our concepts and ideas about the medical services need to be pragmatic, to begin with.

Let me discuss some such concepts and a few associated experiences that I have:

Concept-1 : Allopathic doctors or specialists are well trained and educated people and they know more than us about diseases and medicines.

Not always true. There are many doctors who happened to have obtained their medical degrees somehow without proper learning. Many of them also do not update their medical knowledge and are pitifully low in their common sense and basic skills. All doctors cannot be trusted fully under such a situation. It is better to have their opinions and advice varified by other means including seeking second or third opinions. I have come across doctors and specialist serving in big hospitals who do not know how to take the blood pressure of a patient properly or to interpret it. More damaging is their ignorance about the various medicines they prescribe to the patients. What they know about these medicines are what the medical representatives have told them. There also exists an unholy nexus between the medicine manufacturers (pharma companies), the druggists and the doctors.

Concept-2 : Big five star hospitals provide the best medical service. Not true always. Their charges could be five star rated, but not the services they provide. The bigger the hospital, the bigger the chances for negligence and fatal errors. Most often the hospital supporting staff are underpaid and exploited in such hospitals. A friend of mine who was otherwise well built and healthy became an unfortunate victim of such an error in a big five star hospital. He suffered from a viral influenza and had a severe cough for a few days. He was forced by his near and dear ones to go for a medical check up in a good hospital which made him visit this hospital as an out patient. The hospital people for one full day forced him to run here and there from morning to evening to carry out various tests ( a thing a good experienced family physician of yester years would need to assess the patient's condition!) By this exertion coupled with his cough and low fever made him further weak making the hospital admitting him as an inpatient. A drip and an oxygen mask were routinely fitted and a sedative was administered for him to remain remain motionless on the hospital bed for the night without disturbing any one. The sedative caused stomach convulsions causing him to vomit with the mask covering his mouth and nose and the vomit entering his lungs straight away. No one noticed immediately and when noticed some time in the night he had already dead almost. The hospital authorities kept this a secret to the extent possible and declared him of having a cardiac arrest in the night and kept him on artificial respiration for a few days there after only to remove the respirator later and declare him officially dead when they felt that his family would not be in a position now to pay the huge medical bills.

Concept-3: Surgical methods are the best treatments for getting a new lease of life for some more years and one must do it if you can afford at the earliest. A highly erroneous idea propagated by the so called modern hospitals. No surgery is safe and the chances are always 50:50. [ You have to sign the papers of agreement with these conditions at the last moment !] There exist non-invasive treatiments in other systems which might provide similar or better relief ! Only when the body is severely wounded, or non responsive otherwise, surgery  should be thought of. I know a few people who have been recommended for open heart surgeries some twenty years ago but didnot submit to it and living even now heartily !

Concept-4 : Expensive medicines are the best in effecting a cure. Not true always. On the contrary, expensive medicines can aggravate the situation and may even cause drug induced problems that could be even fatal.

Concept-4: Allopathy is scientific and all other medicine systems are quackeries. There is no substance in this. If you analyze the systems with objectively and with an unbiased mind, you find that all systems are equally good or equally bad. It is better to chose the system depending upon the ailment. Sticking to any one system stubbornly is foolish. I have found all the existing medical systems useful to some extent. It is better to keep it in mind that no system can extent your life beyond what God has determined!

Concept-5 : The more the tests the better the doctors understand the ailment and the treatment. Not always true. Tests do provide some information but it is wrong to assume that all kinds of tests are required for deciding the treatment course. Many times patients are required to undergo various kinds of tests for various reasons not always linked to the treatment. It is also important to keep it in mind that some invasive tests might cause more damage than good in some cases.

Concept-6 : There is a cure for all diseases and ailments in modern medicine if you can spend the money. Totally false. There are many diseases and health problems for which no system of medicine can provide a total solution.

There are more such things.

My only submission to my readers is to be cautious and careful when you or some relative or friend of yours need a medical assistance in the present day situation.

Be careful not to get entrapped helplessly in modern day hospitals established for the sole purpose of extracting money from the suffering people and suck out their life time earnings.

Some of those magnificent buildings out there posing as modern hospitals can turn out to be physical and financial death traps to some !

   

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