Correspondence Address:
Imran Mohammed
Department of Pharmacology, Hamdard Institute of Medical Sciences and Research and Associated Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi - 110 062
India

Full Text

Sir,

The conclusion of the study conducted by the Mala Kharkar and Suresh Bawalekar about the discouraging culture of the adverse drug reaction reporting is correlating with many studies published on this topic in the last two decades. All of these revealed that practitioners have knowledge about adverse drug reactions (ADR) reporting importance but it is not being reflected in their practice. [1]

The dichotomy in knowledge and practice is not only seen with respect to lack of ADR reporting but also irrational poly-pharmacy, drugs prescriptions of favored brand products by their brand names, avoidable prescription of fixed dose combinations and unnecessary use of vitamins without any specific diagnosis of anemia or vitamin deficiency are rampant. This leads to the increase burden of cost of therapy, adverse drug reactions, drug interactions, development of drug resistance and poor compliance with the patients. [2]

The perception/practice of the prescribing physician is based on the assumption that the drug available in the market has the necessary approvals and has undergone the rigorous safety and efficacy studies. [3] However, recent 59 th parliamentary standing committee report has shown that physician knowingly or unknowingly are acting as the accomplice of pharmaceutical firms in promoting their brands. [4]

Irrefutably an in-depth introspection on part of the medical system is required for an ethical patient care practice. What happens to a patient visiting medicine clinic developing a skin reaction or gets pregnant? Invariably they are consulted by the concerned specialist. However, when a physician notices an uncertain adverse reaction or not sure whether a generic is as good as the brand name or deviates from the general rules of prescriptions, regrettably, there is a void whom to consult. The closest department in a medical teaching hospital would have been the 'Clinical Pharmacology and Therapeutics'. But unfortunately, despite being the part of the medical college, pharmacology has come to be increasingly considered as non-medical specialization. The department of pharmacology has been reduced to tailoring only the animal pharmacology.

This situation of not translating knowledge into practice would remain unless Medical Council of India introduces few clinics in the domain of 'Clinical Pharmacology and Therapeutic' for better patient care.

First: 'Cost/Benefit Clinic' to assess and minimize the burden of health care cost to patients by monitoring prescriptions, issuing list of low cost medications available in the market for clinicians to prescribe.

Second: 'Rational use of drugs clinic' to improve prescription writing, decreasing antibiotic resistance and gradually reducing unnecessary prescriptions.

Third: 'Side Effect Reporting and Prevention Clinic' to help administer safer medication. It will release advisory to the clinicians about recurrence of particular side effects and other alternatives available in inevitable cases. It will give information about banned and irrational drugs available in the market.

Fourth: 'Bioequivalence clinic' releasing advisory to fellow colleagues for prescribing generics which have the similar efficacy as that of the high cost branded drugs.

The present day pharmacologists have to involve themselves in the patient care and other services in the hospital to realize the full potential of knowledge, perception and practice.

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