183 e-Letters

  • How to ensure safety of medications without spreading hysteria

    The information conveyed by Valerie Evans, Peter Roderick, and Allyson Pollock is compelling and of serious concern. While I agree that the explosion of brand-name fixed dose combination (FDC) medications in the Indian market is not safe or rational, I worry that the presentation of the information in this analysis may create some hysteria based on some of the lay media coverage of this study. It is unfortunate that there is such little clinical evidence on the safety and efficacy of the most commonly used Metformin FDCs that are sold to treat type 2 diabetes in India, but is irresponsible to publish such an article without some discussion of the potential harms that could come from abruptly stopping the Metformin FDCs .

    I agree that “the convenience of FDCs should not trump efficacy” - but there is already significant distrust in Western medicine by many patients in India without further added hysteria. The authors of this study bring to light the importance of tighter regulation and improved standards for the pharmaceutical industry in India, but the paper would have been better with a more evenhanded presentation of the information. Efficacy data on the Metformin FDCs may be limited, but there is no telling the degree of hyperglycemic crises that may emerge if many patients stop all their medications on the basis of lay media coverage of this analysis without first consulting with their prescribing physicians.

  • The Social Determinants of Health: What's missing?

    Donkin et al have highlighted the constructive steps being taken to implement policy change facilitating the Social Determinants of Health (SDH) across the globe 1. Although progress is not universal, what has been achieved deserves praise.

    We write, however, to highlight one key omission from the standard SDH model: religious faith. This deserves greater recognition as a social determinant of health for two reasons. First, is scale: a recent study demonstrated that 84% of the world’s 7.4 billion people affiliated themselves to a religious group 2. Second is the impact of religious faith on health, shaping both health beliefs and use of healthcare services 3.

    Theories of supernatural causation of illness are ancient and diverse. They are also universal: a 1980 study of health belief systems worldwide found evidence that supernatural causes of illness “far outweigh” natural ones 4. Of course many such models may be counter to the Western biomedical model. They should, however, still be acknowledged, not least because when believers encounter Western biomedicine the two models typically become mixed without any sense of conflict.

    The close link between healthcare services and religion is evident in both the historical (for example, medieval Christian hospitals in Europe) and contemporary (e.g. faith-based non-governmental organisations worldwide) contexts. The relationship between religion and healthcare is not confined to simple delivery. Religious fait...

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  • Efficacy and cost analysis of three types of therapeutic feeds in children with severe acute malnutrition in trbal villages of Nandurbar,Maharashtra,India. cra, India

    We, read with interest the article by Garg et al on costing of therapeutic feeds.
    We report our results on a similar trial conducted on 1092 tribal children of SAM,randomly given 3 therapeutic feeds i.e .C-RUTF(commercially produced ready to use therapeutic food),L-RUTF (locally produced RUTF) and ARF(Amylase rich energy dense food) giving 550,513 and 420 kcals respectively.Pea nut paste,sugar ,milk powder,oil were common ingredients,in identical proportions in C-RUTF and L-RUTF while ARF contained amylase rich flour instead of peanut paste.Micro nutrients were present in all three alike.At the end of 8 weeks of treatment,52.8% recovered in C-RUTF group,43.5% in L-RUTF group and 44.8% recovered in ARF group; the difference being statistically significant.The cost of treatment was 63, 59 and 43 USD approx. in the 3 groups respectively.Thus, though cost of ARF was the least compared to C-RUTF and L-RUTF ,recovery rates in ARF group were also compromised.The logistics of preparing the feeds in tribal village Anganwadis,issues of cleanliness in food preparation,time and labour required were also matters of concern.All these factors will require consideration while scaling up of community management of SAM.
    The clinical trial was registered under clinical trial registry of India,no.CTRI/2014/09/004958 and the data is the property of the Govt. of Maharashtra,India.