{"id":4720,"date":"2007-09-12T10:40:09","date_gmt":"2007-09-12T15:40:09","guid":{"rendered":"http:\/\/sepiamutiny.com?p=4720"},"modified":"2007-09-12T08:05:02","modified_gmt":"2007-09-12T13:05:02","slug":"more_regulatory","status":"publish","type":"post","link":"http:\/\/sepiamutiny.com\/blog\/2007\/09\/12\/more_regulatory\/","title":{"rendered":"More Regulatory Evil: Palliative Care"},"content":{"rendered":"

There’s an article<\/a> in the New York Times about the problems faced by doctors in India who want to prescribe morphine to terminally ill patients, especially those who are suffering from cancer.<\/p>\n\n

The centerpiece of the article is a Dr. Rajagopal, who runs a palliative care clinic in Kerala, the one Indian state where morphine tends to be accessible. Dr. Rajagopal has been lobbying to make morphine more accessible to ordinary Indians nationwide.<\/p>\n\n

About 1.6 million Indians endure cancer pain each year. Because of tobacco and betel nut chewing, India leads the world in mouth and head tumors, and has high rates of lung, breast and cervical cancer. Tens of thousands also die in pain from AIDS, burns or accidents.

\n\nBut only a tiny fraction \u00e2\u20ac\u201d Dr. Rajagopal estimates 0.4 percent \u00e2\u20ac\u201d get relief.

\n\nClinics dispensing morphine are so scarce that some patients live 500 miles from the nearest. Calcutta, a city of 14 million, has only one. (link<\/a>)<\/blockquote>\n\n

Ironically, India grows the poppies from which much of the morphine used in western countries is derived. But government regulations (a highly familiar villain, in the Indian context) make it virtually impossible for ordinary people who are seriously ill to get access to it:<\/p>\n\n

Elsewhere, the state laws enforcing the Narcotic Drugs and Psychotropic Substances Act, passed in 1985 to curb drug trafficking, are complex and harsh. The book outlining them is 1,642 pages, and even minor infractions can mean 10-year sentences. Legal morphine use in India plummeted 97 percent after 1985, reaching a low of 40 pounds in 1997. It has since crept up.

\n\n\u00e2\u20ac\u0153India is a regulatory morass,\u00e2\u20ac\u009d said David E. Joranson, director of the Pain & Policy Studies Group at the University of Wisconsin medical school. \u00e2\u20ac\u0153It is controlled by the Ministry of Finance, and the rules are based on excise regulations that go back to the British Raj.\u00e2\u20ac\u009d

\n\nEach shipment requires five licenses. Pills must be locked in two-key cabinets. When patients die, families must return unused pills \u00e2\u20ac\u201d sometimes a struggle in a country where the dead may be cremated with their medicines.

\n\nMany pharmacists just cannot be bothered.(link<\/a>)<\/blockquote>\n\n

Obviously, simplifying the regulatory process would help this situation a great deal. One would obviously still want tight control and monitoring of the morphine that is dispensed, but not so much that it discourages the use of the drug where it could be of help.<\/p>\n\n

There is some hope. At the end of the Times piece, the reporter describes an interview with Dr. Anbumani Ramadoss<\/a>, a Cabinet Minister at the Ministry of Health and Family Affairs, who has expressed support in Parliament for greater emphasis on pain relief in the Indian health system.<\/p>\n\n

Does anyone have personal experience (i.e., with friends or family) of trying to get access to painkillers or palliative care in the Indian health system? <\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

There’s an article in the New York Times about the problems faced by doctors in India who want to prescribe morphine to terminally ill patients, especially those who are suffering from cancer. The centerpiece of the article is a Dr. … Continue reading →<\/span><\/a><\/p>","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25],"tags":[],"_links":{"self":[{"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/posts\/4720"}],"collection":[{"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/comments?post=4720"}],"version-history":[{"count":0,"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/posts\/4720\/revisions"}],"wp:attachment":[{"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/media?parent=4720"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/categories?post=4720"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/sepiamutiny.com\/blog\/wp-json\/wp\/v2\/tags?post=4720"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}