Concerned about the irrational use of drugs to treat tuberculosis by private practitioners, the government now plans to rope in chemists and bring prescriptions under its scanner. But the move, say experts, will pose an ethical question about the rights of the patient. ”To check unregulated drug use, we are thinking of a mechanism where we can audit the prescriptions received by chemists,” Ashok Kumar, deputy director general of the central TB control division under the ministry of health and family welfare, told
“We have already roped in chemists and drug sellers in some states for guiding and counselling the TB patients received by them,” he said. This move will help government reach out to the private physicians who often prescribe drugs that do not fall in line with the government’s regulations on treating the disease.
TB kills two people every three minutes, and accounts for over three lakh deaths every year in India. The official said irrational drug usage has led to drug resistance of the TB-causing bacillus (bacteria). And most of the time, it has been seen that incorrect dosage by private practioners or multiple prescriptions by them leads to drug resistance. ”Chemists can direct the patient to the DOTS centre, and at the same time the move will help us know what drugs are being prescribed by the private physicians for TB,” Kumar said, adding that the “ethical and legal issues will have to be considered”.
However, experts say the auditing of prescriptions could pose ethical and legal issues. ”There are ethical issues involved in monitoring prescriptions as it is related to patient’s right to privacy,” P.D Sheth, past president of the Indian Pharmaceutical Association (IPA), told IANS. ”But as far as chemists informing patients (about DOTS) is concerned, we are very much part of the effort and it has proved beneficial in Mumbai,” he added.
Blessina Kumar, an HIV-TB activist, feels as long as the rights of the patient are protected, the move is fine. ”As long as there are mechanisms for maintaining confidentiality of the patient, the move is good. But the challenges in implementation and larger issues of TB also need to be brought up,” Kumar told IANS. Over 10,000 pharmacists across the country are registered with the IPA.
“The idea is to generate data on use of anti-TB medicines in India. Much of the prescription auditing will have to be done by private pharma shops that receive TB patients in abundance,” Sheth added. But before this takes off, government in partnership with IPA has launched a programme to educate patients on DOTS and creating awareness on the importance of completing minimum six-months of compulsory TB dosage.
Under the plan, pharma companies in Mumbai have been counselling and referring patients to the government referral centre and DOTS clinic for the last two years. According to Vishwa Mohan Katoch, director general of the Indian Council of Medical Research (ICMR), drug resistance is a cause for worry. ”There is huge variation in drugs that private physicians are giving to TB. Whether it is known as MDR or XDR, the drug resistance is a cause of worry,” Katoch, who has leprosy, TB and HIV-AIDS among his research work, told IANS.
Under the Revised National Tuberculosis Control Programme (RNTCP) that was implemented in the country over a decade ago, patients are given the six-month long Directly Observed Treatment Short course (DOTS).
“Even if a TB patient is going to a local physician, the physician prescribes his own set of medicines that could add to the drug resistance of the disease-causing bacteria,” he said. ”We cannot fight even the most powerful form of TB unless our physicians stick to one mode of medication,” he said. Summed up Kumar: “There is a strong intervention needed from drug controllers. TB is an issue about social and ethical responsibility of the private practitioners, chemists, and the government’s policies need to be complied by.”