Last month, chemists in many states went on a day’s strike to protest against some proposed norm about the sale of antibiotics. Not many cared about it. The issue at hand, however, deserved more serious attention. It concerns the lives of one and all.
The grounds for chemists to shut down shop was the government's reported move to check over-the-counter sale of antibiotics, and to make prescriptions compulsory for selling such drugs. The government ostensibly wants to control the menace of antibiotic resistance. And this it intends to do not only by making prescriptions compulsory, but by making it legally binding on chemists to keep a copy of the prescription too. This is what got the goat of chemists.
The chemists, no saints themselves as anyone would know, have a reason to be irked. Going by the sheer volume of antibiotics that are prescribed in India (roughly two out of every three prescriptions include one or more antibiotics/antibacterials), it would be unmanageable in a matter of days for them to keep copies of prescriptions just to please the law. But then, the government has the knack for coming up with solutions that are not practical or feasible.
For their part, chemists have now got the ruse to come up with their own set of unreasonable demands – they want two of their representatives to be on the technical advisory board that is studying the new norms. UPA-II surely knows how to cook its own goose.
The problem – that of antibiotic resistance, however, remains. Antibiotic resistance or better antimicrobial resistance (AMR) frequently pops up in news items. The last time it did was in April when a Cardiff University-led team found new strains of resistant bacteria in New Delhi's drinking water supply, including species which cause cholera and dysentery. The findings were the first evidence of the environmental spread of the highly drug resistant, disease-causing bacteria NDM-1, which had previously been found only in hospitals. This was bad news.
This, and many studies in the past, would have been at the back of the mind of the Ministry of Health and Family Welfare. AMR is certainly a public health hazard and needs to be brought under control, but the way the ministry has tried to go about it clearly indicates that it either has no understanding of the problem, or just wants to throw the baby with the bath-water. Perhaps it can only think of bureaucratic solutions to scientific problems.
For the uninitiated, AMR is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene. (WHO)
The World Health Organization (WHO) says, “Inappropriate and irrational use of medicines provides favourable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread.”
Here are 10 ways that the AMR menace can be tackled, if not brought under total control:
i) Pharmaceutical companies are wont to launch new antibiotics or antibacterials every few weeks/months. They usually phase out earlier products in favour of what they call higher-generation antibiotics. This unethical industry must be controlled first.
ii) At the personal level, AMR takes roots when patients don’t complete an antibiotic course. Doctors must ensure that patients are encouraged to complete a course.
iii) In a country like India, most patients do not even buy a full antibiotic course from the chemists since prices are usually prohibitive. This needs to be addressed.
iv) Doctors too need to resist the temptation to prescribe higher antibiotics when lesser ones can serve the purpose.
v) The plan of the government to introduce the dual prescription norm to control over-the-counter (OTC) sales of antibiotics cannot be gulped down simply because most drugs are not OTCs in the first place. Scheduled drugs should never be sold OTC.
vi) Monitoring of drug usage is practically non-existent in India. Studies conducted are usually based on sample sizes that are never big or diverse enough for a country like India. Studying sales of, say, the antibacterial norfloxacin, for instance, is not the same as finding out about the market size of plasma TVs.
vii) The entire prescription regime in India is flawed. Doctors have to perforce use their imagination while prescribing drugs, not knowing who’s resistant or hypersensitive to which drug. Without preliminary tests, a doctor can at best, only guess.
viii) Most doctors, barring those engaged in research or academics, are barely able to keep pace with the way the pharmaceutical industry, particularly the money-driven antibiotic segment, has been evolving. It ought to be up to either the government or the Medical Council of India to fill in the information gap.
ix) Medicines are all about people. The people have to be involved in the process anyhow. How this can be done, though definitely monumental, is a different story.
x) The current Union Minister for Health and Family Welfare himself is a problem. He’s a man who believes that if couples of a reproductive age watch television at night, they won’t have the time to procreate, and hence population would remain in check.
Whether corruption has a direct impact on everyone’s lives may be debatable, but AMR is something that can get anyone killed.
(The author of this piece has worked in the pharmaceutical industry and sold drugs for one of India’s largest antibiotic manufacturers.)