Health Adda 2019

Spurious Drugs, Lives and Our Reputation
The news of 66 children falling ill and dying in Gambia (West Africa) allegedly after consuming cough syrup preparations manufactured in India was deeply disturbing.
Death of children in large numbers was bad enough. That they died possibly due to a spurious drug was terrible. And that the drug was manufactured in India and exported to that country where this tragedy occurred was deeply disturbing.
The contaminant in the 4 brands of cough syrup is suspected to be diethylene glycol, or DEG. Toxicity was suspected to have caused kidney failure.
The pharmaceutical industry in India has been a success story of sorts, standing shoulder to shoulder with some of the best international medicine manufacturers, supplying affordable therapies to many parts of the world.
As we piece together the bits of news that appeared in the press, the following questions continue to disturb:
Can we claim impunity for allowing an Indian company to export a medicine to another part of the world and then not take responsibility if they were spurious and caused deaths there? Do we then admit that our ability to monitor our products is compromised, and yet we are OK with permitting them to be exported?
The official note being put out that those batches of cough syrup from that company were not allowed to sell in India but were allowed to be exported to Gambia smacks of double standards. Are we setting different prices for lives of children in India and those from Gambia?
What about our quality and standards? Some Indian companies maintain high international standards, Could the tar rub onto them? And how does the common man know which ones he can trust?
Should we be concerned about our claim to be counted as a develop(ed) nation?
I do not recall any medicinal product in recent years being manufactured in a developed part of the world and sold elsewhere that could cause this kind of disaster.
A recent review in Indian Journal of Pharmaceutical Sciences estimates that 12 to 25% of Indian medicines for exports failed to meet standards (substandard, contaminated or spurious); the figure could be much higher for medicines manufactured for local sale.
Last but not the least, there is a pattern in crime called recidivism, another name for repeat offenders. It appears that the company in question had been hauled up several times for poor manufacturing standards and even deaths in India. And we closed our eyes as it was not for our children!
(Regret the country named in print media as Ghana)

Two-Way Patient Doctor Relationship
Doctors are sometimes accused by disgruntled patients as being unsympathetic, brisk, rude, unprofessional, unscrupulous, money-minded and many more.
The range of behaviour and attitudes of the patient sitting across the table can be equally varied in spectrum, complexity and taxing!
Indian cities offer the well-to-do patient a wide range of doctors to consult. Hence if the barriers of fees and waiting time can be overcome, most patients go on to collect a few or at times, several opinions.
An anxious young mother had brought her smiling 12-year old son for abdominal pain and had proudly said that she had consulted 18 doctors, all the very best in town, in the last fortnight alone. Not knowing how best to react I had asked in a bemused tone which of the 18 prescriptions she had tried, to which she had said that she had not followed any one!
A “second opinion” is a good thing. The situation however gets tricky when having collected several prescriptions of several doctors without telling one what the previous had advised, the patient decides by himself which of the medicines he takes from one prescription, and which from another, which medications he takes from the cardiologist’s prescription and so on, often not able to trust or put his faith on a single doctor for comprehensive continued guidance.
Many medications can have interactions, and the patient not disclosing the true picture can sometimes land him and the doctor in trouble.
Some patients obviously seem to suffer from an innate ability to trust, but expect the doctor to go out of his way and take deep interest in his welfare. If professional equation is sought, why then the disappointment or annoyance if the doctor refuses to share his personal number or refuses to take a call in an emergency in off-duty hours?
With the rapidly evolving transactional nature of the doctor -patient relationship, old-world values such as trust, faith and empathy are beginning to fall by the side.
Politeness, courtesy, professionalism, and appropriate medical care are to be expected from a doctor. No excuses. The problem arises however when one starts expecting the additional factors of “empathy”, “kindness” and “personal attention” to come on as a free add-on even if they misbehave with the care-givers, just because they have paid a bill.
Patients as well as doctors belong to the human race and have their varying shares of imperfections, and any interaction will unfortunately always remain a 2-way process.

health Adda (Years)