Folic Acid

Mumbai : Is a doctor’s prescription necessary to buy medicines in India? An overwhelming response will be in the negative. For those in variance, try a test: ask your neighbourhood chemist for a medicine for relief from a scratchy throat. A lemon-ginger strip of cough lozenges may be recommended. But a friendly staff member at the counter may even promptly hand you a strip of azithromycin, with an assurance that it will work in two or three days. Satisfied with the courteous support, you return happily. If the chemist declines your request, you may be upset and never visit the shop again. This is the general user experience. In sharp contrast, pharmacists in the US or European countries may bluntly say no to such requests for prescription drugs. However, those countries have a long list of drugs that are sold over the counter and may not need prescriptions. A well-known endocrinologist from Chennai had a tough time sourcing an antibiotic to treat an infection while traveling in the US. After seeking help from a local acquaintance there, he managed to get the medicine. He reminisced about the ordeal of missing some essential medicines in his travel pouch. Barring rare exceptions, chemists in India observe no rules in selling medicines. Some, however, do follow stringent norms for sedatives or painkillers. The law is clear for such drugs, which are categorized under Schedule H of the Drugs and Cosmetics Act, 1940. It strictly requires a doctor’s prescription. Having easy access to medicines in India has turned into a veritable bane. Drugs move unhindered, without a semblance of regulatory scrutiny. No records are monitored, even when laws mandate written records for such prescriptions. But here is a question: can chemists be singularly blamed for misuse or for pushing drugs where people do not follow the rules? That topic came up at a recent meeting of the Drug Technical Advisory Board, the committee that helps India’s central drug regulatory agency in forming key opinions. It has boiled down a list of 27 drugs to be sold over the counter, but with restrictions on dosages and the quantity dispensed. These include antipyretics, painkillers, antacids, cough syrups, oral contraceptives, antiseptics, laxatives, nasal sprays, iron and folic acid tablets, besides a few SOS medications. The recommendation also includes making smaller pack sizes to prevent misuse or overdosing. Part of those deliberations covered the looming threat of antimicrobial resistance, which has seen an alarming rise due to the over-consumption of antibiotic drugs. Top officials in the advisory committee note that the aim of the move is to increase accessibility to commonly used medicines while ensuring patient safety. Global drug makers have lobbied for over two decades and called for clear rules on what can be sold as OTC drugs in India. Such a category never existed in India. While laws that are in place for prescription-based drugs are not followed, can a list of OTC drugs make things any better? The decisions of the committee are well-intentioned and must be formulated. But in the absence of a tight surveillance and monitoring mechanism to identify misuse and leakage points, such rules may not make any difference. By Vikas Dandekar ,