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| HEALTH TRIBUNE | Wednesday, July 9, 2003, Chandigarh, India |
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Growing
threats from fake drugs
How human mind cures diseases
Beware of cholera
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Growing threats from fake drugs NEXT time your child’s fever fails to respond to a tablet of Nimesulide or Paracetamol, or that nagging cough of yours continues to become worse despite medication, or asthma refuses to react to the inhaler, chances are that you have been duped by your neighbourhood chemist. He might have sold you a fake or substandard medicine as it meant higher profits for him. Omnipresent fakes in sophisticated blister packs comprise nearly 35 per cent of spurious or substandard medicines in the market, with the authorities being unable to do precious little to safeguard your health. Despite the use of holograms by large pharmacy companies to protect their products, spurious drugs business continues to flourish in northern India. Punjab, Haryana, Himachal Pradesh, Delhi, Uttar Pradesh, Bihar, Gujrat and to some extent Madhya Pradesh have the bulk of spurious drug manufacturing units. In UP, the major sale of spurious drugs is in Agra, Lucknow and Varanasi. The size of the spurious market is around 15-20 per cent of India’s total pharmaceutical market. Dr Sandeep Puri, Medical Superintendent at Dayanand Medical College and Hospital, says fake drugs generally contain the same salts (as the original), but their purity and quantity is lower. As a result, patients consume more drugs to get the desired results. Sometimes even large quantities of the drug produce no relief. He says, “It is very difficult to tell the difference between fake and real by merely looking at the package. The technology employed for making fake drugs has become so advanced that even an expert cannot tell the difference.” According to him, there are two kinds of fakes in the market, one in which the packing is very similar to the original, but the name of the medicine on the package is different. While in the second kind packing is different, the medicine has the same name as the original manufactured by a well-known company. Medical practitioners such as Dr Harkanwal Sidhu, Head of the Department of Medicine at Guru Tegh Bhadur Hospital, says that though a lot needs to be done to eradicate fake or substandard medicines from the market, the least the administration can do is to ensure that the chemists are forced to sell drugs only against a prescription and to issue a cash memo. This step alone would lower the sale of spurious medicines by half, according to him. President of the Punjab Civil Medical Services Association (PCMSA), Dr. Hardeep Singh, too considers eradicating spurious drugs from the market a herculean task, as it has become very difficult to identify counterfeit medicines. Even the substandard medicines have a very good packing, making them appear of good quality, he says. “Today the growing fake drug market is no longer restricted to producing tablets and capsules. It has now graduated to the production of expensive and sophisticated injections, expensive tablets and inhalers”, says Dr. G.S Grewal of SAS Mediscan Hospital. He says that the procedure involved in manufacturing these expensive drugs is complicated, but it more than compensates by the profits it offers. Fakes of life saving antibiotics like Netromycin too are available in the market, he says Harsher legal controls and stricter punitive measures to dissuade the manufacture of spurious drugs are urgently required. It is not allopathic drugs alone that have their spurious competition. In April the Delhi police arrested one Dr H.K Sachdeva who was allegedly involved in manufacturing and sale of spurious homoeopathic medicines at Sachson Homeo Pharmacy in West Delhi. The doctor is believed to have a bachelor’s degree in homoeopathic medicine. Similar cases have also been reported relating to the sale of Ayurvedic and Unani medicines. Fake Indian drugs are not only sold in the domestic market. Many are sent overseas, too especially to the states of the erstwhile Soviet Union. Several people have been arrested while trying to smuggle out spurious drugs in bulk to these countries. Fake drugs are an international phenomenon and they constitute about 15 per cent of the international market and 35 per cent of the domestic market. Most people associated with the manufacture, sale and use of genuine drugs feel that only harsh punishment such as life imprisonment or even death penalty can check the cancerous growth of spurious medicine market.
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How human mind cures diseases THE human mind plays an important role in curing diseases or in compounding the misery of being unwell, indeed in increasing the intensity of ailments. Observations based on my own experience as a physician for more than five decades are corroborated by those cited in books and journals Some of these may not stand the scrutiny of hitherto understood fundamentals of medical science, but are nevertheless true happenings experienced by qualified, rational and educated, down-to-earth people in the profession. It is now being widely accepted by many in the medical profession that just as the well-known placebo, there is the exact opposite of it called “nocebo”, the term used to describe the fact that signs and symptoms of certain diseases can be made to appear through negative suggestion. Dr Lowen, a renowned professor of heart diseases, also a Nobel Laureate, cited two cases in support of this line of thought. Once, during a round in the ward, he remarked to his fellow doctors about a patient having a “gallop rhythm”. What he was referring to was actually a serious sign in the heart disease. The patient had overheard the conversation. Astonishingly, a remarkable improvement was seen in the patient’s condition a few days later. The reason, he explained to his students, was the role of the mind in making the patient believe he was hale and hearty, for he had wrongly assumed gallop rhythm to mean something akin to the gallop of a horse! This made him believe that he was physically healthy as well. Another incident narrated by him was that of an old man, a heart patient, who was critically ill. There was little hope of his recovery. One day, in passing the doctor remarked that the old man was really lucky to have such a devoted daughter who was always by his side, looking after him with such care. The old man informed the doctor that devoted she was, but that she was his mistress, not his daughter. The doctor then told him that he was luckier still, that he ought to marry her. The old man replied that he was quite aware of his condition - he was not going to live for long and it would be loathsome for him to leave such a beautiful young lady a widow at such young age. The doctor lightly said, “Who says you will die so soon? Why, I can give it to you in writing that you will live for many more years.” The old man half jokingly replied, “Okay, can you give me a lease of life for five years? If yes, then I’ll gladly marry her.” In the same spirit, the doctor wrote a note and gave it to the old man. A few days later the patient was discharged and the incident forgotten. One fine day the doctor was surprised to see the same old man in the hospital with his young beautiful companion, whom he introduced now as his wife. The old man told the doctor that his five years were over and hence he needed another lease guaranteeing that he was fit to live at least another five. The doctor indulgently obliged him with another note in the hope that he may enjoy the bonus period. Yet another five years passed, the old man appeared again on the exact date, but this time he was quite sick. The difference this time around was that he was alone. His wife, he informed had expired in an accident. On being asked if he had come for another promissory note, he told the doctor that he was sensible enough not to be overly optimistic or greedy. He died within the next two years. The
writer is a former Chief Medical Officer, Panjab University,
Chandigarh
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Beware of cholera CHOLERA is an acute intestinal infection caused by the bacterium Vibri cholerae, spread through contaminated water and food. In highly endemic areas, it is mainly a disease of young children, although breast-feeding infants are also affected in rare cases. “When cholera appears in a community it is essential to ensure hygienic disposal of human faeces, adequate supply of safe drinking water and good food hygiene,” stresses Dr Rajesh Kumar, Head of Community Medicine Department, PGI. In an unprepared community, fatality rates can be as high as 50 per cent, but in areas with an organised response, with a well-established diarrhoeal control programme, it can be limited to even less than 1 per cent. Most persons infected with the bacteria do not become ill, although the bacterium is present in their faeces for seven to 14 days. When illness does occur, more than 90 per cent of the cases are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhoea. Less than 10 per cent of the persons develop typical cholera with signs of severe dehydration. “Cholera is a disease which travels fast and, as such, is difficult to catch, unlike malaria or typhoid which have a longer incubation period,” explained Dr Rajesh Kumar. Its bacterium has a short incubation period, from less than one day to five days, and causes a copious painless, watery diarrhoea that can lead to severe dehydration and consequent death if treatment is not given promptly. Diarrhoea and vomiting due to infection quickly leaves the body without enough fluids and salts, which can kill a person within hours. However, the treatment too is very simple as an infected person can be completely cured by giving fluids, immediately after the first symptoms show up. The easiest and simplest method to treat the problem right at the outset is taking lots of oral rehydration solution (ORS). “Apart from a large number of ORS available in the market, an easy home remedy can be a solution of one glass of clean boiled water with a pinch of salt and scoop of sugar,” explains Dr Rajesh Kumar. Some lime juice can be added to enhance the taste. Contrary to the belief that giving more fluid will cause vomiting, the intake of fluid should be kept up, he adds. Effective food hygiene measures are very important for protection against cholera. These include cooking the food thoroughly and eating it fresh, preventing cooked food from being contaminated by contact with raw foods, water and ice, contaminated surfaces or flies and over-ripe and unwashed fruits and vegetables. Washing hands after defecation, and particularly before contact with food or drinking water, is essential. In 1970 cholera invaded West Africa, which had not experienced the disease for more than 100 years. The disease quickly spread to a number of countries and eventually became endemic in most parts of the continent. In 1991, cholera struck Latin America, where it had been absent for more than a century. In 1973, the WHO World Health Assembly deleted from the International Health Regulations the requirement of presentation of a cholera vaccination certificate. Today, no country requires proof of cholera vaccination as a condition for entry, and the International Certification of Vaccination no longer provides specific space for recording cholera vaccinations. In some countries, two oral cholera vaccines that provide high-level protection for several months against the disease are also
available. Though, suitable for use by travellers, these have so far not been used for the public health purpose, doctors associated with the Internal Medicine Department of the PGI point out. The severity of the current form of cholera is far less than the earlier classical type. “The mortality rate in the case of classical cholera was very high and the Bengal and Indo-Gangetic plains were the worst affected by it,” say public health workers.
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Nearly 90 per cent of the Rs 2000 crore pharmaceutical industry is dominated by little known companies, leaving a small field for the multinational players in the health care system. The industry, including those manufacturing fakes and spurious drugs, is growing at the rate of about 20 per cent annually, which means that every year the chances of your buying a medicine that can do more harm than good (as some even contain toxic material) are also rising proportionately. Though the World Health Organisation (WHO) figures of 35 per cent fakes in the market are not taken seriously by the Indian authorities, they agree that the presence of fakes or substandard medicines is alarmingly high.