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LATEST NEWS UPDATES | Rx Negative, Genetically by Pragya Singh

Rx Negative, Genetically by Pragya Singh

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published Published on Jul 2, 2011   modified Modified on Jul 2, 2011

People who play doctor or heed quackery are biting off more than they can chew

Whenever a patient with bleeding in the stomach or a child whose fever has not subsided in a week is admitted into Sasaram-based physician B.B. Singh’s clinic, he immediately knows that it’s a case of self-medication. “At least 40-50 per cent of my patients have either had sleeping pills, or antibiotics, or painkillers without a prescription,” Dr Singh says. “I’ve worked all over the world, but never seen anything like this,” he adds.

And in a consumer-driven market environment where you can get just about any medicine you want across the counter, it doesn’t matter if you’re from a rural village in Bihar or an educated Delhiite.

Manju Chatrak is among the four or five patients who show up at south Delhi-based Dr Alka Bhasin’s doorstep every month with serious kidney problems from pill-popping. Many like Chatrak, who is in line for a kidney transplant (finding a donor can take months or years), often wonder why they took all those off- and on-prescription drugs.

“I won’t deny that I popped a lot of pills, but I’m also a little angry with the doctor I’d been going to previously, who didn’t test me correctly,” Chatrak says.

Self-medication is increasingly becoming the norm, and not just for minor ailments—stomach aches, skin problems, colds or fevers—for which many over-the-counter (OTC) remedies are available. Schedule ‘H’ drugs, meant to be administered only on doctor’s prescriptions, are also widely sold in the open. This practice is not exclusive to big cities, where both drugs and diagnoses are free-flowing. It’s in rural India that pill-popping is becoming more rampant.

In the cycle of self-diagnosis and self-medication, there is no mechanism to regulate pharmacists and quacks, and, to an extent, the doctors too. While avoiding doctors and medical tests is a key reason for many to indulge in self-medication, the irony is that many still end up hospitalised with serious complications.

“People who self-medicate on prescription drugs, or take OTC medicines excessively, usually go to doctors too late. Till then, they are happy to eat whatever medicine their local chemist or friends and family suggest,” Dr Bhasin says.

A recent study on drug purchase patterns by CubeX, a medical business intelligence outfit, found that 25 per cent of patients seek a pharmacist’s advice on medication, around 20 per cent go to chemists with their own choice of medicine, while another 15 per cent prefer to use home remedies. Hardly 40 per cent visit a doctor when they’re unwell.

“You can just buy a Diazepam, a Proxyvon, or other drugs, without prescriptions. We don’t seem to realise how important they are. The problem worsens in rural areas,” says Susan Josi, managing partner, Sorento Healthcare Communications, of which CubeX is a division.

Many rural residents have little option but to self-medicate—they don’t have access to doctors or can’t afford the treatment. Dr Samarjit Choudhury, who practises in Haridwar, says half his patients—he attends to a minimum of 200 daily—are from rural areas. Some travel 100-150 km to see him. “Most people from rural areas whom we treat for overuse of drugs are addicted to painkillers, followed closely by sleeping pill users. This is because quacks are often their only source of ‘treatment’,” he says.

Having tried various home-made remedies and the pain-numbing concoctions suggested by quacks, they only seek medical help when nothing else works. “Usually, the doctor is the last person a patient goes to. They usually show up pumped up with the wrong medication. This includes children,” adds Dr Singh.

Studies show that the OTC business in India has grown from Rs. 120 crore in 2007 to Rs. 200 crore in 2010—it’s probably the fastest-growing sector in rural areas. “A sizeable chunk (of the business) is in rural areas, where prescription antibiotics are very commonly sold without a doctor’s advice. This is the area that requires the most consumer education and regulation of chemists,” says Josi.

In India, OTC is not a separately defined class of drugs. It simply refers to medicines not included in other categories like Schedule ‘H’ or Schedule ‘X’ (narcotic drugs). So moving from prescription to OTC does not generally require regulatory approval; it’s just a marketing shift, where companies focus more on chemists. If the frequency of prescriptions for a medicine dwindles, drug firms can simply push their sales through chemists, especially with ‘trusted brands’.

India’s chemists are at the heart of the healthcare system, but they rarely exercise caution. “When it comes to harmful combinations of drugs, there’s a lot of ignorance,” says Dr Rommel Tickoo, senior consultant, internal medicine, at Max Devki Devi hospital in Delhi. Few Imodium users, for instance, know that the drug is not recommended for infectious diarrhoea. Similarly, some varieties of Norflox, a commonly used drug for dysentery, can lead to seizures. “If half the people using these drugs knew half the consequences, it would reduce my patients by half too,” quips Tickoo.

Quacks who prescribe steroid-based drugs, gurus who recommend ayurveda concoctions laced with heavy metals and the misuse of OTC analgesics, are the primary culprits. Self-medicating on these drugs has long-term side effects. Ailments for which allopathic medicine is still hunting for a viable solution—like skin diseases and backaches—also contribute to the widespread misuse of OTC drugs. People seek instant relief from chronic pains through ‘wonder drugs’—another source of long-term health troubles.

“Five to seven people come to us every week with stomach problems related to the misuse of NSAIDS (anti-inflammation drugs and painkillers). And a couple end up getting admitted,” says Tickoo.

Experts have now begun to attribute the resurgence of major illnesses to the overuse of prescription drugs. Dr Abha Majumdar, director, Centre for IVF, Sir Ganga Ram Hospital, has treated a series of women for fertility-related issues over the past two years only to find that they were being given anti-TB drugs.

“It seems doctors who fail to identify causes for infertility, but find traces of TB bacillus in their patients, start antibiotic-heavy treatments without further examination. This is leading to a resistant strain of tuberculosis—an extremely dangerous trend,” Majumdar says. The illness has resurfaced in large numbers in the last decade despite earlier anti-TB efforts having had a measure of success.

With the pill-popping rage testing the limits of medical science and logic, the outlook is alarming, particularly with ‘wellness’ and ‘inner-beauty’ products and medicines reaching rural areas.

Outlook, 11 July, 2011, http://www.outlookindia.com/article.aspx?277447

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