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?