Vedas and fertility

Health Care No Comments

Infertility has been known from the Vedic era. Examples of fertility and assisted reproduction can be read in cases of King Dashrath, Ganesha, Kartikeya, Dhritarashtra, Vidur and Pandu etc.

The three Shahi Snans mentioned in our Vedic literature are undertaken in the month of Magh, Vaishakh & Kartik (Vikram calendar) months. Shahi snan denotes exposure to sunlight to get Vitamin D. The rituals also involve eating the calcium-rich sesame seeds in a fasting state. Increase in both vitamin D and calcium are necessary to increase fertility.

The main wedding season starts from Devuthan Ekadashi, Tulsi Vivah followed by Amala Navami. The seeds of Shyama Tulsi are known to increase the viscosity of semen and in women they help the release of eggs, a clomiphene-like action. Amla also increases sperm concentration.

Pooja means dharam karam i.e. whatever we offer to God, we should also offer to ourselves (God is in me, the basis of Advaita philosophy).

Indian doctors have been practicing Fallopian tube patency test or HSG (hysterosalpingography) for years. In this test, water or medicated oil dye is used to test and flush the fallopian tubes. It was noticed that post-HSG, the women showed improved fertility.

Now, with the advent of CT, MRI and hysteroscopy, use of HSG has reduced, while the need for IVF has increased. Can we consider the use of vedic era methods and HSG to get better fertility results?

Unfortunately, IUI, which was done by GPs, has gone in disrepute because of some unethical practices by so-called sadhus and saints and is now in the domain of IVF specialists only to the extent that it is now being covered under a separate Act.

Dr KK Aggarwal
National President IMA & HCFI

There is still confusion among doctors regarding the word “Generic”

Health Care No Comments

Confusion still prevails among doctors as to what does the word “Generic” mean. I have tried to explain what is a generic drug as below.

There are two types of drugs – patented or generic.

The patented drugs are introduced in the market by the original company that researched the basic molecule. Let us take the example of Pfizer, which introduced two original molecules – Amlodipine and Sildenafil – and launched them in the international market as Amlogard (Amlodipine) and Viagra (Sildenafil). Being their research molecules, Pfizer had exclusive rights for 10 years based on their patent. These drugs are called patented drugs and the pharmaceutical company will have exclusive rights to them till the patent expires.

After 10 years as the patent period expires, other companies can also market these molecules under their own brand name or as generic molecules. These are called non-patented generic version of the drugs.

There is no difference by law in the quality of generic or patent versions of the drugs.

For example, amlodipine in India is still available as Amlogard (Pfizer) @ Rs. 8/-; however, Dr. Reddy’s Lab also markets it as Stamlo, at less than Re.1/-. Similarly, Viagra (Sildenafil) was introduced @ Rs 600/- during the term of the patent, but the generic version is now available at less than Rs. 25/-.

When we are asked to write generic name of the drug/s, this means that we should write the generic version of the drug/s and not the patented drug/s still marketed in India.

Prescribing Amlogard or Viagra, when the generic Indian versions are available, cannot be justified. The generic version will be available at fraction of a cost than the patented versions.

Let us take another example of the patented drug Clopidogrel, which is available as Plavix (original drug) and Deplatt, the Indian generic version. Plavix costs Rs.100/- and Deplatt Rs 5/-.

Why write imported patented versions, when Indian generic versions are available.

India is the largest exporter of generic versions of the drugs in the world as they can manufacture drugs at fraction of a cost compared to international brands.

The word ‘Brand’ has nothing to do with the words ‘generic’ or ‘patented’ drugs.

In India, generic versions of drugs can be sold in the name of molecule (generic-generic) or brand (generic-brand).

The only thing that the Indian Medical Association (IMA) wants is that all generic versions of drugs in India should be permitted to be sold only at one price by one company. At present, the generic versions are being sold at three different prices (generic-generic, trade-generic and branded-generic) by the same company.

Dr KK Aggarwal
National President IMA & HCFI

New guidelines for ‘deprescribing’ PPIs

Health Care Comments Off

Proton pump inhibitors (PPIs) are a very commonly prescribed class of drugs for patients with acid peptic disorders. They have been generally regarded as safe and well tolerated. And, their long-term use is common.

However, recently, there have been concerns about the use of PPIs, especially long-term use. PPIs have been linked to increased risk of osteoporotic fractures, pneumonia, Clostridium difficile infection and rebound acid hypersecretion, especially in the older population. Long-term use may also affect patient compliance to the prescribed treatment.

Evidence-based recommendations published in the May 2017 issue of Canadian Family Physician to help the physician decide when and how to safely stop the PPIs or reduce their dose, called ‘deprescribing’ PPIs. This can be done in three ways:

• Reducing the dose by ‘intermittent’ use for a fixed duration; ‘on-demand’ use or using a lower ‘maintenance’ dose.
• Stopping the drug can be done by abruptly discontinuing the drug or via a tapering regime.
• Stepping down means abrupt discontinuation or PPI tapering followed by an histamine-2 receptor antagonist (H2RA)

These guidelines recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease (GERD) or esophagitis, and whose symptoms are resolved.

• Decrease the daily dose or stop and change to on-demand use. This has been given a strong recommendation.
• Or, an H2RA can be considered as an alternative to PPIs. This alternative has been given a weak recommendation due to the higher risk of symptoms recurring.

These recommendations are not applicable to patients who have severe esophagitis grade C or D, or a documented history of bleeding gastrointestinal ulcers or have Barrett esophagus.

(Source: Can Fam Physician. 2017 May;63(5):354-364)

Dr KK Aggarwal
National President IMA & HCFI

« Previous Entries