MURAD BANA <[EMAIL PROTECTED]> wrote:
Expensive psychotropic drugs
Sale thriving at the cost of patients' wellbeing
By Shahina Maqbool
ISLAMABAD: The absence of effective regulations governing the introduction,
sale and consumption of expensive drugs for the treatment of mental disorders,
coupled with lack of qualified psychiatrists and the existence of an unholy
alliance between drug manufacturing companies and doctors, have combined to
increase the trauma of people suffering from psychiatric and mental disorders
in Pakistan -- a country where mental health services are almost nonexistent,
and where available, are limited either to the psychiatry departments of
teaching hospitals or private-run clinics.
A consumer survey released by TheNetwork for Consumer Protection here Friday
reveals that the sale of psychotropic drugs (allopathic only) in Pakistan is
touching an annual figure of Rs3 billion. For instance, during the year July
2003-June 2004, the sales stood at Rs2.76 billion (US $46.77 million). Of
these, antidepressants accounted for sales worth Rs821.17 million (US $13.4
million), showing an increase of 23% from the previous year; tranquillisers and
hypnotics worth Rs1.36 billion (US $23.18 million), showing an increase of 18%
and 137% respectively, from the previous year; and antipsychotics worth
Rs377.02 million (US $6.39 million). The sale of 'nootropics' (so-called brain
stimulants) was worth Rs187.6 million (US $3.18 million). To put the above
figures in context, the Gross Domestic Product of Pakistan is approximately US
$61.6 billion whereas the per capita income is US $440.
Pakistan has only 150-200 qualified psychiatrists -- an alarming ratio of one
psychiatrist to a population of one million. The majority of the psychiatrists
is urban-based, whereas 70% of the population is rural-based. Except in a few
instances, psychiatry is neither taught nor examined at undergraduate level,
leaving most practicing physicians with poor diagnostic and management skills.
In view of the acute shortage of psychiatrists, most people end up consulting
general practitioners for the treatment of mental and psychiatric disorders.
Patients who cannot afford doctors' fees or purchase expensive drugs, which are
sold even without prescriptions, have to rely on quacks.
According to studies, 25-66% women and 10-40% men in Pakistan suffer from
common mental disorders. There are an estimated 3 million drug addicts. Suicide
rates have dramatically increased from a few hundred to more than 3000
annually. Serious mental illnesses account for another 1-3% of the population.
Health spending is a pitiable 1% of the government's annual budget and mental
health does not have a separate budget. There is no health insurance and a
poorly funded public health service is accessed by only the poorest. All
healthcare costs are borne by patients themselves.
Coming to the murky relationship between drug manufacturers and doctors, the
survey reveals that a multinational pharmaceutical company recently launched a
drug for dementia in Pakistan and flew about 70 Pakistani doctors to Bangkok
for a three-night all-expenses-paid trip. Pakistani doctors were part of a
larger group that also included doctors from other countries. A conservative
estimate of costs for the Pakistani doctors alone comes to about Rs. 7 million
(US$ 120,000). The drug in question costs Rs. 320 per recommended daily
maintenance dose - prohibitively expensive for the vast majority.
The survey quotes an article by Dr. Murad Musa Khan, Professor of Psychiatry at
the Aga Khan University, Karachi. "With little or no regulation of medical
practice or drug prescribing and dispensing, companies and physicians are free
to act as they deem fit. Malpractice litigation against doctors is unheard of.
Pharmaceutical companies have therefore targeted psychiatrists aggressively.
The traffic is bidirectional - psychiatrists are as demanding of favours as
companies are of providing them," he writes.
According to Dr. Murad, some of the inducements on offer include sponsoring
attendance at conferences, all-expenses-paid trips for self and spouse for a
drug launch abroad, free drug samples and expensive gifts (watches, air
conditioners, briefcases, laptops, etc). Other methods include funding a
physician's family wedding, holidays and other events. "One of the latest
incentives is for the pharmaceutical company to provide the physician with a
down payment for a new car. All the physician has to do in return is write 200
prescriptions for the company's expensive drug," he writes.
Can integrity be regained by psychiatrists in Pakistan? Dr. Murad believes they
can, provided that there is a will. "No matter what the circumstances, the
interest of the patient should remain paramount. Anything that compromises this
must be identified and eliminated. This includes accepting any kind of
inducement from pharmaceutical companies. Alternative ways of funding
attendance at conferences must be found. This must be strengthened by strong
institutional policies limiting direct contact with pharmaceutical sales
representatives," the survey quotes Dr. Murad as having said.
Source: http://www.dawn.com/2006/08/19/nat21.htm
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The prophet (peace and blessings of Allah be upon him) said: "By Allah, if
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The prophet (peace and blessings of Allah be upon him) also said, "Whoever
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follows him, without the reward of either of them being lessened at all."
[Muslim, Ahmad, Aboo Daawood, an-Nasaa'ee, at-Tirmidhee, Ibn Maajah]
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