PROBLEMS POSED BY "LEGITIMATE" DRUGSby Jayendra K. Patel
Doctors and Drugs In these countries, drug companies maintain close personal ties with doctors by the systematic use of trained representatives, the so-called "detail men". They frequently present them with gifts and "reminder" items in order to establish and strengthen their contacts with medical practitioners. In the United States these gift items can be as many as 400 per year. Studies have shown that the visits of these detail men tend to influence a doctor's prescription practice and there seems to be a direct relation between the number of visits from a particular company and the propensity to prescribe a specific drug. But could these practices perhaps present a danger to the medical profession? May they not bring about a change in the practice of medicine? With respect to medical treatment, orthodox doctors have led themselves be guided by certain principles. They accept that, while hypotheses are a sound basis for therapeutic experiments, they are insecure guides for therapeutic practice. They also recognise that no therapeutic strategy is without hazard and that rational treatment entails a trade off between risk and benefit. Therefore, the indiscriminate prescription habits of many doctors cause alarm among the thinking community. Many resistant strains of bacteria, viruses and parasites have emerged. This could be the result of prescribing drugs without any rational indications. Patients may at times also be at fault in this matter. They may demand antibiotics for simple ailments, most of which are self-curative or can be treated with simple drugs like aspirin, which have proved their efficacy over the years. In affluent societies, if doctors do not prescribe the latest range of the costly antibiotics or the most recent medicines for certain chronic diseases, they are named "fossil doctors." So the problems continue: indiscriminate prescription and prescription without indication.
Over the Counter Drugs In developing tropical countries, including Kenya, we are facing a difficult task with respect to drugs since some diseases are becoming resistant to drugs. A prime example of this is malaria. The anti-malarial drug chloroquin was freely available to the public and there were only some very mild allergic reactions to its use. These reactions which were not life threatening. But malaria is now chloroquin-resistant and fansidar has become the first line of treatment. However, life-threatening reactions to fansidar have been reported on account of sulpha allergy. The fact that many patients assume they suffer from malaria and are able to obtain this drug even without a proper examination is therefore a serious matter. Ideally, before any drug is either prescribed or sold, there should be a brief review of the patient's medical condition in order to avoid drug interactions or contra-indications. It is obvious, therefore, that pharmacists have a key role to play here. They should not—for the sake of quick profit--sell medicine, such as antibiotics and habit- or dependence-forming drugs over the counter. And of course, doctors should not prescribe such drugs unnecessarily. Customers also need to be educated about possible side effects of both over the counter drugs as well as of prescribed drugs. The development of laid down procedures as well as closer cooperation between pharmacists and general practitioners are essential for the creation of a reliable system of monitoring and of reporting adverse reactions to drugs.
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