How social factors influence overprescribing in India

By Paromita Goswami, Shiv Nadar University and Anindita Chaudhuri, University of Calcutta

KOLKATA, 24.10. – India is being hit by a depression boom. Madness 56 million of his people have the condition, and another 38 million have an anxiety disorder. It belonged to India top 15 Causes of early death in 2019. Unsurprisingly, antidepressants are rife: prescriptions growth by 23 percent last year.

In Japan, pharmaceutical companies coined the term “Kokoro no kaze,” meaning “coldness of soul,” to describe depression. This carefully crafted disease awareness campaign was behind a growing acceptance of depression and antidepressants as treatments. corresponding Professor Hiroshi Ihara.

In India, job interviews with medical professionals, clinical psychologists and even traditional healers show how the pharmaceutical industry is taking new measures to expand its market.

Physicians have described how drug companies keep prescription records and in many cases pay physicians a percentage of the value of the prescriptions.

“If someone writes a prescription for 100 rupees, he gets 10 rupees; the amount is added…[and] paid for by conference sponsorships, trips abroad, books and gifts,” said a clinical psychologist.

GPs are often willing and able to prescribe low-dose antidepressants, and consequently “liberal prescribing of antidepressants by non-psychiatrists” is widespread in India. corresponding Psychiatrist Gopala Sarma Poduri.

But the pharmaceutical industry is not solely responsible for the overprescribing of antidepressants in India. The situation is more complex and nuanced.

Patients may turn to an antidepressant because they are stigmatized into seeing a psychotherapist. Mihir*, a general practitioner, reported that even when he recommends the services of a specialized psychiatrist, patients often refuse.

“[Patients] do not realize that they have such a problem. … [They would say] I have diarrhea or palpitations, why are you sending me to doctors for crazy people?”

Patients often prefer medication to psychotherapy. A clinical psychologist said: “People think they don’t have depression if they don’t take medication and only go to the therapist to talk; If there is no medicine, there is no problem.”

Indian medical education has been criticized for underemphasis on psychiatric issues. “People go to a GP first… but GPs have a limited understanding of psychiatric medicine and may be constantly switching medications and resorting to polypharmacy,” Prabir said.

Often, the lack of economic resources to afford therapy leads patients and their families to seek care from a general practitioner or non-specialist, whose inadequate training makes them particularly vulnerable to misdiagnosis and overprescribing of antidepressants.

With 0.3 psychiatrists and 0.07 psychologists per 100,000 inhabitants In India, there is no way to effectively manage the case numbers. Suggested Numbers For these categories, we recommend at least one to four per 100,000.

A shortage of qualified mental health professionals makes it impossible to address the needs of the hard-to-reach individuals country folk. The problem is so acute that in 2010 the Ministry of Health proposed a bachelor’s degree in community and rural health care.

This program could not be started. In remote areas, researchers have shown A large proportion of antidepressant sales are “generated not by licensed physicians but by an amorphous group of non-licensed prescribers who have never received formal medical training.”

In many ways, these unlicensed prescribers are inevitable. As one surgeon put it: “Our rural folk are dependent on ‘quacks.’ We are unable to provide qualified paramedics, so the so-called unauthorized or so-called quacks cannot be eliminated overnight.”

Patients are often forced to switch to antidepressants even when they don’t really need the treatment. The drugs are cheaper than the therapy.

“A therapy session lasts 30 to 45 minutes and that affects the fees. A person might then think, “I have to set aside 2500-3000 rupees for the consultation and I will just talk… On the other hand, if I take antidepressants, my monthly medical bills will not exceed thousands of rupees,” the psychologist said.

Clinical depression is a sad and increasing reality in India. The promotion of prescription products by drug companies has definitely happened and continues relentlessly despite changes to the Indian Medical Council Regulations in 2002.

But Big Pharma cannot be held solely to blame. There is a clear case of socio-cultural economic causes, including stigma, lack of affordable care, and infrastructural limitations such as the unavailability of qualified medical professionals, creating a breeding ground for the proliferation of overprescribing.

Paromita Goswami is Professor of Marketing and Social Innovation at Shiv Nadar University. Anindita Chaudhuri is Associate Professor at the Department of Psychology, Kolkata University.

Article courtesy of 360info.

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