Arun Bal Anil Pilgaonkar MODERN drugs are now part of the armamentarium of medical practitioners at every level and are universally perceived to have powerful effects. Of the 5 billion people in the world, between 1,3 to 2.5 billion have little or no access to the essential drugs. In India only 20 per cent of the population has access to essential drugs. Between 1952 and 1983 the number of the production units grew three-fold, investment 24 folds and bulk drug production 18 folds. Yet the production of essential drugs in 1980 accounted for only Rs 3.5 billion of an overall total production worth of Rs 12.6 billion. In the five years between 1978-79 and 1983-84 the industry's sale of essential drugs with the lowest price mark up actually dipped from Rs 554.7 million to Rs 493.5 million while sales of the other drugs for which government allows higher mark ups grew by 25 per cent from Rs 1544,4 million to Rs 1983.8 million. Thus essential drugs constituted only 16.8 per cent of the total drugs consumed. This means that resources are being used for products that arc not essential, at a time when a large pro portion of the population is without access to even the most basic drugs. India provides a paradoxical example of the overproduction of the drugs (total production Rs 2500 crore) existing simultaneously with the shortage of essential drugs for some of the major diseases. The main reason for this anamolous situation is that the drug production is not consistent with the disease pattern of the country. There is plethora of non-essential, hazardous drugs. It is estimated that at present there are anything between 40,000 to 60,000 Tlrugs formulation in the market. More than half of these are non-essential or hazardous. WHO estimates that some 500 million dollars have been mobilised to support national drug programmes. At first glance that seems to be impressive figure; however this is only 5 per cent of the amount being spent by the industry to promote all drugs. (Towards Rational Drug Use', Health Action International.) MANAGEMENT OF PAIN Analgesics or painkillers form a major part of the aggressively marketed drugs.
