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| EDITORIAL |
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| Year : 2018 | Volume
: 23
| Issue : 1 | Page : 3-4 |
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Rational use of medicines: Unmet wishes
Vijay Thawani
People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| Date of Web Publication | 3-Apr-2018 |
Correspondence Address:
Dr. Vijay Thawani
People's College of Medical Sciences and Research Centre, Bhanpur, Bhopal - 462 037, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmgims.jmgims_8_18
How to cite this article:
Thawani V. Rational use of medicines: Unmet wishes. J Mahatma Gandhi Inst Med Sci 2018;23:3-4 |
Long time has elapsed since the rational use of medicines (RUM) was advocated for the betterment of the health of citizenry. While developed economies speedily progressed in the RUM, we continue to sit on the fence, kill time, and delay the process to usher in RUM in totality. The urgency demands that we should leapfrog and learn from those who have done better than us. Unfortunately our apathy, callousness and indifference are slowing down the pace in attaining the RUM.
It has been realized that the country should produce only rational medicines. We do have a national list of essential medicines which is updated in years. Yet nonessential medicines continue to be manufactured in the country. The pharmaceutical industry continues to manufacture obsolete medicines, medicines of questionable efficacy, and useless combinations and there is no stopping. World over, there are two groups of medicine classes, namely, the branded and generic, but we in India continue to boast of a third category of branded generics.
We have drug price control order, and yet the National Pharmaceutical Pricing Authority was created to monitor the prices of medicines in the country. The very fact that maximum retail price printed on the medicines offers more than thousand percent profit margin to the retailer in some cases shows that those given the task of monitoring medicine prices are not doing their work. The pharmaceutical industry continues to fool the users. There are companies manufacturing the same active ingredient in same formulation and same concentration, but marketing in different names, at variant prices. Does this mean that the one offered at lower price is not standard?
The trade schemes offered by the pharmaceutical companies to stockists/distributors and then by stockists/distributors to retail pharmacies are usually free medicines or cash incentives to boost the sales. These, therefore, are not billed and the receivers of such schemes get the same in gratis, escaping all taxes which otherwise can go to the exchequer. Very few buyers of medicines get the cash memo for the medicines, and most of the medicine sale, therefore, is unaccounted. The retail pharmacists continue to practice selling products of their choice which is obviously based on the margin of profit earned. Thus, the product offering highest margin is sold, affecting the affordability of the buyers. Even scheduled medicines continue to be sold over the counter, without prescriptions indicating that this is going on with the connivance of the authorities.
Very few hospitals have standard treatment guidelines for their prescribers. Moreover, those which have are not able to enforce the same. The result is that the prescribers do not consider cost efficacy of the therapy and final looser is the patient who spends more. Thus, the value for money is not there in purchase of medicines. Fanciful brands are prescribed because prescriptions of these get returns for the prescriber. Medical council and medical associations keep appealing not to accept and display pharmaceutical company complimentaries in places of patient contact; yet calendars, stickers, tabletop items, and promotional stationary can be seen in hospitals.
Government promotes setting up of generic medicine stores in hospitals, but not many hospitals have generic medicine stores within the premises. It is obvious that medicines which could be otherwise be made available at cheaper price to the patients are not made available to them because hospitals have other interest. Some even go to the pretext that generic medicines are not standard, not of good quality, and not efficacious which is absolutely unfounded farce.
The medical professionals are not open to prescription monitoring, audits, and analysis. They feel it to be violative of their right to prescribe, which it is not. The prescription monitoring has been found to bring in the desired change in RUM by improving the quality of prescriptions. Those who resist the re-examination for licensure to practice are more afraid of corrective criticism than the guidance that this will bring. The antimicrobial prescriptions are not based on isolate reports. Newer and higher generation antimicrobials are prescribed without any restriction and check. Hospital antimicrobial policy is a paper tiger.
All said it is needed that RUM is the need of hour and needs to be supported by all if the country has to progress in RUM. If not done earnestly the future generations will accuse us of being party to irrationality, which is destined to doom the health of the nation and its citizenry. Enough harm has already been done. Let us be proud promoters of RUM.
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