Oliver Wendell Holmes, the 19th-century American writer, physician, and dean of Harvard Medical School, once said, “If all the medicine in the world were thrown into the sea, it would be bad for the fish and good for humanity.” Medicine is meant to cure diseases and save life, right? How is it a problem then?
Part of the answer lies in the understanding that medicines save life but not without a cost. It is often noted that legally prescribed medicines sometimes have a negative effect on the human body. Many of us remain dependent on medicines for various diseases which have a long-term effect on our body. As Charles E Page, M.D. remarked, “The cause of most diseases is in the poisonous drugs physicians superstitiously give in order to effect a cure.” Now consider the claim of Robert Henderson, “Every drug increases and complicates the patient's condition," or the comment of William Osler, M.D., “The person who takes medicine must recover twice, once from the disease and once from the medicine.”
The purpose of this article is not to address any complicated medical science issue or pharmaceutical aspect, rather to draw attention to the indiscriminate use of medicine in Bangladesh and its perils.
The situation in Bangladesh is dangerous because of several reasons. While the government facilities and provisions are often considered to be inadequate, many people living in the villages just cannot afford standard healthcare. Many government-appointed doctors have private arrangements for “better care” which are even more unaffordable for the general public. There are then the “unnecessary” tests that haunt the patients. As standard services are rendered expensive, and therefore largely inaccessible, often patients are left with cheaper alternatives such as low-cost services and non-prescription medicines. Things get worse when the drugstores take up the task of prescribing medicine, which they do a lot!
In small towns and especially in the villages, this is a common practice although it is less frequent in the big cities. Those at the drugstores often prescribe unnecessary and sometimes low-quality drugs (medicines produced by companies of questionable repute) because it is good business. Though the vendors must take certain certification from the government, profit-making surpasses all other purposes. Additionally, taking medicine based on “prescriptions” by elder members in a family is not a rare practice either. At a time when experts are talking about the negative effects of even legally prescribed medicines, the effects of non-prescription medicines can be horrible and far-reaching. Add to that the fact that the effects of a medicine can sometimes pass through generations.
The idea of “human-centric security” emerged as a dominant security approach replacing the traditional military-centric security in the post-Cold War era. The main theme of the human-centric security approach is that any issue that poses challenges to the survival and well-being of people is a security threat. The human-centric approach addresses issues like climate change, natural disasters, resource scarcity, irregular migration, food shortages and unavailability, human and drug trafficking, and infectious diseases as security threats. In the same manner, indiscriminate use of medicine can also be called a security threat, because it weakens human health and poses dangers to a healthy survival.
While conventionally it is believed that medicines are an important means of addressing health security threats, which mainly emanate from diseases and infections, a closer look reveals that the very use (and abuse) of medicine has the potential to be a security predicament for the future generations. The medicines which are made for saving life and ensuring health security are, in fact, posing a threat because of substandard prescription, indiscriminate use of drugs and lack of awareness about medicine.
Right to medical services is one of the five basic rights of the people, but considering the aforementioned issues, the question that comes to mind is how well we are implementing that.
In the developing countries, securing the basic needs and rights of the people is always a challenge even though government efforts may not always be lacking. As regards our health rights and issues, there is a lot that both our government and civil society members can do. In this particular case, if professional doctors come forward to help the general people, those at the lower strata of society will surely benefit from it and reduce their reliance on non-prescription medicines. A few days ago, I came across the cases of two professional doctors who offered general medical advice to the people in their localities, one free of cost while the other by setting up a clinic where treatment could be sought for a fee of Tk 5. Many more doctors should come forward to offer such services for the betterment of the general people. After all, the goal of the doctors is to serve humanity.
Moreover, we can also reduce the cost of medical services by increasing awareness about the good and bad practices of medicine-intake. William Osler, often described as the father of modern medicine, once said that one of the first duties of the physician is to educate the masses about not to take medicine. Awareness is a key prerequisite as millions of people in thousands of villages across Bangladesh remain dependent on over-the-counter (OTC) drugs, and a significant number of them keep taking medicines as the first line of defence against a disease or infection.
If we cannot start taking proper steps regarding indiscriminate medicine intake now, we might have to pay a very high price in the future.
Sarwar J. Minar is Senior Officer, International Programs and Relations, Independent University, Bangladesh (IUB). He can be reached at firstname.lastname@example.org