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Dr K K Aggarwal

Medical Council of India Code of Medical ethics: 1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.

Interpretation

1.Use of Generic names of drugs: it’s not use of generic drugs

2. Every physician should: the word SHOULD makes it a binding

3. As far as possible means to the best of his or her capacity

4. Prescribe drugs with generic names:  is not same as prescribing generic drugs. It only means the name of the salt should also be written.

5. Shall ensure that there is a rational prescription: Rational means prescription of drugs which are evidence based and or with informed consent.

6. Rational use of drugs: means same when dispensing.

Thus Medical Council of India says “prescribe drugs with their generic names” which makes sense as what they insist is that as far as possible we should write the name of the salt also. By writing the name of the salt one will be able to avoid lot of prescription errors and will be able to do and prescribe drugs rationally. For example instead of writing Stamla 5 mg once daily at night one should write AMLODIPINE (STAMLO) 5Mg a bed time.

What is the difference between a patented and a generic drug

1. PATENT DRUG means a drug belonging to the original company who has researched the pharmaceutical molecule. The company will have rights of that molecule for ten years. During these ten years, no other company can manufacture and sell this compound. After ten years, the patent finishes then any company can copy or modify the molecule and come out with its own brands.

2.  After the patent is over the patent drug becomes a GENERIC DRUG.

3. Brand means any drug which is marketed by a company specific name. Both patented and generic drugs can have a brand name. Brand names are so designed so that a person can easily remember the drug, or its action

4. The word GENERIC NAME means the original salt name of the compound. It is not same as generic drug.

5. A drug can be sold under any of the three categories: Under the name of the generic salt (no brand name), unpopular brand name and a popular brand name. The same company usually sells them under all three categories. Under the salt name they sell in a supply of 100 or more; under unpopular brand name they pitch for an institutional bulk supply and under popular brand name they market for individual doctor’s prescription. The cost of the generic salt will obviously be cheaper.

6. Actually almost all the drugs produced inIndiaare GENERIC DRUGS (generic equivalents) under different BRAND NAMES. The prises of them may vary and are not controlled by the doctors. MRP is decided and permitted by the government.

7. In USA BRAND is the name given to the patented drug. After ten years the sane drug is sold as generic equivalent.

How to reduce the cost of the drugs being prescribed

1.            One can write AMLODIPINE (Dr Reddys lab) instead of a known brand. In that case the chemist should give the unbranded version of the drug which will be cheaper.

2. The government should ensure availability of unbranded drugs with generic name.

3.The reimbursement policy should be to reimburse the cheapest drug (branded or unbranded with generic name version). If a person wants a costlier brand he or she should be allowed to pay the difference.

4.            For example, there are three types of stents inIndia-  the Drug Controller of India approved stents, the European approved stents and American approved stents with Indian stents being the cheapest and the American the costliest. If the Government reimburses all three of them, most of the patients and doctors will opt for the costlier American stents. The Government should reimburse only for the cheapest stents and anybody who wants an American stents should pay the difference.

5. Similarly, the insurance companies, public sector undertakings, CGHS and related agencies should reimburse for the cheapest drugs and devices. But will be policy makers and the politicians allow that because they are the ones who will opt for costly branded drugs or devices.

6. Quite often it is argued that the drugs differ in efficacy and bioavailability. That is the difficult to understand as if a drug is approved by the Drug Controller of India, its efficacy should not be a matter of concern or challenge.

7.  There are also arguments that drug licenses are a State subject and the reliability of a state licensed drug may be under question mark.

Conclusions

I personally feel that ever doctor should write a brand with the name of the generic salt in the bracket so that prescription errors goes to minimum.

Also the Drug Controller of India should release a website where every doctor should be able to find out which drugs are cheapest in the market and yet approved by the Drug Controller of India.

Conducting a CPR 10 Camp at Modern Era Convent School, Janakpuri, Padamshri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA said that in last 2 ½ months at least two lives have been saved by public who has learnt Cardiopulmonary Resuscitation.

Dr. Aggarwal said that 50 people die every day inDelhiof a cardiac illness and 5-6 lives should be saved every day if general public learns CPR. He said that Heart Care Foundation of India plans to train one lakh people within this year.

Over 1200 school children were trained in CPR which is based on the mantra – “within 10 minutes of sudden cardiac death (earlier the better) for the next 10 minutes (longer the better) compress the centre of the chest of the victim with a speed of 10 x 10 i.e. 100.”

Addressing the gathering Ms K.G. Modi, Principal of the school said that as a good Samaritan, it is the duty of every teacher to learn CPR and in turn train parents and school children so that every child learns that CPR 10 training is not only for organization but is also for each and every person and family.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 25409  people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute.”

The movie 3 Idiots showed this to the public and one can recall what different it makes when Chamatkar is replaced by Balatkar. The basic message that mugging is not good comes from Hindu mythology where Goddess Saraswati is shown carrying a Veena in her two hands, a small Vedic book in other hand and a small rosary in another hand.

Two hands having veena indicate that more importance is given to practice and skill and less importance is given to book (held in one hand) and rosary (ratta marna) in one hand.

The small book in one hand indicates that you cannot learn by reading alone and small rosary indicates that you cannot learn by mugging up. The answer is – Suno Samjho Jaano Karo.

 

Preventing Death Due To Hypothermia

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People can die of hypothermia in this season. Imagine a situation when you come across two people lying in a JJ cluster area with no clothes early in the morning. One of them is shivering and the other one is not. The one who is shivering indicates that his body is trying to compensate with the low body co-temperature.

The other one, who is not shivering, may be dead, dying or normal.

Recall your naturopathy teaching “Sar Thanda, Pet Naram and Paon Garam”. If the sole of the feet and the feet are cold and the person is not shivering, this is a medical emergency. On the contrary, if the person is not shivering and the feet are warm, it is not medical emergency.

Therefore, hypothermia with no shivering and hyperthermia with no sweating are bad signs.