NLEM drug shortages: There should be a centralized system for reporting drug shortages

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The National List of Essential Medicines (NLEM) contains drugs that are considered to be most effective and safe to meet the most important needs in a health system. The drugs are selected on the basis of the disease burden in the country including what is of immediate concern. Medicines in NLEM are listed with reference to all levels of healthcare: Primary (P), Secondary (S) and Tertiary (T).

The list was last updated in 2015, which now contains a total of 376 medicines. In 2016, cardiac stents were added to the list.

Shortages of drugs, especially those in the NLEM, therefore are a cause of concern.

Few days back, there was a shortage of syrup furosemide, a life saving drug for children with heart failure. About two years back, there was a shortage of two drugs in the market, d-penicillamine (DPEN). D-penicillamine is used to treat patients with Wilson’s disease (copper overload) with liver, neurological and psychiatric manifestations. And, patients have to be on this drug lifelong.

Both furosemide and D-penicillamine are included in the National List of Essential Medicines (NLEM).

There can be several reasons for drugs running short in supply. These can include manufacturing and quality problems, delays and discontinuations, regulatory issues or problems in the supply chain. Patient care is affected as safe and effective drugs are then substituted with alternative drugs, which may be more expensive and may not be as effective as the first-line drugs.

In the United States, manufacturers provide the FDA with most drug shortage information. And, the agency works closely with them to prevent or reduce the impact of shortages.  All current and resolved drug shortages and discontinuations are reported to FDA at drugshortages@fda.hhs.gov, which are then compiled in a Drug Shortages Database.

But, unfortunately no such system exists in India to take care of drug shortages. There should be a centralized system, which informs doctors about the drugs that are running short in supply and, where drug shortages can also be reported.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

India faces the dual burden of obesity and malnutrition: HCFI

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Increasing obesity levels in rural India a cause for concern

New Delhi, 10th May 2019: Obesity is increasing more rapidly in the world’s rural areas than in cities, according to a study of global trends in body-mass index (BMI). The study, published in the journal Nature, analysed the height and weight data of over 112 million adults across urban and rural areas of 200 countries and territories between 1985 and 2017. The prevalence of obesity in India is increasing and ranges from 8% to 38% in rural and 13% to 50% in urban areas.

Rural areas in low- and middle-income countries have seen shifts towards higher incomes, better infrastructure, more mechanized agriculture and increased car use. These factors not only bring numerous health benefits, but also lead to lower energy expenditure and to more spending on food, which can be processed and low-quality when sufficient regulations are not in place. The need of the hour is large-scale awareness on the importance of healthy eating patterns.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Obesity is the mother of conditions such as diabetes and heart problems. India faces a dual burden. On the one hand is malnutrition and on the other is obesity. What makes obesity in India different from the rest of the world is that in our country, it is marked by the ‘Thin-Fat Indian Phenotype’. This means that there is a higher proportion of people with body fat, abdominal obesity, and visceral fat, in comparison with Caucasian and European counterparts. Hence, world obesity generally reported in terms of waist circumference, and a BMI beyond 30, significantly underestimates the prevalence of obesity in India. Indian obesity needs to be estimated according to a lower threshold of BMI 25. Additionally, even a normal BMI of up to 23, might show higher instances of isolated abdominal obesity.”

Two primary culprits of obesity include a sedentary lifestyle and unhealthy eating patterns. The consumption of processed food has increased manifold. This, combined with untimely working patterns and lack of physical activity, make the situation worse.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The traditional Indian diet is rich in carbohydrates. People consume large quantities of rice, rotis, and even bread. Apart from this, there is widespread availability of fried and unhealthy fast food today, which are all contributors to empty calories in the diet. Indians are caught amidst all this and therefore, the increase in the prevalence of obesity does not come as a surprise.”

Some tips from HCFI

  • The key to weight loss is reducing how many calories you take in.
  • The concept of energy density can help you satisfy your hunger with fewer calories.
  • To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates.
  • Make exercise an important part of your daily routine. Start slow and increase the duration as you go along.