Drugs Doctors and Patients

How did L. Leela get tablets of Colchicine without prescription? If you are a non Indian reader of my blog you are justified in wondering. If you are a reader from India then you know how and it will be of no surprise to you.

I will tell this sordid story of easy availability of drugs and the damage that this is causing to people with a real life story and follow it up with another later.

Mr C has been my patient for over twenty years, that is, when he is in Bangalore. A senior executive, he is often posted out of Bangalore and seeks attention with other doctors or self medicates. He suffers from high blood pressure and diabetes for which he takes medication and consults doctors when there is trouble. When living in New Delhi he developed pain In his back for which initially he saw an orthopedic surgeon who prescribed him a drug which belongs to a class called NSAIDS [non steroidal anti inflammatory drugs].The commonly prescribed drugs such as diclophenac, Ibuprofen, Indomethacin, paracetamol, aspirin etc belong to this class. He was asked to take one of these for five days when the pain was acute and was asked to report back. He never did go back. Instead whenever he had some back pain he took these drugs and got pain relief. Few months ago he went for his annual medical and he was found to have elevated levels of creatinine in the blood, a sure sign of renal disease. His creatinine levels were near normal when the test was done a year ago. Indiscriminate use of the pain killer had irreversibly damaged his already fragile kidneys [due to high blood pressure and diabetes] and he is now in end stage kidney disease and on three times a week dialysis. This means spending the rest of his life hooked on to a machine for over six hours, three times a week. If the drugs were not available to him and he was forced to go to the doctor this misery, possibly, would not have happened.

How then did Mr C get his Ibuprofen?

n India pharmacies are run by businessmen. The license to run a pharmacy is obtained in the name of a qualified pharmacist who is usually not the owner. Even if he is one, he would be reluctant to let go an easy custom for want of a prescription. Many of them are located near the patient and those who work in the pharmacy are friends of the patient and are unlikely to refuse a request. Old prescriptions are used with impunity and doctors too are to be blamed for indiscriminate prescriptions.

Let me tell you all another ongoing problem a patient of mine is facing. She is a seventy four year old lady who is a severe diabetic with complications and who has chronic urinary tract infection caused by a versatile organism called E.Coli. This one belongs to a class of germs who are called ESBL producing organisms. Meaning there by, that they are clever enough to survive the onslaught of most of the available antibiotics. How did this happen? We doctors to a great extent, and patients to some extent, are responsible. How did she manage to acquire this dreaded multidrug resistant strain? Please go to the website given below and read the article by Dr Chatterjee. How is she being managed? An ongoing struggle for both of us.

On many an occasion the illness especially the one caused by virus is self limiting and no drug is required. Rare is a doctor [of any variety] who says so to the patient. Almost always a drug is prescribed. This is especially so with painkillers and antibiotics. To learn more about the havoc we doctors have caused I draw your attention to an article by Dr Biswaroop Chatterjee [Turmoil over New Delhi Metallo-Beta Lactamase-1: a tale of ersatz patriotism] which has appeared in the recent issue of Indian Journal of Medical Ethics [www.ijme.in]

Have we, both doctors and patients learnt our lessons? Sadly, the answer is no and the sordid tale is continuing and I shudder to think of the future scene of resistant infections. Probably we will be back into 1930s [pre antibiotic days] very soon.

Scary isn’t it?