You are an ordinary law
abiding person. You pay your taxes, you ask for bills when buying the smallest
things and pay the VAT, have a drinking permit, obey traffic lights and, like
our most Honourable Dr. Manmohan Singh, are a victim, silent sufferer of
coalition politics. It is tough balancing the pulls and pressures of your
wife/husband, children, employers and whoever else pressures you. You believe
that you should be a good citizen. You read the Times of India, your blood
pressure rises when you see Anna Hazardous on TV spouting homily after homily
and Prashant Bhushan smirking as he accuses everyone of corruption.
Then one Saturday day, like
many of us, you go to a party have more to drink than in good for you and wake
the next morning feeling like shit with a pounding headache, daggers being
thrown by your wife in protest of your behaviour the previous night. In these
trying circumstances, you drag yourself to the neighbourhood Chemist and get
yourself a Combiflam to take care of the headache. Your wife, to make you feel
worse, has ordered you to also get some Corex cough syrup as her throat is a
bit itchy. You decide to buy some Erythrocin just in case your wife’s itchy
throat becomes an infection. Loaded with this you head home and try to enjoy
the fragrant Dum Biryani your wife has made for Sunday lunch.
While you are still in your
drink infused haze, let me tell you that you have done something very wrong.
You have bought not one, but three prescription medicines, all without the
mandatory prescription. Have I got your attention now?
Let me be clear, I do not
wish to enter the controversy of how due to the indiscriminate use of
antibiotics in India drug resistance is building up and other such larger
matters. Neither am I questioning the point of whether Homeopaths, Ayurveds and
Unnani Doctors should be regulated and so on and so forth. My point is
something slightly different.
Did you realise that the sale
of the medicines as seemingly ordinary as what I have listed is supposedly strictly
regulated? Did you realise that despite such strict legislation, almost all
dispensing chemists routinely flout all these regulations? Did you realise that
you too are breaking the law? And, did you know, that one of the medicines I
have listed is often abused to induce a `high’. Read on, it gets interesting.
India, like the best of the
first world nations, has stringent, extensive and reasonably logical laws
regulating the manufacture, sale, prescription and consumption of medicines. There
is a plethora of legislation regulating medicines; however the one legislation
that is of most relevance to us is the Drugs and Cosmetics Act, 1940 along with
its Rules. It’s a massive body of legislation, and the official Government of
India publication of the basic Act along with its Rules is some 617 pages.
This Act, briefly, contains
most of the legislation relating to the manufacture, sale, prescription and
consumption of prescription medicines. The Act has Schedules attached which
list medicines that are to be sold only on prescription. The way the Act is
supposed to work is that a Registered Medical Practitioner i.e. a doctor is to
prescribe medicines to make you well. If the doctor prescribes any medicines
that are to be sold only on a prescription then you as the patient have to take
this prescription to your dispensing chemist who then sells you the medicines.
The Act mandates that the dispensing chemist has to sell you only as much
medicine as has been prescribed. The dispensing chemist is required to maintain
a register which contains details of, among other things, name of the doctor
prescribing the drug, name and address of the patient, the name of the
manufactures and the potency of the medicine, the quantity sold and the
signature of the chemist. If the dispensing chemist prefers, he can issue an
invoice containing all these details and do away with the register. Not only is
the dispensing chemist supposed to dispense only the quantity prescribed, but
the dispensing chemist is to dispense the medicines only once.
In addition to the three
very `ordinary’ medicines I have referred to viz. Combiflam, Corex cough syrup and Erythrocin a simple
antibiotic. By the way almost all antibiotics can only be sold on a
prescription. Despite this clear and unambiguous legislation, breach is
universal. I am not talking about more `serious’ medicines like sleeping pills
or tranquilizers but medicines that have become part of our almost regular self
medication expertise. Have you ever thought what will happen if every
dispensing chemist was to insist on selling you a prescription medicine only on
a prescription? There would be anarchy. We have let the situation slide so much
that a pull back is going to be very painful. Some of the effects would be that
patients used to buying strong analgesics like Combiflam will find they have to
use less powerful analgesics like a simple paracetamol which may not provide
them with the instant relief they are used to getting with a sledge-hammer
drug,. They will proceed to argue with the dispensing chemist saying that they
have in the past bought Combiflam without a prescription so why is the chemist
being difficult now. Doctors will find even more patients at their doorsteps.
Patients will find costs of medical help shooting up. The poor will be hard
pressed. Absenteeism will rise. The number of patients would be far in excess
of doctors who could service them. Does this mean that we should abandon the
very sensible practice of requiring a prescription to dispense medicines? I
think not, but how does one get over these very practical difficulties?
Why have we reached this
situation in India? One where prescription medicines are dispensed for the
asking without the need for a prescription? Why do we self medicate? I believe
the answers lie in the reasons I have listed in the preceeding paragraph. Who
is responsible for this state of affairs? Obviously, we ourselves with our
laziness to visit a doctor, we with our self medication, our chemists who have
no fear of dispensing medicines in flagrant breach of the law and of course our
vastly inadequate enforcement machinery that is also corrupt.
You may well ask how does a
dispensing chemist maintain his registers if he is selling medicines without a
prescription. Well the answer is, just like the liquor store owners do with
their sales. Fictitious doctors and fictitious patients. So once again you have
a situation where the records of the dispensing chemist are fudged and would
show that Dr. Bijlani has been prescribing a multitude of medicines to a
multitude of patients. On the other hand Dr. Bijlani when questioned would have
no record, no knowledge, no idea and, in fact would never have had the patients
nor the medicines prescribed on his files.
Here is something else I bet
you did not know. Corex the cough syrup is regularly used by those addicted to
induce some sort of stupor. Corex is India’s largest selling prescription drug.
Ketamine, the drug used at raves, is regularly prescribed by dentists as a
powerful analgesic. Prescription drugs are a serious and should not be abused.
India has the world’s second
largest population, and this population is not in the best of health and the
population is poor. Logically, India should have at the very least the world’s
second largest number of dispensing chemists in addition to pharmaceutical
sales. To regulate all this we should have the world’s second largest
admistrative, regulatory and Governmental set up. Are we in any way capable of
this, I mean the regulation? I certainly
think not. I am sure you agree. In that case, now how about considering this. Due
to the indiscriminate use of antibiotics in India, which will only increase
with time and affluence, will drug resistance become a really serious issue?
