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Wonder drug ‘Oral Rehydration
Salts’ underused in India ?
Infectious diarrheal disease is a major public health
problem, particularly among children below 5 years, in
developing countries. However, the problem is usually
self-limiting if handled properly. Because of the disease
there is loss of water and electrolytes from the body and
the intestinal lining of the affected area may wear off.
In most cases treatment simply requires replacement of
the water and electrolytes allowing time for the body to
eliminate the causative organism and regenerate the
intestinal lining. Most children who succumb do so
because the fluid loss is not adequately corrected so
that severe dehydration with accompanying electrolyte
disturbances sets in. A solution of Oral Rehydration
Salts (ORS) provides a balanced mixture of glucose and
electrolytes and in the overwhelming majority of cases is
all that is required to correct the dehydration and save
the child. About 90% of such cases fall in this category
while only 10% affected need specialized treatment.
ORS has been observed to work wonders in several
developing countries. For instance, in Indonesia, compare
to the figures in 1992, the number of children dying of
diarrhea fell from 6 lakhs by about 90%. Elsewhere in the
world too it contributed to the decline of infant
mortality rate (IMR). However, a survey carried out in
India in 1992 revealed that ORS usage is only 31% and
about 7 - 8 lakh childhood deaths from diarrhea every
year could easily be averted by this simple
‘medicine’. According to Dr. John Elliot Rhode,
a former country chief of UNICEF, and an international
expert on nutritional diarrheal diseases, if India can
increase the use of ORS to at least 60%, the number of
children dying of this disease every year will come down
by 80%. Dr. Rhode also opined that the situation in India
was even worse than in some sub-Saharan African countries
because of the population density and the resultant
onslaught of organisms.
Is our public health authorities, physicians and health
workers and each of us doing our bit to address the
problem?
Source: The Hindu 1998; Apr 25.
National
Pharmaceutical Pricing Authority - the paper tiger
The Government of India has a Drug Prices Control
Order (DPCO) in place which has fixed the maximum retail
price of 73 essential and important drugs in this
country. Looking after the DPCO is the National
Pharmaceutical Pricing Authority (NPPA) functioning under
the Ministry of Chemicals and Fertilizers, although the
implementation of the DPCO rests with the Drug
Controllers of individual States and Union Territories. A
recent report in India Today highlighted the fact that
flouting of DPCO regulations is rampant in the country
and pharmaceutical companies continue to make lakhs and
crores of rupees, illegally, abetted by the indifference,
and in some cases possibly the active connivance, of the
enforcement ‘authorities’. As a single example,
10 tablet strips of Norfloxacin 400 mg has been sold for
Rs. 58/- while the actual price is fixed at Rs. 22/-.
Karnataka has become the first state in the country to
start formal large scale inquiries into the issue of
flouting of the most recent set of DPCO regulations. The
state accounts for an average annual drug sales of Rs.
1000 crores and investigations by the state’s drug
control department has unearthed that at least 61
companies have made Rs. 36 crores in a single year simply
through overpricing of drugs that come in the DPCO
scheduled category. This includes such large and reputed
companies as Ranbaxy and Natco and such drugs as
amoxicillin, cloxacillin, metronidazole, norfloxacin and
metronidazole. Consumers and even chemists &
druggists are largely unaware of DPCO regulations and the
companies continue to take advantage of this ignorance.
When confronted with evidence by reporters, company
officials try to obfuscate the issue by advancing
arguments that the DPCO regulations are not clear or that
the concept of DPCO is outdated in the context of free
market economy.
The contribution of the pharmaceutical industry to the
health sector cannot be doubted but this does not license
them to dupe customers. Upward price revisions are never
communicated to physicians and consumers but price
reductions are touted in full page advertisements in
medical journals and other media. The Government, on its
part, does nothing to educate consumers. Enforcement
officials are either ignorant or choose to look the other
way. Given this scenario, all responsible consumers must
take interest in this issue and bring instances of DPCO
violations to the notice of the state drug control
department or the NPPA.
Source: India Today 1998; Jul 20, pp 60-61.
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