Recent prescription pattern and uncertain health future in Bangladesh

Salman Shah Bhuiyan

It’s too difficult to find any person who didn’t go to the physician. And it’s also a common scene of patients who hold a piece of paper in their hand after exit the doctor’s room which is filled up with a lot of medicines and tests. Is it prescription? According to Tripathi (2008) prescription, an order written by doctors for patients contains directions for pharmacists to compound or dispense medications regarding patient diagnosis history and diseased condition. World Health Organization (WHO) was suggested some guidelines to evaluate a prescription pattern. Most of the cases, in national aspects, physicians do not follow the guidelines. The irrational prescription pattern is a common finding in Bangladesh. Maximum physicians prescribe the patients in wrong as well irrational way.

Firstly, we can say the generic name of the drug which is totally absent in the prescription. Many brand name drugs have cheaper generic content which confers less therapeutic effects. On the other hand, polypharmacy is a common problematic issue. Polypharmacy refers to the use of four or more medications by a patient. Therefore, patients are easy to prone drug interaction, nonadherence, hospitalization, and mortality. In the rural area, this trend is spread tremendously. Another problem is prescribing of inappropriate antibiotic. Sorrowfully, in Bangladesh, most of the physicians think that without antibiotic a prescription will be incomplete. But it’s a great threat to patients, leading to adverse drug reactions, bacterial resistance, and elevated costs. Children are also arrested by this rule. A study of antibiotic use in a rural area of Bangladesh found that 26% of purchased drugs were antibiotics for children aged 0-4 years. The most frequently prescribed antibiotics are ceftriaxone, cefixime, and amoxicillin. Therefore, those drugs have abnormally high resistance.

Illegible hand writing in prescriptions kills than 7,000 people annually. It’s a shocking statistic of America, according to a July 2006 report from National Academy of Medicine. If it’s applicable to America, then how much the condition can be worse in Bangladesh? Just imagine!! Unclear hand writing of prescriptions can result in misinterpretation and mistakes which are a common incident in our country.

Besides, various lacking commonly found of the renal and hepatic patient’s prescription.  Renal disease affects drug elimination and pharmacokinetic processes. So it’s so significant to adjust the dosages of drugs according to creatinine clearance and filtration rate. Besides, dose adjustment also necessary for hepatic patients. The liver converts fat soluble medications into water soluble medications that excreted through the urine. So some fat soluble medications should be avoided totally. But in our country, almost all physicians do not pay attention about drug dose adjustment for those patients.

Some physicians use the abbreviation in a prescription which has a chance of spelling error or ambiguous. In addition, diagnostic history of the patient is not mentioned clearly. They are used to prescribe a lot of unnecessary tests, vitamin tablets, and costly branded drugs which are a usual objection of suffering patients.

Notably, Bangladesh formulated its National Drug Policy in 1982 to ensure that common people can get the essential drugs easily and rational use of drugs through appropriate prescribing and dispensing the health care professionals. Has the policy fulfilled yet?

Now many questions may arise that, what’s the problem? Why this problem? One of the big problems is the autocratic tendency of a doctor. There is an uncomely proverb that “A physician is worse than a disease” but in many cases it’s true. Many doctors take very less period to consult a patient. They can never imagine co-relating with a pharmacist about patients case. And they are not accountable to anyone about their activities. Lack of knowledge or inadequate training of doctors is another reason.

In a rural area, community practitioners, health workers or quack doctors are prescribed to a patient that is in completely unethical and also bears health hazard probability. Pharmacists also have responsibility. They are failed to provide the proper use of drug information to the doctors. Pharmaceuticals company all time try to impress the doctor in many ways to write down their brand drug. Health regulatory authorities of Bangladesh also have some drawback. They are not concerned about those errors. Many directorates under Ministry of Health and Family Welfare have evaluated these sectors. But their dull activity can’t detect this problem properly.

The irrational prescribing pattern is a habit which cure is troublesome. But everything is possible. Physicians need to be clarified in their conception about the rational prescription pattern, clinical pharmacology, and pharmacotherapy to improve prescription practice rather. Doctors, pharmacists, and nurses all together should need to build triangle health care committee to minimize health problem. Though this trend is not turned on in our country yet it’s highly expected.

As a naïve pharmacist, I hope those problems will be solved immediately. Governing bodies have to be more concerned and should take necessary steps for the irrational prescribing pattern. No interruption is desirable in our public health care system. Patients will get their proper consultancy and be happy.

Trust me, I dream that!

Md. Salman Shah Bhuiyan is a student at Department of Pharmacy, East West University. He can be reached at   salman133145@ gmail.com

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Cupid’s chemicals

Abu Jar

Love is the most beautiful gift in this world which brings tons of happiness with joy for our life. When we first fall in love, we can’t stop smiling. It is a divine feeling! Suppose you saw someone and suddenly you are getting flushed cheeks, a racing heart beat, and sweaty palms, then congratulations my friend, you are in love. In other words you have love bug. Hence we can say that love isn’t a just random thing, there are some mysterious chemicals, neurons and hormones those are working together to make us fall head-over-heels for someone.

It can be said that love may be one of the most studied, but least understood, behaviors. Helen Fisher which is a biological anthropologist studied 166 societies and found evidence of romantic love, the kind that leaves one breathless and euphoric—in 147 of them. Another associate professor of psychiatry named Schwartz of McLean Hospital in Belmont said: “there’s good reason to suspect that romantic love is kept alive by something basic to our biological nature.”

Actually, falling in love is getting into a beautiful trap set up by nature. So love is nothing but a natural occurrence which we cannot fight or ignore. According to a science-based study by Arthur Arun, ‘the mind of a normal person takes between 90 seconds to 4 minutes on average  to determine whether it is struck by love or not.’ The study also points out that 55% of the role in love is played by body language; this means a brain detects the activities of body movement and decides. It also tells that 38% of the decision to be in love is contributed by the voice of our desired one and 7% is the reaction in love is due to a lover’s statement or choice of words.

A recent study based on the topic “science behind the love” is conducted at Rutgers University by Helen Fisher. She has proposed that we fall in love in three stages named lust, attraction, and attachment, each involving a different set of chemicals.

Lust, Lust is the first stage of love and it is driven by the sex hormones testosterone and estrogen. Testosterone is not only found in men but has also been shown to play a major role in the sex drive of women. These hormones as Helen Fisher says “get you out looking for anything”.

Attraction, This is the truly love-struck phase. Definitely, when we fall in love we can’t think of anything else! They often lose their appetite and some time may pass a sleepless night. Actually, they prefer to spend hours is day dreaming about their beloved one.

In the second stage of love, a group of neurotransmitters called ‘monoamines’ play a crucial role,

  • Dopamine – cocaine, and nicotine also activate it.
  • Norepinephrine – Also known as adrenaline. It makes us sweating and gets the heart pumping.
  • Serotonin – One of the love’s most important chemicals and one that may actually send us temporarily insane.

Attachment, Attachment is a bond which helps the couple to take their relationship to advanced stages. In other words, the attachment is the bond that keeps a couple together longs enough for them to have and raises the offspring. Many scientists believe that there might be two main hormones working behind the feeling of attachment. One of them is Oxytocin and the other one is known as Vasopressin.

Oxytocin, This is actually released by the hypothalamus gland during child birth and it also helps the breast to express milk. Therefore it is responsible for creating the strong bond between mother and child. It is also released by both males and females during orgasm and it is thought to have increased the bonding a couple when they are intimate.

Vasopressin, A very important chemical which plays a significant role in the long-term commitment stage. It is considered to be a pivotal controller of the kidney and its role in long-term relationships was first discovered when scientists looked at the prairie vole.

At the end, we call all these chemical reactions as love. To us, it feels like love because it makes us feel like flying in the sky. But the most important thing is that all these human emotions are probably nature’s beautiful way of keeping the humans alive and reproducing. When our brain entices us to fall in love, it feels like our body releases an irresistible cocktail of chemicals. We believe we’re choosing a partner, but actually, we may merely be the happy victims of nature’s lovely plan. We can agree that love is one of the most delightful feelings of our lives and may be it would be not wrong if we say that “love is blind” because you never know when your brain will encounter love.

 

Abuzar Ibn Faruk is a graduate pharmacist from East West University, Bangladesh. He can be reached at asif8ewu@gmail.com.

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Sunscreen – A protection or Threat to Skin Cancer

Sabera

Sunscreen, or sun cream, is a topical product like lotion, spray, gel or other formulations protect skin by absorbing or reflecting some of the sun’s ultraviolet (UV) radiation and thus helps protect against sunburn. Skin-lightening products have sunscreen to protect lightened skin because light skin is more susceptible to sun damage than darker skin. No sunscreen provides 100% protection against UV radiation. Some UV radiation will always reach the skin, damaging the cells below. This damage builds up over time and can increase your risk of skin cancer.

Sunscreen use has risen in past decades, as media outlets and doctors tout the benefits of sunscreen for protecting against skin cancer and sunburn.  When the product has a market of billion dollars a year, corruption arises. Not all sunscreens are created with equal quality and in many cases, the ingredients used in sunscreen are harmful, not helpful.

Sunscreen contains chemicals to filter UV radiation, as well as other ingredients such as preservatives, moisturizers, and fragrance.In rare cases, chemical ingredients cause skin reactions, including acne, burning, blisters, dryness, itching, rash, redness, stinging, swelling, and tightening of the skin.

There are two types of chemicals in sunscreen:

  • chemical filters, which absorb UV radiation before it can damage the skin
  • physical filters, which contain micro-fine particles that sit on the surface of the skin and act as a

physical barrier.

  • Mineral barriers are also used.

Mineral sunscreens typically include ingredients like zinc oxide or titanium dioxide, which create a physical barrier to protect the skin from the sun.Chemical sunscreens use one or more chemicals including oxybenzone, avobenzone, octisalate, octocrylene, homosalate and octinoxate.

New research reveals that the chemicals commonly used in sunscreen are endocrine disruptors, estrogenic and may interfere with thyroid and other hormone processes in the body.The most common sunscreen chemical, Oxybenzone, was found in 96% of the population by a recent study by the Center for Disease Control and Prevention. This is especially alarming since oxybenzone is considered an endocrine disruptor, can reduce sperm count in men and may contribute to endometriosis in women. Such high percentage using oxybenzone is a health hazard and threat especially on children or pregnant/breastfeeding women.

Another reason is the use of Vitamin A derivative, retinyl palmitate, that is often used in sunscreens was shown to speed up the growth of cancerous cells by 21%. Spray sunscreens have become increasingly popular in recent years, but have additional dangers, especially if inhaled. Consumer Reports warns that spray sunscreens should not be used on children and that adults should exercise caution and make sure not to use on the face or inhale them.

Of the 1,400+ sunscreens tested by the EWG (Environmental Working Group), only 5% met their safety standards and over 40% were listed as potentially contributing to skin cancer.

Many sunscreens also contain methyl isothiazolinone, which the American Contact Dermatitis Society named as its “allergen of the year”. The EWG’s most recent report listed Neutrogena as the #1 sunscreen brand to avoid, citing high concentrations of oxybenzone and other hormone disrupting chemicals, and misleading claims about their SPF levels.

We’ve already established that some sunscreen is harmful and may do more harm than good, but another important consideration that is often ignored: Vitamin D.

Most sunscreens completely block the body’s ability to manufacture Vitamin D. Statistically, 75% of us are deficient in Vitamin D and Vitamin D deficiency has been linked to higher risk of cancer and heart disease (which kill more people than skin cancer per year). So it seems that we are literally cutting off our noses to spite our faces when it comes to sun exposure. We lather up with chemical sunscreens that have the potential to greatly increase skin cancer risk and reduce Vitamin D production in the name of avoiding skin cancer. The consequences are we increase our risk of more widespread diseases related to Vitamin D deficiency.

From the analysis, we may think that we shouldn’t exercise caution in exposure (especially overexposure) to the sun, as more and more evidence emerges about the dangers of most sunscreens. For this, it is important not to be dependent on sunscreens only.

In fact, a study in the Journal of Clinical Pharmacology and Therapeutics reports that:

Sunscreens protect against sunburn, but there is no evidence that they protect against basal cell carcinoma or melanoma. Problems lie in the behavior of individuals who use sunscreens to stay out longer in the sun than they otherwise would. Vitamin D inhibition is, at this stage, unlikely due to insufficient use by individuals. Safety of sunscreens is a concern, and sunscreen companies have emotionally and inaccurately promoted the use of sunscreens.

Despite the push for more awareness about sun exposure, and the advice to use sunscreen whenever we go outside, the incidence of skin cancer, especially melanoma, is rising dramatically.In fact, skin cancer rates are rising by 4.2% annually, despite the fact that we spend less time outdoors and wear more sunscreen.

Some mineral sunscreens are safer but also contain some of the chemical ingredients above and have the same risks. Additionally, if nanoparticles of zinc oxide or titanium oxide are used, these can enter the body and carry risks as well. Since these offer physical barriers, it is also more difficult to accurately pinpoint the SPF of some mineral sunscreens.

If sun exposure is a major concern for you or you have a family history of skin cancers than the safest option for you is to avoid the sunscreens that the EWG has said might contribute to skin cancer and use the safest form of sun protection by covering up.With all the information and misinformation about sunscreen out there, the easiest and safest way to avoid sun damage is to stay in the shade, wear a hat or long sleeves.Another important step to protecting the skin from sun damage is supporting the body internally by eating healthy food and food containing more antioxidants.

Sabera Rahmanis a master’s student of pharmaceutical science, she has completed her graduation under the department of Pharmacy, East West University. Sabera is a student correspondent at Association of Life Science and Engineering Writers (ALSEW). She can be reached at sabera.rahman@ymail.com

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