One of the greatest achievements of modernity has been the strides made in the field of medicine. And, yet, the easy availability of life-saving drugs has now become a matter of concern. According to a new study, 13 out of the top 20 antibiotic cocktails sold in India are classified as neither evidence-based nor recommended by the World Health Organization. This means that 229 — 58 per cent — of the 395 fixed-dose combinations of antibiotics sold across the country were on the WHO’s “not recommended” list. The data only get grimmer. All 10 admixtures of ofloxacin and metronidazole remain unapproved but are available in the market. Although the Central Drugs Standard Control Organisation, India’s principal drug regulatory authority, has banned 37 out of the 229 formulations, it has approved 63. Data from 10,000 stockists from 30 regions across India indicate that nearly 38 per cent of India’s antibiotic combination sales can be sourced to the 13 FDCs on the WHO’s black list. Thirty-seven formulations — 16 per cent of antibiotic FDC sales — were being sold despite bans by the CDSCO.
The findings have raised concerns about the functioning and transparency of the CDSCO, which has not only approved formulations rejected by the WHO but has also refrained from enforcing its own bans. This shows a massive disregard for public health. There are additional problems plaguing the medical ecosystem. One controversial but widespread practice that makes the prescription of drugs by doctors subject to scrutiny is that of ‘gift-giving’. Doctors are offered incentives — free meals, holidays, expensive gifts and so on — by pharmaceutical companies in exchange for endorsing their respective drugs. It must be mentioned that the Uniform Code for Pharmaceutical Marketing Practices, meant to regulate the functioning of pharmaceutical companies, is yet to be implemented. Earlier this year, a study published in The Lancet found that almost 30 per cent of antimicrobial deaths — the consequence of resistance to drugs — recorded in 2019 were in South Asia. This can be attributed to the unfettered use of over-the-counter medicine, including antibiotics, and self-medication that have severely compromised the efficacy of life-saving drugs. India is also vulnerable to a culture of overmedication: the mildest of conditions are treated with antibiotics, resulting in drug resistance. Unapproved and banned antibiotic combinations must be removed from the market. This must be complemented by measures to raise public awareness about the misuse of antibiotics. The real challenge, however, would be to stop the unethical practices indulged in by segments of the medical fraternity.