Today, in several public hospitals in Delhi, patients are systematically prescribed good quality medicines on time. This is the result of the work of the Delhi Society for the Rational Use of Drugs (DSPRUD), a non-government organization headed by Professor Ranjit Ray Chaudhury and a team of committed professionals who have worked hard to bring into existence a rational drug policy in Delhi. Part of the World Health Organisation (WHO)'s world-wide initiative to provide good quality medicines for users of the public health system in various parts of the world, the success of Delhi has led to an expansion of the programme in fourteen other states including the three newest ones.
In spite of this success, Prof. Roy Chaudhury laments that the media has not done much to publicise this major step in medicare in the nation's capital. Occasionally, he said, reports will appear about breakthroughs in cancer research - or the hype around SARS. "But do people really know that India was the first to come up with guidelines for the disease through our website?"
A proactive media could step in and help the medical profession enormously. For instance, he felt that it was most important to give publicity to the resurgence of tuberculosis. "It is no longer something that afflicts the poor and the malnourished," says Chaudhury, who is the President of the Delhi Medical Council. In the present times, the disease has had a fresh lease of life through the rampant spread of HIV-Aids: a dormant TB germ is activated in the HIV patient due to reduced immunity. Today, there are four million HIV affected persons in India - of whom 50 per cent have tuberculosis as well. Internationally TB is the leading cause of death of women in the reproductive ages of 25-44 but in India a person dies of the disease every minute. According to the WHO, if not controlled, in the next decade cases of tuberculosis could go up to four million in India: That means at the present population level one out of every 250 persons in this country will be infected.
"India is the worst sufferer as far as TB is concerned, says Chaudhury, "as it has the most number of cases and the largest number of which are untreated". "And yet," he added, "the irony is that most of the discoveries relating to the disease have been made in India". It was in this country it was established that sanatoriums for recovery were not needed but that treatment could be conduced on a domiciliary basis. It was in India that it was recognised that a sputum test, and not an additional X-ray, was sufficient for an accurate diagnosis. Chaudhury's despondency leads him to quote Dr. Mahler, a former Director General of WHO: "The whole world benefits from the fruits of Indian research --- the whole world except India".
However, not one to give up, Chaudhury feels that with a proactive media that could pressurise policy makers and educate the public, things could change. For instance, he said, "In the area of tuberculosis the media could run reports or spots on TV that bring home the fact that if TB drugs are not taken in time and the full course not completed, then an almost inevitable relapse occurs. Subsequently the patient develops a resistance and a second line of drugs -- which are 400 times more expensive as well as more toxic -- would have to be used. It needs to be known that 90 per cent of TB cases can be cured. We have the technology but it is rarely applied or availed of." There are standard procedures on the treatment of the disease which have been worked out by the DSPRUD and the media can draw the attention of doctors to these freely available, simple-to-follow guidelines, he adds.
Further, the media can also pressurise governments to give widespread publicity, through hoardings and newspaper and TV advertisements on DOT centres (Directly Observed Treatment centres) about their location, nature of work and so on. "Such a collaboration between the medical profession, the media and the government will certainly help in combating TB, the ramifications of which are frightening," he says.