Is pumping in more and more medicines into the sick person a remedy for his/her ill-health? If it were so, we would have been healthier now, considering the advancements in the drug industry over the years.

Unfortunately the emphasize seems to be not on improvement in basic health conditions but on higher productivity for larger profits. This is why the drug industry has proliferated so much but the health status has not made corresponding strides. Social conditions like increasing population, pressure on the limited resources, unregulated urbanization etc. aggravated public health problems leading to enhanced morbidity and mortality. Simultaneously the demand for more drugs and hospitalization also increased. Trying to fish in troubled waters, the drug manufactures responded to the situation by producing and selling lot of useless, irrational, unscientific, hazardous and costly medicines at the expense of essential drugs which always remained in short supply. Because, for them the former was economically more viable than the latter.
Doctors unaware of the questionable scientificity of such drugs begin to prescribe them indiscriminately to the detriment of consumer interests. They think that by giving a long prescription they can improve their image and competency. Obviously some ignorant patients would be misled to believe that more the number of drugs (and costlier), better the care. But in the process, what was not evident was the irrationality of the doctor on the one hand and the damage from unnecessary medicines to the patient on the other, apart from the colossal waste of resources. Antibiotics, tonics, restoratives, cough syrups and pain-killers are medicines prescribed by some doctors recklessly.

The Tonics culture
Patients are made to believe that tonics, mixtures of B-complex vitamins in solutions of sugar and alcohol, are the short-cuts to good health. Many people do not know that enough nutritious food, sufficient rest and acceptable lifestyles are the best restoratives and not tonics. A balanced diet takes care of the need for vitamins, minerals and other nutrients. Tonics comes in the form of capsules, tablets or flavoured liquids. The nutritive value of tonics are insignificant compared to their cost. In short, such commercial preparations, some of which may not even include correct proportion of vitamins and minerals, cost many times higher than they are really worth.
Tonics are available in the market for everybody, for all sorts of real and assumed debilities, like chronic diseases, loss of appetite, weight loss, fatigue etc. Tonics can cure none of these problems. The worst case is tonics for the newborn babies, who do not need any food for normal growth, other than breast milk for the first four months of life and home-made supplements, beyond that period.
There is no valid scientific reason for these tonics to be produced, as no authentic medical textbooks recommend their use. Tonics are not all that safe either. Excess intake of vitamin A and D can harm the user. It is hazardous to use tonics containing caffeine, strychnine, leptazol etc. Tonics and health restoratives do not find a place in the rational drug policy of Bangladesh. England does not regard tonics as drugs.
The sale of tonics in India is 12 per cent of total sales of pharmaceutical products. In an UNCTAD study in 1977, it was found that 34 per cent of all drugs sold were tonics, tranquilizers and cough mixtures.
Dr. S.G. Kabra advises his fellow doctors "do not prescribe the so-called tonics. They improve the health of the manufacturer and not the health of the patient".

Cough up for no cure
Nobody can escape getting a cough once in a while. The reasons for this can be many. It may be caused by a simple cold or by more serious infections like TB. As people look for quick remedies, the attractively packed, highly advertised cough syrups come handy for the practitioners. Cough syrups and expectorants are widely prescribed and used by people even without medical consultations. There are two kinds of preparations in the
market; cough syrups and expectorants. Cough syrups are meant to subsidize coughs and expectorants are meant to help the body to throw out sputum from the throat by inducing cough. So they have opposite actions. The drugs which stimulate coughing are ammonium chloride, ipecae, etc. and those which suppress coughing are codeine, noscapine etc. Antihistamines that dry the secretions like benadryl, piriton, avil etc. are also generally included in these preparations.
It is ridiculous to mix both the groups of drugs in the same preparation. This is irrationality of the worst kind. It has no pharmacological support and hence WHO essential drugs list omitted them. Bangladesh has banned all cough syrups and their combinations. As some of these preparations contain addictive properties (habit forming), their prolonged use may do more damage than good by causing stomach upsets, drowsiness etc. Chloroform present in many of these cough syrups, may damage the liver and may even cause cancer.

Pain-killer- an easy kill
Pain-killers are another group of widely used irrational drugs. They are supposed to suppress the feeling of unbearable pain in the patient. Some of these pain-killers have the potential to knock out the patient. They do not remove the cause of the pain, but removes the symptom and gives a false sense of relief. Certain pain-killers contain caffeine in small quantities. There are also some other pain-killers which are combinations of analgesics and vitamins. They have been already banned from use as they do not increase the therapeutic value, but just increases the cost. With about 40 million poor people in India, who do not even get adequate food, it is nothing but a crime to promote tonics, cough mixtures, tranquilizers and such other avoidable substances. Can any amount of these products cure the problem of poverty? With a perennial drag in health financing and an acute shortage of essential drugs for the diseases of poverty like TB, Malaria, Kala Azar etc. India has valid reasons to stop promoting unessential medicines. How much of a national waste it is to continue to produce such huge quantities of irrational and useless medicines? Strict actions should be initiated against false and misleading claims made in drug advertisements. The well-developed Indian pharmaceutical industry should heed to the health needs of the consumers. Bold initiatives are needed to weed out unwanted preparations and to step up production of essential drugs needed for rational and people-oriented health care programmes. Consumer groups should warn the gullible public about the machinations of vested interests working overtime. They should campaign for rational prescription practices by the doctors and initiate action against those who sell banned or hazardous drugs and those who administer such drugs. A radical change in the concept and approach are overdue. When will the end user of drugs, the consumer, start calling the shots?

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