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Recently there was an important case that came to the Supreme Court (SC). The petitioner demanded the SC to direct the doctors to inform the side effects of all drugs they prescribe to the patients. But the SC rejected the demand by saying it is impossible for the doctors to do that and said if it ordered so, the doctor would not be able to examine more than 10 to 15 patients a day. True, but no other relief is available to the petitioner?
Origin and apprehension
What could be the origin of this demand? Either the petitioner or his relatives might have experienced or suffered due to the side effects of the drugs or he might be an orthodox, ardent supporter of other systems of medicine. No wonder, many Indians including well educated people think that there are no side effects for Ayurveda, Siddha or Unani medicines as they are all herbal drugs. Is it true? No, because no systematic scientific study similar to modern medicine has been done on those formulations. Many of them have harmful metals, minerals and untested herbals. That’s why they are yet to be recognized as medicines in most of the Western countries. On the other hand, all allopathic drugs are first tested on animals, then on humans for many years and side effects detected before marketing. Thus there may be a motive for the people to throw mud against modern medicines, as to say, they are all dangerous. Manufacturers of it please note! Nevertheless, we must address the concern of the patients, but how and where?
Doctor's responsibility
The Supreme Court is right in pointing out, doctors may not have time to point out each and every side effect of all the drugs they prescribe. Imagine even if he explain it to the patients, how many of them would have patience, ability and memory to understand them? Even if it is given in printed form will they understand medical terms? Think it over, how much time and energy is required for explaining the meanings of such terms. Again side effects may not occur for every patient, most of the time it appears after prolonged use, abuse or misuse only. Hence, it is a sheer waste of time to explain it to every patient. Then shall we reject it outright, as our honourable Supreme Court has done? No. Is it not our duty to remove the fears of the patients who we put at risk of side effects of drugs? It is definitely the doctor’s responsibility, as they only put the patients in risky situations by their prescription.
What to do?
If the doctor has no time to explain the side effects of drugs why can't he engage some assistant? That is a million dollar question. We wonder why this thought has not come to the minds of honourable judges. Why did the learned senior lawyers not demand it? Who is suitable for the job? Do you think nobody other than a doctor is there? Naturally the inventor, the maker, the analyst, the dispenser simply the custodian or Kartha of drugs – the pharmacist is the best suitable person for the job. How does everyone forget his role at the same time? How developed countries solved the problem? Why and how educated people of Western countries accepted the prescription of doctors without questions? Did the persons concerned with this case verify it? Why no mention of it in the Courts – both in Delhi High Court and Supreme Court? Thus scores of questions flood the minds of the most unfortunate class of India – the pharmacists!
Role of pharmacists
It is mandatorily the duty of pharmacists to explain the method, time, dose, side effects, etc., of the medicines he dispenses. Was it insisted on in the Court by the lawyer or Judge? For out-patients the dispensing pharmacists will explain the side effects of drugs, for in-patients? As of now nobody is specifically assigned that duty in India. If there is time and knowledge the ward nurse may explain it. But most of the time they keep mum, fearing the doctor's wroth. Thus there is a vacuum in the wards of the hospitals which are filled with clinical pharmacists in developed countries. There they explain not only side effects, they actually watch for it, if it occurs, report to the treating doctor and even modify drug regimen in consultation with the doctor concerned. Simply they undertake Therapeutic Drug Monitoring (TDM) and thereby remove the fear in the minds of patients. Why is such an essential service not introduced in Indian hospitals? Obviously people expect better and error free health care service from the government. But our government is not ready to even upgrade the qualification of pharmacist from diploma to degree. Why, not even ready to compel pharmacists to wear white apron and ID card while on duty! Hence the people of India should knock the doors of the government forcefully first. But they knocked on the wrong door with insufficient backup data and got rejected.
History of side effects
Only after the greatest tragedy of the Century – the Thalidomide tragedy – in which about 1,00,000 infants were affected in Europe, the clinical pharmacy service was introduced to monitor the drug's effect. Now more than 60 years have passed. India is yet to introduce that service! The government and especially doctors should listen to the genuine concerns of patients. Simply rejecting their demand is not the solution, particularly when a solution is available and successfully in practice in developed countries.
Other problems
Recently we heard a shocking knife attack on a doctor in Chennai hospital by a disappointed son of a cancer patient. Such incidents cannot be avoided by opening police outposts inside hospitals or by installing metal detectors. Think of the basic reason – the root cause! Patients with life-threatening, painful diseases and their attenders are in anxiety, worry, fear and disappointments. Simple psychology! Hence they require soothing words and counseling daily rather than medicines and treatment at that time. We know doctors have no time for it. That's why a well-educated Pharm. D graduate with 6 long years education and special training is appointed as Clinical Pharmacist to assist the doctors in this task. They explain the effects of all drugs prescribed and counsel the patients daily in wards. It is a mystery why Indian doctors are not demanding that time tested clinical pharmacy services. Are they not aware of the services in foreign hospitals? We don't think so!
Miles to go!
If the learned judges and senior lawyers are not aware of the clinical pharmacy services in developed countries, there is no wonder. It is the failure of pharmacy graduates for not propagating their services. It indicates the miles to go by them. They should educate the people and popularize these wonderful services in every possible forum and ways. Pharmacy Council of India (PCI) which introduced Pharm. D course has a greater role in this, they should take up this work, advertise in media and press the Indian government. Then people themselves will start demanding it and thereafter if you go to Court they may direct the government to start it. Now is the golden opportunity, dear pharmacy graduates (their associations and PCI) do not miss it!
(The author is ex president, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)
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