Few years, after the inspiring  Alma Ata Declaration that proposed the goal  of Health for All by 2000AD, the Indian  Council of Social  Sciences Research and  the Indian Council of Medical Research  set up a  joint study group to review  the health care  systems  in the country and recommend a strategy  to achieve  the Health for All goal.

One of the most  intriguing and provocative  observation in this report, which has kept me  wondering all these years was  a call  to vigilance against  the over medicalization of the system since Health  is ‘well being’ and not just ‘disease control’.

The committee consisting  of some of the senior most   medical and social science  professionals  in the country observed that “ Eternal  vigilance  is required to  ensure  that the health care  system  does not  get medicalized, that  the doctor drug producer  axis  does not  exploit  the people and the abundance of drugs  does not become a vested  interest  in ill health”

As a young  faculty  member of a well known  medical college, I found this call to ‘vigilance’ against  making ill health and drug prescribing  a vested  interest  – a  rude shock considering that doctors often thought of themselves as a noble profession concerned only about the wellbeing of their patients.

This  stimulated  a life-long  learning effort  at understanding  the doctor – drug – producer  axis  in reality, identified  by the report  as the major villain and the prescribing  practices  of the doctors  as the key culprit.

Two more  observations  of this expert  group based  on extensive  review of current  data and trends  were equally  disconcerting. These were :

  • “One of the most distressing aspects of the present health situation in India is the habit of doctors to over prescribe  glamorous and costly drugs with limited medical potential . It is also unfortunate  that drug  producers  always try to push doctors  into the using their  products by all means – fair or foul”.
  • “There is now an over production of  drugs  ( after  very costly ones) meant for rich and well-to-do while the drugs  needed by poor people  ( and these  must be cheap) are not  adequately  available. This skewed pattern of drug production is in keeping with our inequitable ‘social structure which stresses  the production  of luxury goods  for the rich  at the cost of the  basic needs  of the poor”.

Over the years,  I worked  closely with the medico friends circle and numerous  networks  and associations to help  initiate,  the All India  Drug Action Network ( AIDAN)  at National level and Drug Action Forum – Karnataka ( DAF-K)  at state level,  committed to policy  advocacy on  rational prescribing   practices  and rational/ethical  drug and pharmaceutical  policies . We used many creative and interesting  methods  in the campaign to encourage doctors to adopt  prescription  practices, more  aligned  with the Health For All  goal.  A short questionnaire was evolved by me  to help  health care providers  – doctors  and nurses –  check whether  they were   ‘Health For All’  oriented  healers  or ‘Drug  pushers’.   I list these questions out  today in this column to help you decide what sort of health care professional  you are:

  • Have you accepted  the concept of an essential  drug list in  your practice to help select  efficacious, safe and good  quality low cost  drugs  from the over 80,000 formulations that abound  in the market  today?
  • Have you accepted the concept of generic prescribing to prevent ‘misuse’ and ‘misinformation’  by pharmaceutical companies on brand specialties , formulations and bio- availability claims?
  • Have you stopped prescribing drugs whose only additional advertised value is  – a cosmetic embellishment, for example, a special  flavor; elegant packing for example, a nice container; or  an irrational  combination?
  • Have you stopped promoting  ‘tonics’  fortified  with an overdose of vitamins and minerals whose only present value is the vitaminising effect on our sewage systems? Do you accept that what the poor need is food and what the rich need  is health education  to prevent overeating?
  • Do  you have a policy against  accepting  physician’s samples and other forms of inducement, both refined  and blatant, from  medical companies, including  unethical trade discounts  and travel and conference related hospitality  offers?
  • Do you propagate simple home remedies, home-based preparations, pharmacy-based low cost preparations and even locally available herbal remedies that are not totally  integrated  with the ‘market economy”?
  • Does your health centre practice  or  hospital department offer   people  various forms of non-drug  therapies, including  holistic  health, counseling and caring techniques?
  • Does your selection of drugs for prescribing  depend on rational  issues like  management  practices, costing, rationale, standardization and so on,  and not, by  the craze  for “phoren’ multinational, private and large companies, or the equally  irrational  emphasis on the lowest priced drug  in the market?
  • Have you stopped having a ‘neo- colonial  ethnocentric’ policy towards alternative systems  and therapies and adopt  a more open policy of enquiry and complementary use of other systems and methods of healing?
  •  Inspite of your commitment to clinical care do you promote:

ü  Clean water rather than antibiotics?

ü  Food rather than pills

ü  Simple investigations rather than hi-tech diagnostics

ü  Mothers milk rather than manufactured infant foods

ü  Primary health care rather than tertiary super specialty care.

ü  Health and wellbeing rather than only  medicines and disease control

The answers to these questions will help you to determine what you really are: A drug pusher or a healer. If you have 10 affirmative answers then you are the model Health Care Professionals of the 21st Century and need to urgently become a member of the global /national people’s health movement! If you have 10 negative answers then you need urgently to attend  a workshop on rational and ethical  prescribing practices to help you become  a more socially relevant health care provider. If you are some were in the middle it is time to sit up and reflect  collectively  in your team or group what you would like to do next. Even the ancients offered  two options.

The Charaka Samhitha described two types of physicians – those who promote life and attack diseases : those who promote disease and attack life. Which type are you ? Which type do you want to be?

medical_cartoon_pollution