Honesty: Does it continue to be the best policy?

Corrupt people keep climbing on the ladder of success, kissing the feet of those ahead of them and kicking the heads of those beneath. Geer Muhammad Ishaq writes on the modernization and institutionalization of corruption in Kashmiri society

Nowadays corruption has become the way of life. It is more organized and institutionalized than ever. It has penetrated deeply into every sphere of public as well as private life. Majority of people working in public as well as private sector are falling prey to it and those who are opposing or resisting it or staying away from it stand completely isolated and crushed. In keeping with ever changing times and trends, of late, corruption too has undergone modernization and assumed new shape and proportions. Whereas vivid embezzlements and misappropriations used to rule the roost once, now corruption is manifesting itself in a much more sophisticated form. Gratification practices have radically changed lending them more user-friendly and so to say compatible with the existing legal framework. Where earlier there used to be embezzlements of crores of rupees in its crude form by turning to forgery, frauds and tampering of records, due to increasing number of such cases coming to fore and falling under the legal dragnet, now people intend to play safe and keep their records unblemished by resorting to a more disciplined yet equally profitable form of corruption that is based on a fixed slice of commission rather than embezzlement or misappropriation. We Kashmiris in particular seem to have advanced so much in such novel skills and tactics that it would be no wonder in case international organizations seek our expertise in framing proper guidelines for this kind of “legal corruption” for their worldwide adoption by prospective clients.

 

To make things a bit more clear, an example is cited for the interest of readers. Suppose you are heading some department and have an annual budget of say Rs. 1 crore at your disposal to be spent on purchase of goods like equipments, books, glassware, chemicals, stationary etc with a small amount being allocated for repair and maintenance activities.  You don’t have to burn your midnight oil in planning your embezzlements since the methodology has taken a much convenient and smooth shape nowadays. Just catch hold of a few selected, accommodating and hassle-free suppliers, check out uncleared stocks lying pending with them since ages which they are ready to sell at throw-away prices, be it exorbitant equipments, substandard chemicals, redundant glassware, rejected books, outdated instruments or any other useless office supplies. Whip up a deal. Ensure him a damn handsome and unexpected price at the cost of state funds for his dead stocks and in return fix a solid lucrative commission for yourself. Next remains your submissive and obedient subordinate staff, in case absolute worthlessness of the goods you intend to procure makes you feel slightly insecure, get a resolution passed and signed by them that all such stuff is urgently required for the efficient running of the department. For this, you don’t have to plead before them or request them in a kneeled-down posture since most of them too have their own ambitions and aspirations relating to their career, perks, nominations, permanent appointments, deputations etc. They too need to seek your favours whether due or undue from time to time and above all need your personal care and patronage.

 

As such, their consent will never be a hurdle in your way, no matter if that plunges them and their dept. ineluctably into a dismal doom. This way make your exercise authentic and fool-proof and purchase goods worth lacs that are either of no use or of little relevance to the actual field of application.  Doesn’t matter if people suffer on this account, don’t worry if dept. deteriorates and never care if funds go down the drain. You and your family should prosper. Your cash reserves should fatten up and your property both movable as well as immovable should expand. A commission of a meager 10% over an annual budget of Rs 1 crore will fetch you a cool 10 lacs per annum, other lavish gifts and compliments not inclusive. An added advantage that brings you solace being that all your documents and records remain as spotless as freshly fallen snow. Even the most experienced and seasoned auditors can’t pick any holes in your accounts, the most dreaded sections of the Prevention of Corruption Act can’t bother you and the most watchful vigilance authorities can’t even touch you. To absolve yourself of any likelihood of being charged of amassing huge wealth grossly disproportionate to all your known sources of income, keep your property on the name of your non tax-payer relatives. But don’t forget to retain all documents with yourself lest you shall land up in a catch-22 situation. This is the magic mantra by which people have over the years kept climbing up on the ladder of success, kissing the feet of those ahead of them and kicking the heads of those behind.

 

Amidst all this bonhomie if anybody’s conscience does not permit him to remain a mute spectator to the entire debacle and shows up even an iota of resistance or resentment, his action is viewed as a fierce incursion and an open rebellion since people wish to run their departments as per their own whims and fancies and expect everybody else to remain deft and dumb and simply dance at their tunes. In no time, acrimonious retaliatory assault is launched against those who do not comply and those who dare to question, thus triggering an unending trail of internal squabbling within the dept. Such a person is labeled as a spoilsport and made to pay a hefty price for his rationality and integrity of character. Hostility manifolds upon him in some of its most ugly manifestations. He is singled out and isolated, subjected to gratuitous insults and made to suffer at every front until he throws up the sponge. All his past contributions are willfully ignored and achievements sidelined. Controversies are created, new disputes raked up and concocted plots hatched against him in a most abominable and despicable manner. He is vilified, persecuted and forcibly coerced and constrained into subjugation and obedience. If he still refuses to relent, he is persistently excoriated and discriminated, his role being retrenched down to a mere observatory status. He is kept at an arm’s length from all vital assignments and decision-making processes.

 

He is segregated, shunned, criticized, abhorred, secluded, targeted, victimized, harassed, humiliated, traumatized, troubled, terrified, maligned, defamed, suppressed, oppressed, obstructed, disillusioned, discouraged, falsely implicated, confronted, rejected, disapproved and ultimately thrown out of the system. Rot of corruption has infected the entire system to such an extent that those who accept it and become a part of it progress and prosper and those who reject it get rejected sooner or later. One who raises his voice against the corrupt and the corruption is banished and never allowed to grow. He faces hurdles at every step and all his progressive moves are opposed and suppressed. He ends up getting totally isolated in his place of work and is slowly and steadily pushed to the bottom level. Gradually he becomes depressed and disillusioned with the system losing all self-confidence and morale to work and excel since his good work is never appreciated and his small mistakes are blown out of proportion and projected as huge scandals.

 

The role played by his other colleagues too turns opportunistic and despicable. Everyone starts holding the odd man to ransom and a senseless spree of usurping his rights and transgressing his jurisdiction gets unveiled. All this is done in a bid to sycophantically please the boss and to gain a few deserved or undeserved favours from him in return. With his morale boosted to a euphoriant extent, the boss then uses all his overt and covert means to hinder his progress and mar his career. If any unpleasant or untoward events have occurred in the dept., he is blamed for them all. In front of higher authorities too, he is projected as a baddie. All his academic pursuits and endeavors get stuck in the mud. The trail of their atrocities and frenzied rage does not end here. Every opportunity is grabbed to falsely implicate and farcically frame him with dereliction of duty. Conspiracies are hatched against him and he is found guilty of offences that he never committed. Under these trying circumstances, how these fearless young men conduct themselves to ensure their survival in such a precarious and corrupt ambience remains worth watching. For certain, their bewilderment and vengeance arising out of the paranoid and disdainful treatment being meted out to them is bound to lead to some deleterious proposition, quite similar to the one that we have been experiencing over the past several years.

 

During their course of fraudulent activities, a few amongst this breed of corrupt officials present themselves as spiritual saints with hitherto unrevealed  powers. They corroborate their mysterious claims by making frequent references to their previous miracles. Such mischievous gimmicks stand them in a good stead in diverting the attention of gullible sect of their staff as also in shrugging off their genuine apprehensions, winning their trust and confidence and thereby covering up their own misdeeds. Occasionally they even threaten their dissenters of dire retaliation and spiritual reprehension in case they don’t give up their resentment. Enlightened souls albeit don’t give a damn to such abysmal and diabolical threats and claims. The poignant attitudes of such distressfully unenterprising officials desperately beseech an immediate change. They need to be introduced afresh to the rudiments of ethical conduct and professional ethos. Indomitably stubborn and invincibly arrogant, they consider themselves supreme and unimpeachable and forget that there is yet another supreme power watching them all the time whom they have to face on the actual day of judgement and account for all their vices. They badly need to shun their desolate egos and stop feigning omniscience lest they will most miserably face the wrath of time.

 

Whatever is being stated here should not be perceived as a specific reference to any particular department, organization, institution or individual. This is the story of many such establishments whether under state or central administration where this sort of corruption is looming large and men of conscience are being persistently harassed, humiliated and suppressed ruthlessly. Many readers of this column will surely find some resemblance or reflection of such unfortunate men and women combating such conditions of duress, at their own places of work. Any such resemblance is purely coincidental. This is a general trend lately observed as being dominant in govt. and semi-govt. offices whose immediate implications have been telling adversely upon our social, ethical, moral as well as financial upliftment.

           

Instead of devising ways and means to chalk out technological, scientific, administrative and economic development of the various institutions existing in our organizational hierarchy, corrupt officials at the helm of their affairs are busy drawing their mean personal benefits and making their own fortunes at the cost of state exchequer resulting into massive economic polarization of our society and consequently fostering our inabilities and inadequacies further in catching up with the global race for overall progress, social reform, economic and technological advancement. Therefore need of the hour is to stir up their conscience hard enough to arouse them from their hysterically complacent states and make them face the hard world of accountability and transparency in their work and conduct. As said by Allama Iqbal:

Ik zindaah haqeeqat mere seene main hai mastoor

Kya samjhega who jiski ragoon main hai lahoo zard

Integration of Pharmacometabonomics, Pharmacogenomics and Proteomics for personalized drug therapy and optimum therapeutic outcome

ABSTRACT:

Metabonomics is the comprehensive quantitative and qualitative analysis of all small molecules in a system (in samples of cells, body fluids, tissues and so on). One of the advantages of pharmacometabolomics over the other omics technologies is that the metabolic profile represents the phenotype of the organism and reflects the overall biological influences, including interactions between multiple genomes (e.g., genomes from animals or humans and their gut microbiome). Pharmacometabolomics uses the predose metabolite profiling in the biofluids or fecal extracts to predict the responses of an individual to a chemical intervention and to identify surrogate markers for subsequent drug administration.

A primary goal of personalized medicine is to provide the best medical treatment for each individual patient by determining which drug will have the best efficacy and have the least amount of toxicity and/or adverse effects. Furthermore, understanding interindividual variations of response to drug treatment, especially in patients with potential adverse reactions, might lead to biomarkers that can be used to predict the low incidence of idiosyncratic toxicity. Personalized medicine is usually based on the concept of pharmacogenomics that studies the influence of an individual's genotype and/or SNPs on their response to a drug or medical treatment. Despite enormous energy and monetary efforts, pharmacogenomics has had limited success in clinical pharmacology to predict drug response with absolute certainty using single or multiple SNPs as biomarkers. The major reason for the limitation is that the response is dependent upon the phenotype of an individual, which is determined by both genotype and its complex interactions with other environmental factors. These environmental factors include diet, lifestyle, gut microbiome, nutrition, medications (polypharmacy), age and exposures to toxins or dietary supplements, as well as the individual physical and pathological conditions (e.g., diabetes and obesity).

The major limitation of proteomic screens is that they are tissue specific and therefore require tissue to characterize protein variability. Further tissue samples from organs such as lung, kidney, heart, or brain are not easily obtained for proteomic screens. Therefore this paper envisages the need for integration of all omics based technologies like Pharmacogenomics, Proteomics and Pharmacometabonomics for an integrated approach towards personalized drug therapy in order to maximize disease related outcomes and minimize unwanted effects.

Nanopharmacology and Nanotoxicology – emerging new disciplines in drug discovery, development and research

ABSTRACT:

Nanotechnology is concerned with materials and systems whose structure and components exhibit novel and significantly improved physical, chemical, and biological properties, phenomena and processes because of their nanoscale size. Nanomaterials differ significantly from other materials due to two principal factors; the increased surface area and quantum effects. These factors can enhance properties such as reactivity, strength, electrical characteristics and in vivo behavior. Nanopharmacology is defined as application of Nanotechnology for the development and/or discovery of methods to deliver drugs and nanomedicines developed to operate on a nanometer size range (typically less than 500 nanometers) with novel engineered properties that provide medical and pharmaceutical benefits, specifically for the treatment of diseases.

Majority of current commercial applications of nanotechnology in medicine are geared towards drug delivery to enable new modes of action as well as better targeting and bioavailability of existing medicinal substances. Nanotechnologies provide a wide range of new opportunities for developments in pharmacology like targeted drug delivery, applications of nano-containers in drug delivery, targeted influence on the immunity and new vaccine types and new hybrid nano-compounds for cancer treatment. Novel applications of nanopharmacology also include nanostructures that allow transport across biological barriers, use of nanoprobes, nanosensors, nanobiochips for study of pharmacokinetics and pharmacodynamics at nanoscale level and use of multifunctional chemical structures for drug delivery and targeting of disease.

Increased usage of nanotechnology in healthcare system without adequate attention to safety and exposure risks has lead to evolution of another new frontier viz., Nanotoxicology that deals with the study of effects of nanomaterials on humans and environment. Nanotoxicology can be defined as a branch of toxicology that analyzes the risks and consequences of exposure to nanoscale materials on the environment and human health. It encompasses study of three main components such as nanopharmacology, nanopathology and nanophysiology. Although a number of techniques are under development to assist nanotoxicology like nanoinformatics that can contribute in risk assessment and development of safe nanopharmaceuticals.

 

With the advent of new technologies and innovative applications of nanosciences, nanopharmacology and nanotoxicology are increasingly assuming greater importance in the wake of unprecedented pharmacological and toxicological effects of nanomaterials on human beings. Therefore these two subjects are emerging as novel disciplines and are receiving an ever-increasing attention of academics and researchers. These two disciplines will progress with advancing nanomedicine related technologies and are likely to occupy the centrestage in times to come.

Journey of a lifetime - my frantic race against time

One year back I undertook a journey of my lifetime, one with full of shocks as well as pleasant surprises, to Mexico. Even though the story is a year old now, its imprints are still afresh on my mind since it had left some lasting impressions behind. Today I somehow feel like sharing my experiences of that incredible journey once again even though I have partially written about it last year in weekly “Kashmir Life”.

As they say, “journeys help you discover your true inner self”. It was my third visit abroad but was not as smooth and hassle-free as my earlier two trips to Turkey and Australia but it helped me a great deal in having a glimpse of the resolute self inside me (no self-boasting intended). This time I was going to present a couple of my accepted research papers at the 12^th annual conference of the International Society of Pharmacovigilance that was scheduled to be held between October 30^th to November 2^nd, 2012 at Cancun, Mexico – the land of ancient Mayan civilization. Out of around 400 delegates I was one among the lucky six people who had been fully sponsored by the International Society for this trip purely on the basis of merit and quality of my research papers. I could never have afforded to miss that golden opportunity under any circumstances.
 

I commenced my journey from Srinagar and my first stop-over was at Delhi followed by Mumbai. A flight from Delhi was not available when I had booked my tickets. Upon reaching Mumbai while I was quickly rushing towards the immigration clearance section of the Chatrapati Shivaji Airport in order to catch my next flight to New York I got the huge shocker that all flights to New York had been cancelled owing to the threat of hurricane Sandy that was looming large over the East Coast of USA. The queue of affected passengers was horribly long and each passenger was to my great discomfort and annoyance consuming too much time at the counter.

While in the queue my fellow passengers were woefully narrating how this cancellation was going to wreck havoc to their travel and other domestic plans. Behind me in the queue was an Indian-American wife and in front of me an Indian-American husband. Husband in front of me was constantly being scolded by his wife from America on phone, probably for not listening to her or something else and that was leaving him in a very embarassing situation. On the other side Indian wife behind me was rebuking her husband on phone in Gujrati for something that I couldn't understand. Poor husbands were getting the bashing both in India and America and that was the only source of amusement for me at that very time. After a spine-breaking wait of over three hours in the queue I could make up to the airlines counter where I was offered either a rescheduled flight through an alternative sector or a full refund in case I opted to abandon my onward trip. But in spite of quite serious apprehensions of getting stranded somewhere in Europe or America, I chose to go by an alternative route because I didn’t want to return back home looking like a nincompoop without having fulfilled the basic aim of my sojourn.

I was reminded of an anonymous quote, “If you don’t get lost, there’s a chance you may never be found.” They offered me a route in which I had to change four planes between Mumbai to London to Houston to Mexico City to Cancun and my original journey of 21 hours was getting overstretched to more than 48 hours. Since an alternative sector was available, I quickly grabbed their offer and boarded my British Airways flight to London with words of Alex Noble reverberating in my mind, “Success is not a place at which one arrives but rather the spirit with which one undertakes and continues the journey." Flight attendants of British Airways flight were all middle-aged, obese, senior employees with little enthusiasm usually seen in the younger lot and on top of it there was no vegetarian food available to my utter disgust since I mostly avoid non-veg food during foreign trips. All they could offer me was a plate of stale, dark coloured, somewhat bitter noodles that I couldn't even taste properly and had to manage with some soft drinks and biscuits only.

Upon arriving at London Heathrow airport, it was pleasantly cold, slightly misty and drizzling. London Heathrow airport was awfully busy as usual and after we landed I could count at least seven planes hovering in air, lined up in the sky waiting for their turn to land. Before our landing we too had circled many times over London and in the process we could have a detailed glimpse of the beautiful London city from above. I rang up to my home to inform them about the changed schedule. They had heard about the cancellation of flights and were worried about my itinerary and safety. I assured them on both the counts and they took a sigh of relief even though continuous news about displacement of lakhs of inhabitants and cancellation of thousands of flights at East Coast of USA was making me increasingly nervous since my next stop was Houston, USA from where I had to fly to Mexico city. My sole target was to reach Cancun in time.

My transit through Houston was smooth and I reached Mexico City in time. However it took me some extra time to go through my immigration clearance at Mexico City airport because of the huge rush of passengers there in spite of the fact that I was lately given preference due to my connecting flight. I reported at the domestic ticket counter 45 minutes before my next connecting flight to Cancun. Travel agent shocked me there by saying that domestic check-in closes one hour before the actual flight and therefore I won’t be able to check myself in. I had to catch the air train and rush back to the International terminal to contact my airlines agency for the next flight. To my surprise in the entire hall of more than 20 ticket counters, not even a single counter was operational. On top of it no Adam or Eve around was able to speak or understand even a single word in English. By then I had already missed my last flight to Cancun and that had left me really distressed.



View of pristine Cancun beach from my hotel room balcony

After running helter-skelter for some time, out of great difficulty I could locate an official who was busy labeling some baggage, for narrating my ordeal and claiming my baggage. To my utter surprise, he quickly generated a printed ticket for me from his computer and told me to rush back to the domestic terminal for catching the next flight to Cancun scheduled at 10 pm. This time air train was very cruel on me since it was arriving to pick me up only after a gap of 15 minutes which I was not in a position to afford since it was already 9 pm and I had to check in immediately. I almost lost all hopes of making it to Cancun in time. Somehow I reached the domestic check-in counter just fifteen minutes before the flight and after some initial dilly dallying and refusal by the airlines staff that I resisted with some stiff arguments, they checked me in at the eleventh hour and I went rushing to board my sixth and last flight to Cancun.

I managed to board the flight just five minutes prior to its scheduled departure and the first thing I did on board was to ask for a glass of water which was offered to me quickly by a Mexican air hostess who was slightly bewildered to see me gasping for breath. However all hardships were not over for me yet. Upon reaching desolate Cancun airport in the middle of night, I received another blow when I was told that my baggage had not arrived and would be delivered next day at my hotel, J. W. Marriott. Consequently I had to spend the first day of the conference uneasily in my travel attire. However my room-mate Raul Rodriguez Ramos, a Mexican Pharmacovigilance student from Guadalajara was sweet enough to lend me his spare razor so that I could shave my beard off.

Early morning when I stepped out onto my hotel room balcony, the sight in front of me was incredibly amazing. Mesmerizing view of clean turquoise waters of Caribbean sea, tidy white sandy beaches and tall hotel buildings of Cancun standing in a row, was nothing short of some heavenly abode. All my travel miseries vanished in a jiffy and I found myself in an entirely different frame of mind. I found my belief in the saying that fruits of patience are always sweet growing stronger than ever. In fact fruits were much sweeter than sweet this time. All my travel torments had paid back so pleasantly. I had absolutely no regrets for taking all the trouble to reach that lovely place on the face of earth. Courteously my travel ordeal was briefly touched upon without naming me by the Chairman of the Conference, whom I had met at the breakfast, in his inaugural address. My return journey back home was as per schedule without any such hassles since the super storm Sandy had already gone past. What transpired during my four day long stay at Cancun is another story to tell, but of course a very refreshing and enjoyable one. It was the most memorable and cherishable confrence trip of my entire life. And yes my baggage was delivered next day at my hotel with complimentary lamination done.

- Dr Geer Mohammad Ishaq

September 25: World Pharmacist Day and the Continuing Dismal Scenario in J&K

International Pharmaceutical Federation (FIP), a global federation representing three million pharmacists and pharmaceutical scientists worldwide, in its 2009 Council meeting held at Istanbul, Turkey decided to observe ‘World Pharmacists Day’ annually on September 25, the day when FIP was founded in the year 1912. Main objective of the World Pharmacist Day campaign is to raise awareness about the professional activities of a qualified pharmacist and educate the public on the invaluable role and crucial responsibilities of the qualified pharmacists in healthcare system and also to inculcate a sense of pride, solidarity and awareness among the pharmacy professionals on a global level. Given the fact that pharmacists represent the third largest healthcare professional group in the world and India too is home to over ten lakh registered pharmacists, Pharmacy Council of India has also decided to celebrate Pharmacist’s Day from this year onwards.

 

Over the past few decades there has been a trend for pharmacy profession to move away from its original focus on medicine supply towards a more inclusive focus on patient care. The role of the pharmacist has evolved from that of a compounder and supplier of pharmaceutical products towards that of a provider of services and information and ultimately that of a provider of patient care. Number of medication options have also multiplied manifold thus raising the complexity of therapies. Pharmacists have a unique role to play in evaluating these options and utilize their knowledge and skills to prevent, detect, monitor and resolve any medicine related problems. The concept of the seven-star pharmacist, introduced by WHO and taken up by FIP in 2000 in its policy statement on Good Pharmacy Practice, sees the pharmacist as a caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager. However the involvement of qualified pharmacists in J&K state in this regard has remained abysmally low, contrary to trends in other Indian states and developed countries. While seeking medical help, people think of a doctor or a nurse or a medical assistant, but seldom does a pharmacist come to mind probably because even a matriculate is eligible to be registered as a pharmacist in this state and anybody can get a license to sell medicines irrespective of his educational and technical background. Amidst all the mess prevailing in our state, people holding degrees in Pharmaceutical Sciences are jobless and have been left to lurch to fend for themselves. All this needs correction by introducing professional services of Clinical Pharmacy alongwith a novel concept of “Pharmaceutical Care”.

 

Pharmaceutical Care is a patient-centered, outcome-oriented pharmacy practice that requires the qualified pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease and to make sure that drug therapy regimens are safe and effective. Professional Clinical Pharmacy services offered by trained personnel holding graduate and post-graduate degrees in Pharmaceutical Sciences can help a great deal in identifying potential and actual drug-related problems; addressing needs and resolving actual drug related problems; preventing potential drug-related problems and optimizing patient therapy outcomes.  It is a practice in which the pharmacy practitioner assures that all of a patient's drug therapy is used appropriately for each medical condition; the most effective drug therapy available is used; the safest drug therapy possible is used, and the patient is able and willing to take the medication as intended. Patients in our part of the globe have not been able to avail such professional pharmaceutical care services so far as a result of which there is large scale dissatisfaction and disillusionment among them since they largely remain uninformed about various lab investigations conducted upon them and about the necessity for various drug therapies prescribed.

 

Clinical Pharmacy on the whole is in its infancy in the state of Jammu and Kashmir and the concept of Pharmaceutical Care is completely new to most of the physicians, nurses and even pharmacists presently working at the government health facilities. As a result of the patient overload of physicians and some other reasons, they are not in a position to offer detailed counseling, patient education and pharmaceutical care services on individual basis to all their patients. Therefore it is for the trained pharmacy practitioners to step in and fill the void by offering such services with a view to achieve definite therapeutic outcomes that improve a patient’s quality of life. Overall goal of professional Clinical Pharmacy services is to optimize the therapeutic outcome management and decrease the burden of five D’s viz, death, disease, disability, discomfort and dissatisfaction among patients. Clinical, economic and humanistic outcomes will also shift towards the positive side as a result of these integrated and seamless healthcare services rendered by a trained pharmacy practitioner. With these aims and objectives, University of Kashmir started a post-graduate programme in Pharmacy Practice four years back at its Department of Pharmaceutical Sciences. The course includes a mandatory practical internship training for one year in a hospital besides a year-long research work in hospital, clinical or community pharmacy that culminates with compilation and submission of a dissertation.

 

Overall scenario in relation to professional pharmacy services in the entire state of J&K is very dismal where we have mostly unqualified people working as pharmacists in retail pharmacies and dispensing medicines to patients without any technical know-how about the same and without providing any basic information to the patients about the use and possible side-effects of medicines. In government sector too, pharmacies within hospitals, primary health centres and sub-centres are manned by Medical Assistants who have not undergone any formal training as required under norms, specifically in pharmacy. We don’t have any positions available for pharmacy graduates and post-graduates at any level in our government sector. In fact their applications are not accepted for Junior Pharmacist posts advertised by the Directorate of Health and Family Welfare on the pretext of being ‘over-qualified’ for the job. Consequently the services of qualified pharmacists remain completely unutilized in the state, depriving patients of precious information about the use of drugs. Every major hospital in our state needs to have a full-fledged Department of Pharmacy Practice with adequate infrastructure, manpower, equipments and funding. Since that is already well stipulated in the approved drug policy of our state, government needs to start working in that direction in its right earnest.

 

Need of the hour is to design, implement and monitor policies aimed at providing professional Clinical Pharmacy services to the patients at primary, secondary and tertiary care level so that the services of pharmacy graduates and post-graduates can be availed at every level of our healthcare system for the greater benefit of the patients at large. Such services will also pave way for the engagement of trained and qualified pharmacists in providing patient education and counseling services, monitoring drug therapy and suggesting interventions wherever required, reporting any adverse drug reactions and drug interactions, supplying drug information to physicians and nurses, conducting drug-utilization evaluation studies, assist in framing policies, preparing monographs and hospital formularies and in providing poison control services. Trained and qualified pharmacy practitioners should be a part and parcel of the medical team during ward rounds and their assistance must be sought in prescribing best possible drug therapy to the patients. It is time to keep pace with fast changing times and trends and establish clinical pharmacy as a full-fledged profession in the state, ultimate aim of which is to optimize the clinical outcomes of drug therapy and thereby improve patient’s health-related quality of life.

 

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and is incharge of Masters Degree Programme in Pharmacy Practice. He can be reached at ishaqgeer@gmail.com)

Drug abuse scenario in Kashmir

In recognition of the efforts of United Nations Office on Drugs and Crime (UNODC) to eliminate the drug menace worldwide, every year June 26^th is observed as the International Day against Drug Abuse and Illicit Trafficking, which serves as a grim reminder of the need to combat the deleterious hazards to society posed by illicit drugs. As per World Drug Report, 2012 published by UNODC, about 230 million people, or 5 per cent of the world’s adult population, are estimated to have used an illicit drug at least once in 2010. It is also estimated that there were between 99,000 to 253,000 deaths globally in 2010 as a result of illicit drug use, accounting for 0.5 to 1.3 per cent of all-cause mortality among those aged between 15-64 years. Illicit drugs undermine economic and social development and contribute towards crime, instability, insecurity besides negative health consequences including the spread of HIV. Expressed in monetary terms, USD 200-250 billion would be needed to cover all costs related to drug treatment worldwide.

 

India is wedged between the world’s two largest areas of illicit opium production, the Golden Crescent and the Golden Triangle. A joint national survey conducted by UNODC and the Ministry of Social Justice and Empowerment, GOI in 2004 showed that the number of chronic substance-dependent individuals were 10 million (alcohol), 2.3 million (cannabis) and 0.5 million (opiates). In the state of Jammu and Kashmir too drug abuse has assumed alarming and epidemic proportions with large number of school and college going youth falling prey to the scourge including a large number of females. Prescription drug abuse is of particular concern among our population. According to a United Nations International Drug Control Program (UNDCP) sponsored survey, Kashmir division alone had 70,000 drug addicts including 4000 women in the year 2008. However a more recent survey entitled, “Community drug abuse study survey in Kashmir” by valley’s renowned psychiatrist Dr Mushtaq Margoob and his team has revealed that there are 24.32 lakh substance abusers (including tobacco abusers) in Kashmir, which includes 2.11 lakh opioid, 1.37 lakh cannabis, and around 38,000 alcohol abusers. As per this study, around 35% of boys of very prestigious schools from 8th standard to 12th standard use these substances daily.

 

Children and adolescents who suffer from neglect, abuse, household dysfunction, exposure to violence and instability are at particular risk of substance abuse. In Kashmir major causes of drug abuse have been linked to long standing conflict and frequent unrest, large scale unemployment and illiteracy, stressful social life, educational and family stress, lack of sports amenities and recreational avenues, easy availability of scheduled prescription products over-the-counter, select areas turning out to be hot pockets of illicit drug use, lack of enforcement mechanism and government control over substance abuse, mushroom growth of licensed drug stores and large scale corruption in the society. Drug dependence and illicit drug use are associated with health problems, poverty, violence, criminal behavior, and social exclusion. However, drug dependence is a preventable and treatable disease, and effective prevention and treatment interventions are very much possible. Best results are achieved when a comprehensive multidisciplinary approach that includes diversified pharmacological and psychosocial interventions is adopted.

 

Unfortunately in many societies drug dependence is still not recognized as a health problem and many people suffering from it are stigmatized and have no access to treatment and rehabilitation. The notion that drug dependence could be considered a “self-acquired disease”, has contributed to stigma and discrimination associated with drug dependence. However, scientific evidence indicates that the development of the disease is a result of a complex multi-factorial interaction between repeated exposure to drugs, and biological and environmental factors. Attempts to treat and prevent drug use through tough penal sanctions for drug users fail because they do not take into account the neurological changes drug dependence has on motivation pathways in the brain. Supportive families are essential to raising socially, mentally and physically healthy and well-adjusted children and preventing later adolescent problems. Factors such as a lack of security, trust and warmth in parent-child relationships, a lack of structure in family life and inappropriate discipline practices and insufficient limit-setting can render children at greater risk of problematic behaviours and subsequent substance abuse and mental health disorders. Therefore family skills training programmes have been found to be effective in preventing many of these risky behaviours, including substance abuse.

 

Regular awareness and counseling programmes through outdoor camps, open air theatres, dramas, painting competitions, video displays etc need to be conducted in every school and college across the state against drug abuse in order to acquaint the students with the dangers and consequences of such addiction. Each and every educational institute must have a full-time position available for a counselor who could either be a qualified psychiatrist or a trained clinical psychologist, who should entrusted with the job of undertaking student counseling from department to department on regular basis and address their stress management or drug de-addiction needs. Govt. must secure slots for drug awareness campaigns in the middle of most popular and widely viewed television programmes. Each school and college must procure a drug-addiction detection kit that come at an affordable price for regular detection of drug abusers. This will act as a strong deterrent too. Similar kits can be used by the police for truck drivers and drivers of public transport vehicles.

 

State government must come out with a comprehensive and discrete policy against drug addiction and chalk out a robust and time-bound action plan at division, district and block levels. An effective coordination and collaboration between various govt. agencies and multiple stake-holders needs to be fostered. A coordinated response of government and non-governmental organizations can be highly effective for drug abuse prevention. Drug de-addiction centres need to be established at all district headquarters with sufficient trained staff and bed strength besides a full-fledged drug de-addiction and rehabilitation centre at the divisional level. Drug sale licences must not be made free for all. Particularly licences to stock and sell schedule X drugs and psychotropic substances must be restricted to a few chosen chemists with an unblemished track record. Sale and purchase records of such drugs must be checked continuously and severe penalties must be imposed upon the defaulters. OTC sale of prescription drugs must be stopped.

 

Involvement of all sections of the society and the government officials like police, traffic police, medical health officers, school and college teachers, principals, religious preachers, housing societies, mohalla committees, drug control and excise officials can go a long way in not only creating awareness and preventing abuse but also in identifying magnitude of the problem in each locality and motivating the abusers towards the rehabilitation. Social engineering is of crucial importance in preventing drug addiction. Perpetual sermons through religious preachers during weekly religious congregations can have a durable impact in discouraging drug abuse. Govt. action plan must begin with identification of vulnerable areas that are prone and sensitive to drug trafficking and illicit use and therefore require focused attention and strategic action. Government needs to strengthen its intelligence apparatus for improving collection, collation, analysis and dissemination of operational intelligence regarding illicit drugs. There must be a reward policy for giving information about drug trafficking or abuse.  Let us make health our “New High” in life, not Drugs.

TOWARDS A DRUG-FREE SOCIETY

Of late drug abuse has assumed alarming and epidemic proportions in our Kashmir valley with large number of school and college going youth falling prey to the menace that unfortunately includes a large number of females too. Prescription drug abuse is of particular concern among our population. Drug dependence and illicit drug use are associated with health problems, poverty, violence, criminal behavior, and social exclusion. However it is not something that is incurable. It is a preventable and treatable disease, and effective prevention and treatment interventions are very much possible. Best results are achieved when a comprehensive multidisciplinary approach that includes diversified pharmacological and psychosocial interventions is adopted.

 

The evolution of the contemporary drug problem has been influenced by a range of drivers. Some relate to demographic trends, such as gender, population, age and levels of urbanization, whereas others are socioeconomic, such as levels of disposable income, inequality and unemployment. Children and adolescents who suffer from neglect, abuse, household dysfunction, exposure to violence and instability are at particular risk of substance abuse. In Kashmir valley major causes of drug abuse have been linked to long standing conflict and frequent phases of unrest, large scale unemployment and illiteracy, stressful social life, educational and family stress, lack of sports amenities and entertainment avenues, easy availability of scheduled prescription products over-the-counter, select areas turning out to be hot pockets of illicit drug use, lack of effective enforcement mechanism and government control over substance abuse, mushroom growth of licensed drug stores and large scale corruption in the society.

 

Unfortunately in many societies drug dependence is still not recognized as a health problem and many people suffering from it are stigmatized and have no access to treatment and rehabilitation. The notion that drug dependence is a “self-acquired affliction”, has contributed to stigma and discrimination associated with drug dependence. However, scientific evidence indicates that the development of the disease is a result of a complex multi-factorial interaction between repeated exposure to drugs, and biological and environmental factors. Attempts to treat and prevent drug use through tough penal sanctions for drug users have failed because they do not take into account the neurological changes drug dependence has on motivation pathways in the brain.

 

Based on the approach that drug abuse is a psycho-socio-medical problem that can be handled through community-based interventions, a multi-pronged strategy needs to be adopted to curb the menace that should mainly include measures towards prevention, control and rehabilitation. Such measures lay emphasis upon creating awareness and educating people about ill effects of drug abuse, dealing with addicts compassionately through a programme of motivation, counselling, treatment, follow-up and social reintegration and by imparting drug abuse prevention and rehabilitation training to volunteers with a view to build up a strong cadre of drug abuse control operators.

 

Regular awareness and counseling programmes through outdoor camps, open air theatres, dramas, painting competitions, video displays, street plays etc need to be conducted by every school and college across the state against drug abuse in order to acquaint the students with the dangers and consequences of such addiction. Even CCTV cameras may be installed in vulnerable and addiction-prone educational institutions to monitor sale and abuse of drugs within and outside the premises. Each and every educational institute must have a full-time position available for a counselor who could either be a qualified psychiatrist or a trained clinical psychologist, who should be entrusted with the job of undertaking student counseling from department to department on regular, door-delivery basis and address their stress management or drug de-addiction needs.

 

Govt. through its information and broadcasting wing must secure slots for drug awareness campaigns in the middle of most popular and widely viewed television programmes. Popular television serials based on stories and scripts related to drug addiction and its consequences must also be relayed from local as well as national channels. Drug de-addiction centres must be established at all district headquarters with sufficient trained staff and bed strength besides a full-fledged drug de-addiction and rehabilitation centre at the divisional level. Each school and college must procure a drug-addiction detection kit that comes at an affordable price for regular detection of drug abusers. This will act as a strong deterrent too. Similar kits can be used by the police for truck drivers and drivers of public transport vehicles.

 

State government needs to take several steps towards controlling the menace of drug addiction. Its approach has to be bi-pronged addressing supply side (that includes enforcement activities) as well as the demand side (that includes rehabilitation and de-addiction measures). On the analogy of National Policy on Narcotic Drugs and Psychotropic Substances formulated in January, 2012, it must come out with a comprehensive and discrete policy against drug addiction and chalk out a robust and time-bound action plan at division, district and block levels. An effective coordination and collaboration between various govt. agencies and multiple stake-holders needs to be fostered. A coordinated response of government and non-governmental organizations can be achieved through government funding support to voluntary organisations for setting up/maintenance of counselling and awareness centres, deaddiction-cum-rehabilitation centres, de-addiction camps and for preventive awareness programmes, workplace prevention programme and training of service providers. Drug sale licences must not be made free for all. Particularly licences to stock and sell schedule X drugs and psychotropic substances must be restricted to a few chosen chemists with an unblemished track record. Sale and purchase records of such drugs must be checked continuously and severe penalties must be imposed upon the defaulters. Drug control department needs to conduct regular market checks and ensure sale of prescription drugs only against the prescriptions of registered medical practitioners. OTC sale of prescription drugs must be stopped.

 

Constitution of block and district level monitoring and vigilance committees with active participation of police, traffic police, medical health officers, school and college teachers, principals, religious preachers, housing societies, mohalla committees, drug control and excise officials can go a long way in not only creating awareness and preventing abuse but also in identifying magnitude of the problem in each locality and motivating the abusers towards the rehabilitation. Social engineering is also of crucial importance in preventing drug addiction. Perpetual sermons through religious preachers during weekly religious congregations can have a durable impact in discouraging drug abuse. Govt. action plan must begin with identification of vulnerable areas that are prone and sensitive to drug trafficking and illicit use and therefore require focused attention and strategic action.

 

Government needs to strengthen its intelligence apparatus for improving collection, collation, analysis and dissemination of operational intelligence regarding illicit drugs. There must be a reward policy for giving information about drug trafficking or abuse.  Inter-state cooperation and coordination in operational intelligence, investigations and legal assistance needs to be improved too. A nodal office of Narcotics Control Bureau must be established in Kashmir division too and in accordance with its guidelines state government has to constitute an anti-narcotics task force headed by an IG level police officer besides a multi-disciplinary coordination committee under the chairmanship of Chief Secretary level officer for regular interaction with central and state agencies. This will make the state eligible to receive grant-in-aid from NCB for infrastructure development in narcotics control. Surveillance and enforcement at entry/import points and land borders of the state needs to be made more stringent and foolproof besides identification and eradication of illicit cultivation as well as wild growth of cannabis and opium poppy.