‘Drug Information System in the country is still in its infancy’
P K Lakshmi is the deputy director of Drug Information Centre (DIC) of Karnataka, first of its kind established in the country by Karnataka State Pharmacy Council. She was deputed to be trained in Drug Information at Austin Repatriation Medical Centre (ARMC) in Australia by the Karnataka State Pharmacy Council. In an exclusive interview with R Baby Manoj, she elaborates the relevance of proper dissemination of drug information among registered medical practitioners and the role played by DICs in this regard. Excerpts:
How did DIC originate and what are its functions? What were the difficulties you faced?
The Drug Information Centre was established by Karnataka State Pharmacy Council (KSPC) in the year 1997 to disseminate drug information to healthcare professionals. It is registered with International Register of Drug Information Services (IRDIS). DIC is the brainchild of Gundu Rao, president, Karnataka State Pharmacy Council. Initially, when we started we did not get much inquiries from doctors or patients. Now the situation has changed for the better.
What are the services provided by the centre?
We provide current and alternative therapy (not alternative systems of medicine) recommendations based on literature and patient data. We assess suspected adverse drug reactions and provide specific information regarding predisposing factors, relationship to dose or duration of therapy, incidence, clinical manifestations and management.
We evaluate the significance of a drug-drug, drug-food, drug-disease or drug laboratory test interaction. We also provide information regarding drug administration techniques, preferred routes of administration and monitoring parameters for assessing efficacy and toxicity.
The DIC attempts to identify drugs obtained from other countries. If possible, we provide product composition and US equivalent along with an assessment of the efficacy and potential hazards of the product.
We disseminate information regarding special dosing requirements for patients (including paediatric and geriatric). Our overall objective is to work towards promoting safe, effective, rational and economic use of drugs. Since the year 2000, we are organising awareness workshops for healthcare professionals. We publish an eight page news letter every quarter.
We also provide poison information and drugs usage in pregnancy. Anyone, in need of poison information can contact us. The poison can be a drug or any other chemical.
If the name of the drug/poison thus consumed is conveyed we can give the exact information about antidote and other related essential information.
From where do you procure the database for the information you disseminate? What is the expenditure on this?
We get the database from the United States. We nearly spend Rs 2.5 lakh/annum for subscription of the data. We also collect information from authenticated websites. We scrutinise all the information and provide our comments on the modality of treatment using different drugs.
Have you received any kind of grants for your activities from the government or other bodies?
Under Member of Parliament Local Area Development (MPLAD) Fund Scheme we received Rs five lakh each from Ananth Kumar, MP, Bangalore and K Rahman Khan, deputy speaker of Rajya Sabha towards equipping the centre during the year 2000 in appreciation of our work.
How many DICs are there in India?
There are about 16 DICs in the country. However, it is not an exhaustive list there may be some more. These include: DIC-Karnataka State Pharmacy Council; DIC – Victoria Hospital, Bangalore and DIC – Bowring and Lady Curzon Hospital, Bangalore with our collaboration; AIIMS Poison Information Centre, New Delhi; DIC-CDMU Documentation Centre, Kolkata; DIC – Maharashtra State Pharmacy Council; DIC – Andhra Pradesh State Pharmacy Council; DIC – Trivandrum Medical College; DIC – JSS, Mysore, Karnataka; DIC – KIMS, Bangalore; DIC – KMC, Manipal; DIC, Ooty; Pharma Information Centre, Chennai; DIC – Sri Ramachandra Research Institute, Chennai; DIC – Sri Rama Krishna Mission Hospital, Coimbatore and Medicines Information Centre – Chandigarh.
What is the relevance of DICs when doctors and pharmacists can give the required information to the needy?
Especially in government hospitals, doctors are burdened with too many patients, leaving them with very little time to a patient. In such situations, the doctor cannot explain to the patients the additional details of the prescription like the side – effects, cautions and proper use of drugs etc.
He/She may not be fully aware of such details as well. In developed countries, the pharmacist would give all the additional details and counsel the patient on all aspects of drugs. In the developed nations and few developing ones, providing clinical and drug information services are part of pharmacy services. However in India, it is still a new concept.
You may be aware that irrational combinations of drugs are available in the country despite US FDA/other countries ban on them. What are your comments? What is the rationale behind companies marketing irrational combinations in the country?
World Health Organisations (WHO) statistics indicate that 80,000 to one lakh formulations are available in India. I don’t know whether it is inclusive of traditional medicines like ayurveda and other systems of medicines. In developed, countries single entities are available as formulations.
When they want combinations, they literally combine one or more separate entities and very few combination drugs are available, this is due to disadvantages of fixed dose combinations, which leaves the prescriber unable to titrate the dose on individual basis.
Here things are different. A combination of nimesulide and paracetamol is available, which is not at all essential. The required results can be obtained with a single entity itself. The motive behind pharmaceutical companies marketing them is purely ‘commerce’.
However, in the case of some of the chronic conditions/ diseases, use of combinations of drugs are essential, to improve the patient compliance. However, it is sad that commonly prescribed drugs such as painkillers, antibiotics, antiallergic medicines this irrational combinations are more. Irrational combinations could be dangerous in the sense that when a combination is taken, vital parameters like half-life of the drugs, dosing in relation to food, drugs with similar actions etc, has to be taken care of.
Some of the drugs may have a very short half-life which have to be given for example three times a day. The other drug in the combination may be of longer half-life, a once-a-day or twice-a-day dose would be sufficient.
When such a combination is used, it is irrational. Some drugs are to be taken before food and some to be taken after food. Drugs having similar actions lead to irrational combinations. Either shortage of the first will take place or excess of the second or vice versa. Many such combinations are available in the market. ‘Pain killers plus pain killers’ ‘Pain killer with antiulcer drugs, fluroquinolone with azole grops of drugs, antacid with sedatives etc are other such combinations widely popular.
There are certain diagnostic centres in the city conducting bogus clinical trials. Your comments.
The clinical trials are conducted by hospitals. WHO guidelines have to be strictly followed while doing clinical trials. The patient has to be briefed by the investigator about the trial and then his/her consent has to be obtained in the required form. Only than the trial begins. The patient has to have the freedom to walk out of the trials any time he/ she wants. The patient/ volunteer has to have full information about the drug, its purpose, and its possible side – effects.
Do you feel the awareness level of registered medical practitioners are satisfactory, especially when instances such as banning and withdrawal of certain drugs have increased?
Doctors in the suburban and rural areas are unaware of the latest developments in the drug industry. Many doctors are still prescribing banned and withdrawn drugs. I don’t know how our country will address this problem. There is no mechanism or apparatus in the country to compulsorily disseminate updated information to medical practitioners.
The government has to take adequate measures to ensure that medical practitioners are properly updated with the latest drug information. Even the general practitioner in the remotest area has to be kept informed of the latest developments.
Could you brief us on the WHO projects undertaken by you.
This month we will be finishing ‘Measurements Of Medicine Prices In Karnataka’. The results will be available this month. The funding is by WHO and Health Action International (HAI). For this compilation, they are funding five-six states. Apart from Karnataka, Tamil Nadu, Maharashtra, Kolkatta and few more states involved in the survey, wherein survey results are completed for Rajasthan and Delhi.
We do some projects for Delhi Society for Promotion of Rational Use of Drugs (DSPRUD).
They are funded by WHO. In turn they give the projects to us. The project such us training of doctors in rational use of drugs has been conducted for government doctors and currently we are doing it for ESI doctors of Bangalore.