Some drugs banned by union health authorities are being sold in Kashmir as there is little awareness among people regarding pharmaceuticals. Syed Asma reports.
Keep yourself updated! Your prescription may include drugs which are banned because they pose health hazards. But due to lack of awareness or the perks associated with them (the drugs and their companies), they are still found in the markets and prescribed by doctors, experts say.
“Many of us do not even know what is banned and what is not; the information inflow is so poor that we are not updated from time to time,” says Manzoor Ahmed (name changed), a chemist at Lal Chowk who was selling some of these medications in his store; stating he had no idea about the list of drugs which are banned.
Authorities impose a ban on certain drugs after observing their health hazards on humans. In India, drugs are banned by the Drug Testing Advisory Board (DTAB) and similar bans are imposed in different states as well. States do not have their own independent advisory boards.
About 69 drugs are banned in India.
However, there are many banned drugs which are available in the market. “They are present in stores because they are prescribed by the doctors, distributed by distributors and manufactured by manufacturers,” says Imtiaz Ahmed, a chemist from Budgam.
The flow of information is so weak that on several occasions, chemists, pharmacists and even doctors are unaware of the latest bans, says an expert.
Responding to this, Satish Gupta, the Drug Controller of J&K says, “The department has increased the strength of inspectorate staff from 16 to 84 inspectors for securing compliance of various notifications issued by central regulatory authority, Drugs Controller General (India), from time to time regarding banned drugs or allied matters.”
The list of banned drugs which are available in the market includes Nimesulide, Phenylpropanolamine (PPA), Cisapride, Human placenta extract, Sibutramine, Gatifloxacin and Rosiglitazone. All of these drugs figure in the banned drug list, but authorities are turning a blind eye over the issue.
On February 10, 2011, the Ministry of Health and Family Welfare issued a notification for drugs like Nimesulide, Phenylpropanolamine (PPA), Cisapride, Human placenta extract and Sibutramine. The notification reads, “The Central government is satisfied that the use of the following drugs is likely to involve certain risks to human beings and safer alternative drugs to the said drugs are available.”
Nimesulide is banned for children below 12 years of age, but its sales are high specifically in pediatric use, say pharmacists and doctors.
It is used as a painkiller, an anti-inflammatory, and usually prescribed for lowering body temperature.
“Nimesulide is banned because it causes liver toxicity,” says Dr Geer Mohammad Ishaq, Senior Assistant Professor at the Department of Pharmaceutical Sciences, University of Kashmir. “Nimesulide is prescribed in extreme conditions. It is used as the last dosage when lowering body temperature is the priority,” says a pediatrician wishing not to be named. Surprisingly, many doctors even did not know the drug is banned for children below 12.
“Nimesulide is the most sold out banned drug in the market. Common people are unaware about what is banned and why is it banned. They trust a doctor’s prescription and purchase the drug,” says Manzoor.
Despite being banned for posing serious health risks, several of these bans have recently been revoked by many high courts on a local level. The courts revoked the bans over lack of proper scientific basis on which these drugs were banned.
“India and similarly Kashmir lack proper infrastructure and a proper database that can prove which drug is having what effect on the patient, and which drug is hazardous for the human population,” says Dr Geer. “This softens the basis of these imposed bans.”
“Besides, every drug has its own effect on a particular population. It varies from region to region, country to country and from population.”
Dr S. Muhammad Salim, Assistant Professor, Community Medicine (SPM) at Government Medical College, Srinagar, gives the example of Diplophenac (Diclofenac) which is a pain reliever and is preferred throughout the world to be taken orally (as a tablet). But in Kashmir, it causes irritation in the mucous covering of the stomach. In the rest of the world, it has not shown any such signs.
To reduce the trouble and strengthen the basis of these bans, experts suggest that health centers, big or small, should have their own Pharmaco-vigilance labs so that there is a record of drugs prescribed and of their effects.
They say that maintenance of these records will help learn about both positive and negative side effects on patients.
Although drugs undergo many tests prior to entering the market, there are chances that they will show adverse effects on some humans, for which maintenance of these records will help, says Dr Salim.
In Kashmir, SKIMS is the only place which has come up with a Pharmaco-vigilance center. It was started in January 2012, but things will take some time to fall into place, says a hospital official.
However, the new approved drug policy has recommended that each government hospital should have a Pharmaco-vigilance center.
The availability of banned drugs in the markets is not the only worrisome element in Kashmir; lately many specialists have been quoted saying that Kashmir has become a safe market for spurious and fake drugs as well.
Dr. Naresh Trehan, a cardiothoracic surgeon alleged that “many deaths in J&K are caused by fake, substandard or expired drugs resold in new packages, and it is known to druggists and medicos that many pharma agencies have been doing so with impunity.”
Another cardiologist, Dr. Surinder Bazaz added, “I have been practicing in Kashmir since 1997, and have come across drugs which you can’t find anywhere else in the country. It seems as if this state has turned into a safe bastion for the trade in spurious and substandard drugs. Perhaps the highest number of fake drugs worldwide is sold here.”
However, drug control authorities have rejected the availability of any spurious drugs in Kashmir.
“This is not based on facts. The inspectoral staff regularly goes into the market and takes up the samples regularly and no spurious drugs have been found so far,” says Satish Gupta.
“We recently carried out a survey by lifting 47 drug samples from a state bound consignment of medicinal preparations at Lakhanpur and referred the same to Regional Drugs Testing Laboratory, Chandigarh for analysis. All samples whose reports have been received by this office so far have been declared as (being) of standard quality,” he adds.
A survey by ASSOCHAM claimed that the annual sales of spurious drugs may be to the tune of Rs 15000 crore. It also added that these sub-standard and fake drug factories are based in Punjab, Haryana and UP and their main market is J&K. State authorities, however, deny the presence of spurious drugs in Kashmir.
“Between these two extreme claims of renowned doctors (and ASSOCHAM survey) and that of the government officials, we end up in confusion,” says a senior pharmacist.
“But patients have their own version to share. Commoners usually complain of drugs not working anymore. It suggests something is wrong,” he adds, “we can land somewhere in the middle and can say there can be a significant percentage of fake, sub-standard and spurious drugs in our market.”
A practicing doctor wishing not to be named said, “All of us in the medical profession know about the malpractices in Kashmir. Authorities and professionals will never talk against it because we all are getting benefitted from it equally.”
