A ban that is only in name

Insight

Pharmacists capitalize on their customers’ ignorance of the ban on fixed drug combinations

In March 2016, the Union ministry of health and family welfare banned the sale of at least 344 fixed drug combinations. As per the notification, “On the basis of recommendations of an expert committee, the central government is satisfied that it is necessary and expedient in public interest to regulate by way of prohibition of manufacture for sale, sale and distribution for human use of said drugs in the country.”

Some of the popular drugs that were banned include cough medicines like D Cold, Phensedyl, Benadryl and Corex, Nimesulide and Vicks Action 500 Extra. The government order sent the pharma industry into panic.

However, most of these drugs are still sold over the counter in Bengaluru.

Of the 17 medical shops that this Insight reporter visited, 13 sell most of these drugs. All of them sell drugs with Nimesulide as their main composition. Corex and Benadryl are still sold without prescription; only two pharmacists asked for a prescription for Corex and Phensedyl.

When asked about the ban on these drugs, three chemists claimed that they did not know about it. They would, however, change their stocks if a ban indeed existed. However, one of them said that as long as “demand” exists, he would continue to “supply”. “I don’t mind giving my customers these medicines for temporary relief if that is what they come looking for in my shop. I have loyal customers, they trust me and know I mean no harm,” he added.

In March 2018, the health ministry banned the sale of over-the-counter topical preparations containing steroids and antibiotics to “prevent the indiscriminate sale of these, without prescription”.

“In a notification issued on March 23, the ministry has put 14 steroid-based creams and ointments under the Schedule H category by making amendments to certain Drugs and Cosmetics Rules, 1945,” according to a report in The New Indian Express.

The decision was reportedly taken after consultation with the Drugs Technical Advisory Board that asked for a ban on the sale of such creams without prescription and had also submitted their recommendations to the Central Drugs Standards Control Organisation.

This move came after dermatologists complained that pharmaceutical companies were selling steroid-based creams and ointments to patients who used them without medical guidance. The creams which have been banned include alclometasone, beclomethasone, desonide, desoximetasone and flucinonide.

The sale of these drugs can be traced to the demand-supply issue. Most citizens are clueless about the ban and continue to buy and consume these. With a demand existing, chemists have no qualms about selling these banned items.

Sheetal Reddy, who works in Bengaluru, said: “No such information was available in the public domain. I did learn about the sale of D Cold and Benadryl being banned through a Facebook post. Regarding many others being banned, I never knew.”

“I once went to a medical store to ask for a tablet for my headache and was given Nimesulide. When I told my aunt, who is a doctor, that I had bought this, she asked me to immediately return the tablet and take a paracetamol 500mg instead. It was only later that I got to know that Nimesulide was harmful and banned in India,” said Renee Malhotra, a student.

“We have used these tablets at least once and know that they provide immediate relief. So we go back to buy them again, not giving a thought to what their side- effects are. People need to be made aware about these things that matter so much,” Malhotra added when asked about the rampant use of D Cold and Vicks Action 500.

Dr Giriprakash Gattu, a Hyderabad doctor, said: “For small issues like headaches and cold, patients don’t want to come to us for consultation and treatments. They would rather pay a tenth of the consultation fee to buy a tablet and be fine with it. We doctors won’t deliberately prescribe banned drugs.”

Dr Ramesh Babu, a general physician at the KC General Hospital, Malleswaram, has a different insight into the issue. He claimed that Bengaluru, despite well developed and more literate in comparison to other places in Karnataka, has a lot of quacks. “These (fake) doctors know which medicine cures what; and don’t bother about their side-effects or their sale being banned. All they care about is getting paid,” he said. And because they charge less than other doctors, people visit them.

Asked why these drugs were banned despite giving fast relief, Dr Babu explained: “The chemical combinations in these drugs are harmful and, in most cases, give rise to deadly side-effects. Dr Gattu agreed: “Medicines are meant to act slowly yet steadily. Immediate relief is only temporary cure.”

Despite the ban, there are other drugs being sold in India which are no longer available in other countries around the world. Painkillers like propoxyphene, oxyphenbutazone; drugs for the brain like Thioridazine, Pergolide, Pemoline; and other drugs like Phenolphthalein, Nandrolone Decanoate, Furazolidone, Nitrofurazone  and Cerivastatin. These drugs were banned around the world for their various side-effects like liver toxicity risks, heart valve problems, and cancer risks.

Even daily commodities that most Indian households would have, like Vicks Vaporub, are banned in most other countries for their side-effects.

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