Bhaskarabhatla Ajay, Chatterjee Chirantan
Erasmus School of Economics, Burgemeester Oudlaan 50, P.O. Box 1738, Building H12-18, 3000 DR Rotterdam, Netherlands.
Indian Institute of Management Bangalore, Room A102, Bannerghatta Road, Bengaluru, 560076, India.
Soc Sci Med. 2017 Feb;174:179-187. doi: 10.1016/j.socscimed.2016.12.022. Epub 2016 Dec 18.
Many irrational fixed-dose combination (FDC) medicines have been approved by the state and central regulatory authorities in India and their use is promoted extensively by pharmaceutical firms. In this study, we examine the previously-neglected role of physicians in India, as their prescriptions are essential for the continued proliferation of FDCs. Primarily using longitudinal data on prescriptions by 4600 physicians spanning 19 disciplinary categories for 48 months between 2008 and 2011 provided by IMS Medical Audit, we study 201 medicines in the cardiovascular and oral-antidiabetic markets. We find that 129.6 million (8.1%) prescriptions for irrational FDCs were written by the sample of physicians in India during the study period, half of which were written by cardiologists and consulting physicians. A further analysis of the regional markets reveals that cardiologists prescribe more irrational FDCs in the richer, metropolitan cities of western India. We also document the role of medical practitioners without an undergraduate degree in medicine in generating prescriptions for irrational FDCs. Our results suggest that an effective government strategy to curb irrational FDCs must recognize that spreading greater awareness about the perils of irrational FDCs is at best an incomplete solution to the problem in India as many who prescribe them are specialists. Organizations such as the Indian Medical Association must develop clear guidelines to stop prescribing such FDCs.
许多不合理的固定剂量复方（FDC）药物已获印度国家和中央监管机构批准，制药公司还大力推广其使用。在本研究中，我们考察了印度医生此前被忽视的作用，因为他们的处方对于FDC药物的持续泛滥至关重要。我们主要利用IMS医疗审计提供的2008年至2011年期间4600名医生涵盖19个学科类别、为期48个月的纵向处方数据，研究心血管和口服抗糖尿病市场中的201种药物。我们发现，在研究期间，印度的医生样本开出了1.296亿份（8.1%）不合理FDC药物的处方，其中一半是心脏病专家和会诊医生开具的。对区域市场的进一步分析显示，在印度西部较富裕的大城市，心脏病专家开出的不合理FDC药物更多。我们还记录了没有医学本科学位的执业医生在开具不合理FDC药物处方方面所起的作用。我们的研究结果表明，印度政府遏制不合理FDC药物的有效策略必须认识到，仅仅提高对不合理FDC药物危害的认识，对于解决印度的问题充其量只是一个不完整的办法，因为许多开具这类药物的是专科医生。印度医学协会等组织必须制定明确的指导方针，停止开具此类FDC药物。
