Saturday, March 14, 2020

A decade of pharmacy practice education and research at Kashmir University – An appraisal

Department of Pharmaceutical Sciences, University of Kashmir is the only educational institution in the entire Jammu and Kashmir that has been offering an under-graduate degree programme in Pharmacy over the past thirty five years. In 2009 post-graduate degree programmes in five different specializations of Pharmaceutical Sciences including Pharmacy Practice were started after getting necessary approval from the University Grants Commission, New Delhi for offering the same as an innovative programme. Masters degree programme in Pharmacy Practice was aimed at orienting the pharmacy education in J&K towards hospital and clinical pharmacy, enhancing competency and clinical skills of pharmacy graduates and capacity building of pharmacists for making them an integral part of the health care team who could assist in providing optimal evidence-based care to the patients.

A decade of education and research in this specialization has been completed last year at the University of Kashmir. It has been quite a rewarding and exciting journey over the past ten years for the faculty as well as students of this programme. This write-up is an attempt to apprise the common masses about the aims, objectives, progress and outcome of this programme with a view to reinvigorate ourselves for another lap with greater resolve, commitment and conviction so as to make qualified and trained workforce available for the healthcare system who could assist in delivering better pharmaceutical care services to the patients of the valley in times to come. This programme is essentially aimed at carving a niche for the qualified pharmacists of J&K and establishing them as an inherent part of the healthcare team that so far comprised of only doctors and nurses.

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. Post-graduate programme in Pharmacy Practice is being offered over the past ten years with these very objectives. The course includes 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 research dissertation. Two year rigorous training of clinical pharmacists fully gears up the trainees to accept full responsibility of the patient’s medication management and suggest modifications, if required in his drug regimen.

While the aim of pharmacy practice education has been to create a qualified and trained workforce that is well-equipped to address pharmaceutical care, patient counseling and other clinical pharmacy needs of the patients visiting out-patient and in-patient departments of our government hospitals, objectives of the pharmacy practice research have been to assess adverse drug reaction monitoring, pharmacovigilance and pharmaceutical care services; evaluate access to essential medicines that includes their availability, affordability and acceptability; evaluation of drug utilization and prescribing practices; estimation of economic burden of the treatment of various chronic ailments like diabetes, PCOS, hypertension, cancer etc; assessment of hospital pharmacy and medicines management services at our government health centres. In spite of some difficulties faced in running the programme smoothly, Department of Pharmaceutical Sciences has been relentlessly marching ahead over the past ten years towards establishment of Clinical Pharmacy Practice as a full-fledged and well recognized profession in J&K.

Post-graduates in Pharmacy Practice who have passed out from the University of Kashmir have worked on 15 different research projects. All the three core areas of Pharmacy Practice viz., hospital, community and clinical pharmacy practice have been addressed while formulating the research design in this programme. Care has been taken to accord top priority to the most intriguing issues facing patient care in the region and the outcome of research has so far been not only interesting and encouraging but thought-provoking too. Research findings of these projects have been published in peer-reviewed, national and international journals of repute thereby presenting a snapshot of the overall drug use and prescribing patterns among Kashmiri population and revealing the gross situation of availability, affordability, effectiveness and safety of essential medicines in various districts of the valley. All these studies were the first of their kind in this region that could be of great help in devising policies and setting achievable targets in ensuring availability and affordability of safe, effective and good quality medicines all across Jammu and Kashmir. For instance one of the doctoral research studies was undertaken to design and develop a medicines management policy framework for tertiary care hospitals that lays out a scientific and systematically organized framework for selection, quantification, demand estimation, procurement, distribution and use of medicines in tertiary care hospitals which if adopted and implemented well can help ensure availability of quality medicines in sufficient quantities throughout the year and prevent drug shortages in our tertiary care hospitals.

Professional Clinical Pharmacy services offered by trained personnel holding post-graduate degrees in Pharmacy Practice 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 world 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. 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 drug information 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.

In spite of this modest attempt by the Department, Clinical Pharmacy Practice on the whole is in its infancy in 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. Overall scenario in relation to professional pharmacy services in Jammu and Kashmir 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 at present. Consequently the services of qualified pharmacists remain completely unutilized in J&K, depriving patients of precious information about the use of drugs.

In order to keep pace with fast changing times and global trends, 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. Every major hospital in J&K needs to have a full-fledged Department of Pharmacy Practice with adequate infrastructure, manpower, equipments and funding. Government of Jammu and Kashmir needs to adopt Pharmacy Practice Regulations of 2015 that are in vogue throughout the country at present. If J&K fails to adopt and implement these regulations even after five years of their promulgation in the country, we shall be failing our patients and depriving them of life-saving pharmaceutical care and clinical pharmacy services. Further since all these prepositions are already well stipulated in the approved drug policy of J&K, government needs to start working in that direction in its right earnest.


(Author is teacher in-charge of the M.Pharm. Pharmacy Practice Programme being offered by the Department of Pharmaceutical Sciences, University of Kashmir)

MEASURES TO BOOST BIOMEDICAL RESEARCH IN J&K

Kashmir valley has been an abode of knowledge and wisdom since times immemorial. Our doctors, engineers, technocrats and scientists have brought laurels and left an indelible impression worldwide by dint of their strong academic credentials and noteworthy achievements in their respective fields. Medical and healthcare scenario in Jammu and Kashmir is changing gradually and steadily. Even though considerable gains have been made over years in improving our healthcare sector, several new health issues are fast gaining momentum because of an increase in different types of ailments due to sedentary lifestyle, food adulteration, environmental pollution, agricultural contamination by use of chemicals fertilizers and pesticides, altered socio-cultural practices and food habits etc.

Though our healthcare indicators are fast improving, much more needs to be done to rejuvenate them as our healthcare needs are enormous and dynamic and a number of challenges exist as a result of the emergence of new diseases of contemporary times. There is need for reassessment of the bio-medical science and research sector of J&K followed by brainstorming deliberations on the challenges emerging out of the fast-changing scenario. In this very context, there is need to develop strategies for enhancing research and promoting research quality particularly in biomedical sciences within Jammu and Kashmir.  A goal-oriented and focused blue-print needs to be developed to achieve highest possible standards in research and keep pace with changing global trends. Top ten strategies for enhancing research in Jammu and Kashmir are listed as under:

1.      Funding for Research

One of the most important requirements for research is adequate funds. We need to explore possibilities of funding for our research at regional, national and international level through public institutions, private industries, NGOs as well as through opportunities for public-private partnership. National level funding agencies like ICMR, DBT, DST, UGC, ICAR, MHRD, SERB in addition to funding opportunities from the industry, academia and NGOs need to be tapped to their fullest. However in certain cases funding from national public and private agencies might not suffice, in which case international funding agencies like WHO, WTO, World Bank, UNITAID, UNO etc need to be approached for grants.

2.      Infrastructure for Research

We need to develop our research infrastructure for enhancing our research and improving our research quality drastically. This can be made possible by identifying and establishing research institutes and research centres within those institutes that are capable of undertaking high quality research. Besides adequate, trained manpower, these centres need to be fully equipped with sophisticated instruments required to undertake high-end research, databases that are required to undertake systematic literature reviews, meta-analyses etc, access to medical literature through Scopus, Sciencedirect, Pubmed, Medline etc.

3.      Manpower for Research

Apart from money it is the manpower that makes a mere go. Adequate, qualified, trained, well-oriented and duly specialized manpower is needed in sufficient numbers to run the research centres and carry out research in identified thrust areas. For developing such manpower courses related to research methodology need to be incorporated into the UG and PG curriculum at college as well as university level so as to develop a research culture and harness a research temperament among our students and scholars. Even at school level curriculum should be inquisitive enough to promote creativity and innovative thinking among ours students who in later course of their life could emerge as ace researchers. Specialized training needs to be imparted to the selected manpower on need-basis depending upon the prioritized thrust areas of research identified by the experts.

4.      Policies for Research

We need comprehensive, goal-oriented and focused research policies at institutional level, regional/state level as well as national level for enhancing research and promoting research quality in tune with fast changing global trends. Such policies should be contextual and need-based and address the most intriguing problems faced by our society. As envisaged in the National Education Policy, 2019 we need to develop research universities and autonomous colleges for carrying our intensive research on thrust areas identified by the experts. Such policies should be evidence-based and practiced and implemented in a time-bound manner.

5.      Incentives for Research

While good research needs to be encouraged through appropriate incentivization, making its use in appointments and promotions of teachers is debatable since introduction of API (Academic Performance Indicators) based assessment of teachers by the University Grants Commission in 2010 has come under severe criticism since it led to mechanization of research output and led teachers towards a rat race of accumulating API points in pursuance to their promotions. Quality of research must receive priority over quantity of research under all circumstances and journal metrics like impact factor that is actually used to assess the quality of a journal is being criticized by many Nobel Laureates like for its use in the assessment of teachers and their quality of research. Research must be evaluated by the peers and experts in the field rather than by journal metrics like impact factor and citation index. Further it needs to be debated whether research output should be used for providing financial incentives to teachers, awarding fellowships and giving recognition to them in their academics or it must be reserved only for the quality of new knowledge added to the existing body of literature.

6.      Collaborative Research

In epistemological terms, the concept of inter-disciplinarity may be regarded as a form of cooperation between various disciplines, which contribute to the achievement of a common end and which, through their association, further the emergence and advancement of new knowledge. Based on the degree of integration of disciplines in research, it is considered that the quality of inter-disciplinarity depends on the degree of influence exerted by the respective disciplines in the cooperative process. If one discipline is dominant, quality is poor. If the influence is balanced, quality is high. For instance trans-disciplinarity is a state of complete balance of influence between all relevant participating disciplines at the highest possible level of co-ordination.

Depending upon the balance of influence between different participating disciplines, collaborative interdisciplinary research can be further classified into cross-disciplinary, pluri-disciplinary and multi-disciplinary research. Multi-disciplinarity is considered to be the least developed form of interdisciplinarity. Collaborative research needs to take into account these different levels of interdisciplinary involvement and collaboration between different participating disciplines for the sake of clear definition of their respective roles. However it goes without saying that carrying out interdisciplinary research is the need of the hour since knowledge cannot be compartmentalized and confined to disciplines. All such boundaries need to be dissolved and knowledge needs to be liberated from all such confines and made freely available to all those who seek it.

7.      Contextual, Need-based Research

Addressing needs of the society through contextual research is the need of the hour. In developed nations, universities organize research fairs and establish research shops that allow community members to visit them and register their research problems based on which research projects are prepared and research undertaken to find solutions to their actual problems. Similarly timely and regular communication of research output to the masses is equally important for greater transparency of our research activities. Research institutions must consider these best practices apart from establishing entrepreneurship and innovation cells within their research centres so as to harness the spirit of entrepreneurship through research.

8.      Translational Research

Merely carrying out research is of no use unless the evidence generated out of scientific inquiry is translated into policy and the policy is practiced and implemented to resolve day-to-day issues on the ground. It is generally observed that the evidence generated through our research hardly translates into policy and whatever little translates into policy is hardly implemented in actual practice which makes the whole exercise fruitless and results into confining of research dissertations onto the shelves of our libraries. There is need for greater coordination between researchers and policy-makers for incorporating research findings and recommendations into our administrative policies. Researchers need to be made part and parcel of policy-making for better productivity, effectiveness and robustness of the government policies.

9.      Integrity in Research

Maintaining integrity in research is of paramount importance and therefore young researchers need to be imparted adequate education about related issues like plagiarism, duplication, gift and ghost authorship, salami publications, outsourced publishing etc at an appropriate level of their training. It is hard to achieve quality in research unless awareness about the importance of integrity, transparency and accountability is promoted and incorporated as an inherent component of the research. Problem of predatory journals that has alarmingly surfaced over the past few years needs to be countered and controlled in its right earnest. Any cases of malpractices in research need to be dealt with severely to set an effective deterrent.

10.  Ethics in Research

Just like integrity, ethics in research is a high priority area for maintaining quality and high standards in research. Prime importance needs to be accorded to the issues like confidentiality, privacy, non-malfeasance, beneficence, autonomy and justice without which no credible and substantive research is ever possible. Awareness about these components needs to be created from the very beginning of research and Institutional Ethics Committees need to be vigilant, proactive about any such malpractices in research and therefore be strict in ensuring full compliance with ethics in research. Unless integrity and ethics are maintained in research, no substantial gains can be made in achieving high standards of quality in research.

Half–baked regulations of UGC


University Grants Commission (UGC) was formally established in 1956 as a statutory body of the Government of India through UGC Act of 1956 for the purpose of disbursing grants to the universities and colleges besides determining, promoting and maintaining standards of teaching, examination and research in the institutions of higher learning. Higher education institutions adopt UGC regulations and implement them in letter and spirit with a pre-conceived notion that the regulations have been framed by the most veteran experts in the field at the topmost level after threadbare discussions and after taking a kaleidoscopic view of the various segments of teaching and research community that are likely to be affected in a positive or negative manner by the regulations.

To a very large extent these regulations serve their intended purpose and achieve their desired objectives well but in a huge number of cases these regulations have proved to be counter-productive bringing a sense of dismay, frustration and dissuasion to those affected by their ill-effects. Negative effects are produced as a result of ambiguities and vagueness of many such regulations that many a times leads to misinterpretation and misunderstanding of regulations and teachers working in colleges and universities have to bear the brunt of those disparities and discrepancies whose career is impacted adversely and irreversibly under such circumstances. New UGC Regulations were promulgated first in the year 2010 that were amended in the year 2013 followed by two more amendments in the year 2016 within a short span of two months. These regulations were then replaced by the UGC Regulations 2018 that are currently in vogue. Four amendments in quick succession between 2010 and 2016 put a whole lot of careers of the university teachers in jeopardy as a result of fast-changing regulations and requirements for their career growth and progression.

UGC Regulations so far

UGC Regulations of 2010 introduced for the first time Academic Performance Indicator (API)based scoring of teachers’ performance in teaching, research, publications and extension activities. While at the very outset, performance based assessment system (PBAS) introduced in these regulations was largely hailed as a step in the right direction towards enhancing standards of quality and promoting excellence in higher education, a large number of teachers working in higher education institutions got adversely affected by several half-baked, vague and ambiguous provisions introduced in these regulations.

One such provision pertained to the eligibility of Assistant Professors for the open posts of Associate Professors and the counting of period of Ph.D. research as teaching experience, that read, “the period of time taken by candidates to acquire M.Phil. and/or Ph.D. degree shall not be considered as teaching/research experience to be claimed for appointment to the teaching positions”. This very clause adversely affected the prospects of promotion of a large number of Assistant Professors all across India whose plea was that “the period of time taken by the candidates to acquire M.Phil. and/or Ph.D. degree” should imply the period when an in-service teacher working on substantive basis in a university was on study leave for pursuing his research degree and not the period when he was actively teaching in his parent department while simultaneously pursuing his M.Phil. and/or Ph.D.

This plea of the affected lot in spite of being genuine was outrightly rejected by the authorities at the helm of affairs back then but was eventually endorsed by the UGC and directions were passed on to the university authorities not to deduce active teaching period from the total experience gained by teachers while applying for the open posts of Associate Professors. However it took them almost three years of spine breaking, disheartening and frustrating struggle moving from door to door, table to table, one official to the other, explaining their grievance to them and seeking a just redressal of the same. In the mean time selection process continued unabated and many a teachers suffered set backs since they were declared ineligible and were not called for interviews for these posts. Damage caused to them was irreversible that could not be undone even by the UGC clarification later. Now even the leave period availed for obtaining Ph.D. is being considered by the UGC as active service for the sake of promotions of teachers.

Similarly second amendment of UGC Regulations brought out in 2013 that included capping provision created a lot of confusion as a result of their misinterpretation by the Universities. Then the fourth amendment brought out in 2016 led to a lengthy and cumbersome process of counting the teaching, extra-curricular and research activities on hourly basis. Many teachers working in universities did not even apply for their promotions owing to these exhaustive, spine-breaking and time consuming requirements under which each and every activity had to be substantiated by documentary evidence. Whether the faculty had attended some meeting or seminar anywhere, supervised some examination, delivered some extension lecture or simply appeared in a television or radio programme, they were supposed to produce documentary evidence for claiming API score against the same. 

API score based performance assessment

When Performance-linked Assessment System (PBAS) based on API scores was announced by the UGC in 2010, it was hailed by all academic circles as a concrete measure to arrest decline in the academic standards of higher education to some extent and infuse some semblance of accountability in measuring teaching and research performance of teachers quantitatively. However today it is widely believed that the PBAS based on API scores has done more harm than good to both teaching and research, because of which it should have been scrapped much earlier. The quantification of teachers’ performance using such stringent criteria had pushed teachers into a ‘rat race’ for gathering points for the sake of recruitment and promotion, and had forced them to mechanically turn into score building machines rather than concentrating on their basic responsibilities towards teaching and students. This scheme had prioritized quantity over quality of teaching and research activities. 

The pressure of accumulating cut-off points within specified time frames had led to some sort of commercialization and mechanization of both teaching and research. This system by no means promoted any free and critical thinking among teachers. Consequently it had led to the proliferation of several unhealthy and unfair practices like publishing substandard research,spurious publications, publication in paid journals, splitting one publication into two or more to get more points (salami publications), publishing books online on fast-track basis with sleazy publishers, outsourcing paper and book writing activities, to mention only a few, which in turn had led to an overall degradation in quality standards of higher education. 

Moreover there are stark discrepancies in API based assessment system too. While it envisaged to accord points for publishing papers in journals, presenting papers in conferences, publishing books or book chapters and completing research projects, there was no allocation in category-III of PBAS for undertaking peer review of papers and books by teachers, for attending a conference or seminar without presenting a paper, for being a co-author in a paper that is presented in some conference, for chairing or co-chairing a scientific session during scientific meetings, for attending expert committee meetings or evaluating research projects submitted to funding agencies. These vital academic activities had been completing ignored while fixing API scores.

While calculating the API for joint publications by multiple authors under the previous scheme, of the total score allotted to the relevant category of publication by the concerned teacher, the first/principal author and the corresponding author were supposed to equally share 60% of the total points and the remaining40% were to be shared equally by all other authors. In case a paper had three authors and it carried a total of 10 points, as per this regulation 3 points each would go to the first and second author and the remaining 4 points would go to the third author who neither happens to be the main researcher nor his supervisor but has contributed in some way in that research. Such irrational distribution of scores made a mockery of this entire system and reflected the myopic vision of the people who had designed and developed it.

Thus API based PBAS had sought to promote a score-hunting attitude among teachers. It promoted mechanization rather than creativity. Teachers working in colleges and universities all across India were feeling stressed and subdued on account of flaws in UGC regulations particularly API based PBAS since these flaws were posing a serious threat to their academic progress and were demoralizing them besides leading to unhealthy competition in educational institutions. Ultimately realizing its follies when UGC brought out new Regulations in the year 2018, API score was replaced by research score for performance assessment of teachers. This system now allows scoring of only research activities with only grades being awarded to teaching and extra-curricular activities. However the damage done in the interim by API based performance assessment can perhaps never be undone. In the second part of this write-up we would discuss UGC Journal List and Journal Impact Factors besides service length required for the promotions of college and university teachers as well as their reliability and validity in promoting research.

Journal Impact Factors

Another faux pas of the UGC Regulations has been the introduction of Impact Factors as means of evaluation of research activities of teachers. Impact factors were basically designed to assess the quality of a scientific journal by calculating the number of times the articles published in that particular journal were referenced or cited by others. Over the years it has been misused instead to assess the quality of the academicians. The impact factor is a flawed quantitative parameter as it is dependent on the number of times a paper is cited. A highly cited paper will push up the impact factor of a journal. No wonder journals that exclusively publish review articles rather than original research papers have much higher impact factors than other journals simply because they attract more number of citations. Many Nobel Laureates like Joseph Goldstein (1985), Peter Doherty (1996), Paul Nurse (2001) and Bruce Beutler (2011) have contested that impact factor is not the right measure to assess the quality of research of scientists since it is the research that counts, not the journal. They have urged that the research must go back to where it belongs i.e., the peers and experts in the field. Quality of research can best be judged by them alone.

There is another side to it. Take for instance a researcher who is working in a resource poor, under-developed setting where scientific, industrial, technological, economical or developmental concepts, processes and procedures that are outdated and sometimes even obsolete to the rest of the developed world, are still as good as innovations given their backwardness and slow pace of development. If such a researcher introduces such concepts at such a place with an aim of harnessing development, streamlining policies and procedures and organizing management activities, in different spheres, his work will hardly ever get published in a high impact international journal given the redundancy and lack of novelty of his concepts in rest of the developed world even though his research and extension work might bring radical changes locally much to the benefit and respite of millions of people inhabiting there. 

Further, the number of citations a research paper will get is dependent upon its life span that increases with an increase in the number of years after its publication. Thus, a far more reliable way to appropriately evaluate a research paper is through peer review by well-known experts in the field who can assess its standards. Let the research assessment go back to where it originally belongs, that is in the hands of peers and experts in that field. Further the API and Research Score, Impact Factor and other Journal Metrics have reinforced the policy of publish or perish reiterating the notion that only good research is publishable research whereas fact of the matter is that research quality has essentially to be judged by the quality of new knowledge that it generates and not by journal metrics or the like. Today perceived publishing value of the research topic and the extent to which results of the study will be cited around the world is subduing and overtaking the fundamental role and responsibilities of a researcher which is to raise pertinent questions, arrive at reliable answers, generate new and innovative ideas, solutions, perspectives that significantly enhance the prevailing knowledge base and lead to the creation of new knowledge.

The backlash against the journal impact factors is not restricted to India alone. It has led to the Declaration on Research Assessment (DORA) which was signed by members of the scientific community during the annual meeting of the American Society for Cell Biology on May 16, 2013. Specifically, the signatories have recommended that the journal impact factor should not be used as a measure of scientific success in funding, appointment and promotion consideration. Instead they recommend that the research should be evaluated on its own merits. Therefore there is need to promote independent, balanced, and objective approach to the research problems with transparency and use of appropriate methodology rather than worrying too much about journal metrics like citation index.

UGC Journal Lists

In the year 2016 UGC came out with its own list of almost 50,000 journals that were to be considered for awarding API score to research publications of the faculty members. Initially the list contained only journals included in Scopus, Web of Science and Indian Citation Index. The list was later expanded to include recommendations from the academic community and the universities were allowed to upload their recommendations, based on specified filtering criteria, on the UGC portal twice in 2017.The UGC-approved List of Journals is considered for recruitment, promotion and career advancement not only in universities and colleges but also other institutions of higher education in India. As such, it is the responsibility of UGC to curate its list of approved journals and to ensure that it contains only high-quality journals. However a study published in Current Science reported that over 88 percent of the journals listed by UGC in its approved list were themselves dubious. Ever since API scores were made mandatory, there has been a mushroom growth of hitherto unknown journals that are always on a prowl to persuade academicians to publish substandard research on payment basis to fetch them the required API scores. As per Patwardhan et al, more than 8,000 predatory journals churn out more than 400,000 items a year, and India contributes more than one-third of the articles in such predatory publications. These predatory journals turned to be a big challenge for the UGC which eventually revised the list removing more than 4000 journals and framing a CARE (Consortium for Academic and Research Ethics) Reference List of Quality Journals. 

However this never-ending process of updating the UGC list lead to another set of distressing problems for the teachers. The fact that a journal listed in the UGC Approved list at one point of time could be removed from the list anytime led to confusion and uncertainty. People who got themselves published in journals figuring in the list at one point of time suddenly found themselves at loggerheads once the journal was removed from the list thus making the list hardly reliable. Instead of investing so much time, money, manpower and energy in preparing and updating these ever-changing and lengthy lists it would have been a whole lot easier and wiser for the UGC to simply notify the databases like Scopus, Sciencedirect, Pubmed, Medline, Web of Science, Science Citation Index etc instead of listing the journals. Any changes in the databases made by their publishers would have got automatically incorporated in the journals too. This is what Medical Council of India followed for considering research papers of the medical fraternity in their promotions. Further the procedure followed by UGC was not devoid of any prospects of getting commercialized and sabotaged by the publishing houses. One wonders why this simply idea did not struck the high and mighty sitting in the offices of UGC.

Service length for promotion of College and University teachers

There is huge disparity and discrepancy in the service length as well as the salary packages as a teacher moves from Assistant Professor cadre to Associate Professor and then to Professor cadre. Lot of injustice is meted out to the junior cadre with a hike of just 1000 rupees from stage 1 to 2and from stage 2 to 3 followed by a quantum leap of around 50 to 100% hike in the salary from stage 3 to 4 depending upon the service length of the aspirant. Till stage 3 salary gap is too narrow and beyond that it is too wide. Opposite of this is true in case of service length. Career advancement scheme that is presently in vogue encompasses 12+3 formula as per which it takes around 12 to 16 years to move from Assistant Professor to the designation of an Associate Professor but only three years thereafter to become a Professor, which is totally inequitable, irrational and unjust. There is need to end this discriminative scheme and switchover to the more rational 9+6 formula or even better 9+3 scheme. This will bring some uniformity and remove discrimination and disparity in the scheme. Zeal, enthusiasm and motivation of an Assistant Professor gets dimmed by this unreasonable promotion system and it not only breeds inertia but corruption too. 

Anomaly and Revisit Committees

By incorporating API score based assessment and its capping, entire brunt was borne by the Assistant Professor for whom it became even more difficult even after 14 years to dream of becoming an Associate Professor since the parameters were very stringent that were only made worse by their misinterpretation.University Grants Commission itself realized various flaws in their regulations after itreceived a flood of representations and complaints from teachers, researchers, colleges,universities, associations from across India since a very large number of teachers were gettingadversely affected by them and their promotions were getting stuck for years together. Many times UGC had to frame anomaly committees and revisit committees to examine theanomalies brought into its notice and revise the regulations. 

After a lot of reluctance UGC brought out a new set of Regulations in the year 2018 that are much more flexible and prudent than the earlier regulations even though the research scores allotted to many research activities are comparatively lesser than provided in the earlier regulations. After allowing lot of damages to the research quality by way of API score based assessment finally UGC has scrapped this flawed system and replaced it by a Research Score based criteria which is expected to bring some relief to the teachers working in higher education institutions though it cannot be expected to undo the damages that it has done to the quality standards of teaching and research in the country over the past decade.

Further it needs to be clarified that no sane person can ever be against incorporation of quantitative or qualitative measures for assessing the performance of teachers but they need to be flexible, rational and just rather than stringent,impracticable, irrational and unjust. Standards that not only demoralize the teaching community but lead to unhealthy competition, infighting, dissuasion and dissidence among them cannot be termed as just and reasonable. In this manner desired objectives of the UGC regulations cannot be achieved and these regulations will prove to be counter-productive.

Patients need counseling, information and education


There has been an unprecedented increase in the number of patients visiting our healthcare centres over the past few decades as a result of constant rise in our population besides a proportional increase in the type and number of diseases suffered by the patients. Compared to a doctor-patient ratio of 1:2000 in India, as against WHO recommendation of 1:1000, J&K has one allopathic doctor for every 3866 people, as reported by Central Board of Health Intelligence, New Delhi. Despite the fact that our doctors have been working very hard to alleviate the sufferings of our ailing lot, as a result of this poor ratio they remain heavily overloaded with work and get little time to adequately counsel and educate their patients about their disease conditions and treatment options at their OPD clinics. This often results into lack of satisfaction among the ambulatory patients about their drug therapy and disease management process and some of them quite often prefer to get themselves treated at private clinics and nursing homes rather than at government hospitals. This void needs to be bridged by well-trained and qualified health professionals by offering patient counseling, health education and information services to our patients so that they don’t feel confused and inadequately informed about the medicines and diagnostic tests prescribed to them.

In the present time and age there is a need to fully equip and empower the patients with credible information and awareness about their disease and drug therapy since they have a right to know and be informed about their ailments as well as about the ways and means that are being employed to get rid of them. A well-informed and educated patient can participate in his or her own treatment and thereby help in decision making. He can help identify errors, if any, even before they occur. Counseling can help promote recovery, improve function and reduce his or her length of stay in the hospital. It can help improve quality of care, improve patient satisfaction and effective use of resources. It can also facilitate patients’ and families’ understanding of their health status, options, and consequences of care. Patients’ potential to follow a health care plan will increase and likelihood of any treatment complications will decrease substantially following effective counseling. 

Apart from diagnostic tests and drug therapy, patients need some empathy, compassion and sufficient attention to fully recover from their ailments. Instead of following a medical model, doctors, nurses and clinical pharmacists need to follow a helping model in patient counseling wherein instead of passively listening to their counselors, patients need to be actively involved in the counseling sessions; counselors must develop a mutual relationship of trust and respect with the patient rather than basing their relationship on their expertise and authority; counselor must assist the patient in identifying his health-related problems and exploring possible solutions rather than identifying problems and determining solutions all by himself so that the patient develops sufficient self-confidence to manage his own medical problems rather than depend completely upon the health professional; rather than establishing a parent-child relationship with the patient it must be a relationship on equal pedestal wherein concerns and sensibilities of the patient are duly respected and taken care of by the counselor and made equal partners in disease and drug therapy management.  This type of a helping approach relationship between health professional and the patient can go a long way in speedy recovery, better satisfaction, lesser disease recurrence and better quality-of-life of the patients. 

For result-oriented counseling sessions counselor has to overcome environmental barriers like excessive noise, difficulties in vision, congested areas as well as cultural barriers like persistent patterns of behaviour, habits, beliefs, customs, attitudes etc. Then there could also be other hindrances or barriers to communication like psychological barriers including emotional disturbances, depression, neurosis or physiological barriers like difficulties in self-expression, difficulties in hearing or seeing, difficulties in understanding etc. Use of audio-visual aids in counseling like phones, projectors, films, charts, posters, laptops, models etc could be of great help in delivering effective and fruitful counseling sessions that focus on personalized advice and medical assistance on taking medications besides information about the etiology, pathology, diagnosis, prevention, treatment, complications and clinical management of the disease. 

When patients are not clear on how to use their medicines (when to take, how long to take, what to do when doses are missed etc), it can result into therapeutic failure, adverse events, avoidable additional treatments & costs. Patient counseling in turn reduces errors in using medication, decreases non-compliance, minimizes risks and adverse drug reactions, maximizes benefits, improves therapeutic outcomes and patient satisfaction. It also assists patient in self-care, improved quality of his life, reduces overall healthcare costs to the patient, hospital, government and society. However only a well trained and professionally qualified counselor can acquire necessary verbal (including language, tone, volume, speed) and non-verbal (including distance, body language, eye contact, facial expression) communication skills required for effective patient counseling. He needs to be fully aware about how to prepare, how to open, how to deliver and how to close a counseling session. Patient counseling is more of an art and a skill than a science. A counselor needs to be as focused, goal-oriented and self-motivated just like a marketing executive in order to be successful in his patient counseling sessions. 

Patients need to be categorized and prioritized for their counseling needs on the basis of their disease conditions like epilepsy, asthma, diabetes and disease severity; drug therapy complexity like multiple formulations; patients belonging to special age-groups like pediatrics, elderly; specialized drug delivery systems like rotahalers; literacy level; sight or hearing impaired or disabled patients; patients receiving medicines with special storage, usage and precautionary requirements; patients allergic to medications; patients who are mentally or terminally ill; patients using appliances or those taking three or more medicines at a time; patients who tend to skip, self-medicate or misuse medicines quite often. Based on this categorization patient counseling plans need to be chalked out with a view to address personalized needs of the individual patients. There is no “one pill for all the ills” scheme or any one “fit for all” solution that can work uniformly for all the patients in counseling.

Every patient has a right to know what is happening to him, a right to ask questions, seek answers and know the therapeutic plan being offered to him besides a considerate and respectful care. Every patient has a right to receive complete information from a physician about his diagnosis, treatment plan, prognosis, specific nature of a proposed treatment or procedure in addition to a disclosure of the risks involved and information about other medical alternatives. They have a right to seek privacy during discussion of one's medical condition and while undergoing medical care. They can expect all records related to medical care to be kept confidential. Patients need to be well informed about the necessity of treatment, alternative modalities of treatment, risks of pursuing the treatment, including inherent complications of drugs, investigations, procedure, surgery etc. They must be informed about the duration of treatment, prognosis of his disease without any attempt to exaggerate or minimize the gravity of patient’s condition as well as regarding all expenses and break-up thereof.

A patient’s level of awareness regarding a disease, its symptoms, and available treatment options significantly affects the quality and efficiency of treatment that a health care professional can deliver. A practitioner has a right to recommend but the ultimate right to make a final decision must always vest with the consumer and therefore the patients must have the choice to say NO as and when desired by them. There is need for recognition that patients have rights which can transform the doctor-patient relationship from an authoritative and paternalistic one into a true partnership. Where a patient’s medical records or case study are being used for research or teaching or if a patient is enrolled as a participant in a study, it should be ensured that informed consent has been obtained or the patient’s identity is concealed to protect his privacy.

Many people in Kashmir harness certain conventional attitudes and beliefs towards health, drugs and disease, most of whom are not based on any logic or rationale. A health professional has to first understand the patient’s approach and belief towards the prevailing disease condition and the prescribed drug therapy that shall go a long way in enhancing his existing rational knowledge base and alleviating his ill-conceived notions, if any, about the disease or the drug therapy. The counselor must recognize the complexity of counseling in order to come out with the most appropriate approach to make the patient realize the risk-benefit ratio of the drug regimen. Information must percolate in a very simple, lucid, unambiguous and lucrative manner so that it is easily understood, retained, recalled and applied by the patient during the course of his treatment. Patients should be inherently motivated to comply with the directions owing to their well-pronounced advantages. Worldwide it has been observed that well informed and educated patients show better patient satisfaction and improved therapeutic outcomes. 

In order for the patients to use their medication appropriately, safely and effectively it becomes necessary for them to be well informed and adequately educated about their disease as well as drug therapy. Unless patients understand their illness and medications well, it will be a bit unrealistic to expect them to comply with their physician’s instructions and adhere to the drugs prescribed to them. Non-compliance in turn can result into failure and ineffectiveness of drug therapy. For better results and therapeutic outcomes our patients need to be fully aware of their disease pathophysiology and therapeutic regimen. Clinical pharmacists having undergone sufficient training and internship in these aspects of medication management are best suited to provide these pharmaceutical care services to their patients.  All they need is legal and statutory authorization to offer these services followed by appropriate positioning in the healthcare system to deliver these services.

Importance and Role of Teachers Associations in higher education institutions


University Teachers’ Associations are duly elected representative bodies of the faculty members working in universities on substantive basis. Generally teachers associations are viewed as opponents of the administration who tend to interfere in each and every matter and just try to thwart or obstruct all that administration tries to do for the betterment of the institution. However such a viewpoint is very far from a correct or factual assessment of their role and responsibilities. Essentially administration’s objectives of institutional growth cannot be at loggerheads or at conflict with the objectives of the teachers’ associations. Both are complementary and supplementary to each other and that should be a strong reason for both of them to work together to achieve their respective as well as collective aims and objectives since all their mutual goals are essentially positive, reformative and progressive in character. 

As conscious citizens and elected representatives of the intellectual class of their society teachers’ associations must be fully aware of their responsibilities and therefore hold institutional interests supreme to their individual interests. Individual progress and welfare of teachers is subservient to the progress and welfare of our institutions. University administration too needs to view teachers’ association as an ally and a votary rather than an opponent or adversary. University teachers need to be provided with a very congenial and conducive atmosphere to render their duties diligently and take their institutions to all new heights of excellence by dint of their hardwork, dedication and commitment which can only be ensured when teachers feel certain and secure about their promotional prospects and are provided with all incentives and amenities required to perform to the best of their abilities.

Following their appointment in the universities common concerns, grievances and aspirations of teachers include a favourable working atmosphere, good service conditions, timely promotions and equal merit-based placement opportunities, decent in-campus residential accommodation, intermittent deputation to conferences and seminars to strengthen their insight and knowledge base, timely remuneration and allowances commensurate to UGC regulations, appreciation and incentivization of their good work and prompt disposal of their individual files at various sections of the administrative block be it recruitment, research or accounts sections sans any red-tapeism and spine breaking hassles. But the moot question is whether these concerns really qualify as grievances of teachers whereas they actually are legitimate rights of a teacher that a university education system should automatically ensure in due course of time without a teacher exerting himself and struggling for the same. 

Unfortunately in the existing scheme of things teachers have to pass through an ordeal and present these genuine aspirations and legitimate rights in the form of a charter of demands which otherwise should have been an inherent part of the institutional policy framework and should have been automatically addressed by the administration of our higher educational institutions since they are vital to the overall institutional development and no institution can thrive or progress without addressing these basic service issues of the most significant stakeholder of higher education i.e., a teacher. Sadly our administrative set-up hasn’t evolved to that level as yet where these concerns could be automatically addressed without a teacher having to pursue the same either personally or through his elected representatives. It has been usually observed that teachers generally experience apathy, indifference and lack of concern while pursuing their administrative matters and keep craving for some empathy, compassion and prompt disposal of their files.

Lack of a uniform policy and practice as well as non-adherence to the principles of equity and justice evokes the need for teachers associations that otherwise would not have been required at the first place. However apart from redressing genuine grievances of teachers, teacher associations are also duty bound to extend full support to the administration for contributing substantially, positively and significantly in all their progressive and constructive measures that are aimed at bringing about progress and development of the institution as a seat of higher learning and raising its standards of teaching and research at par with institutions of national and international repute. Teachers also owe something to the prime stakeholders of our educational system i.e., the students and to the society as well. They cannot remain mute, oblivious and untouched by the concerns of their society at large.

It needs to be emphasized that teachers’ associations should rely on making logical interventions through consistent lobbying, persistent advocacy and persuasive pressure for redressing the genuine grievances and legitimate demands of the teaching community. They should remain committed to work in tandem with the university administration for the overall progress and development of their institutions and for the welfare of their teaching community. They must extend full support to the university administration in all positive, constructive and progressive measures aimed at improving the academic milieu of the university and in turn university administration must extend full support and cooperation in redressing genuine grievances of teachers and providing them succor in fulfilling their long pending demands. University administration must in turn be very courteous, cordial and considerate towards the teachers and address their genuine issues, concerns and grievances in a time-bound manner.

Some people seek their entry into the executive bodies of teachers associations with a personal agenda that can either be positive or negative, constructive or destructive, progressive or vindictive in nature. Some people want promotions for themselves while others seek demotions for others; some people want to raise their own status while others want to threaten or belittle or coerce others and dilute their writ in the institution. Fact of the matter is that not all the people seek to serve these associations with a yeoman’s spirit devoid of any personal, hidden or negative agenda. An office bearer of the teachers association requires a lot of courage, patience, conviction, integrity, tolerance, perseverance, maturity, mannerism, modesty and skill to perform his duties with full sincerity, fearlessness, honesty and dedication since on one hand he has to boldly question the authorities and seek redressal of the genuine grievances of teachers and on the other hand satisfy his clientele who want quick results and prompt resolution of their problems. 

Teacher and student associations are a part and parcel of the university education system that strengthens the democratic apparatus in higher educational institutions. They perform the duties of a watchdog in the higher educational institutions and closely monitor the administration for all its programmes, plans, actions and decisions ensuring that all decisions taken are in the interest of the institution, student and teacher communities and nothing is going in the wrong direction. They need to be encouraged for the sake of fostering a democratic culture in academic institutions since they are responsible for providing a formidable opposition and raising genuine issues for the betterment of the institution. Banning student unions or curbing teachers’ associations, wherever practiced in the country cannot serve the purpose and interests of higher education institutions anywhere. However for any meaningful existence of these associations they should be free from dirty politics and politicking of all sorts. Their agenda and plan of actions should be transparent and crystal clear leaving little scope for any unreasonable doubts and apprehensions. Our universities need to formalize and institutionalize students and teachers associations and provide adequate space to them for raising genuine demands and grievances.

Friday, May 17, 2019

Kashmir University on its way towards carbon-free, green campus


At the onset of May, 2019 University of Kashmir was all set to receive the NAAC peer team for its reaccreditation after a period of almost eight years. Previous accreditation was undertaken in the year 2011. Few days prior to the arrival of NAAC peer team administrative orders were issued imposing restrictions on all sorts of vehicular traffic inside the campus barring a few ones engaged with the NAAC visit. This was apparently to facilitate uninterrupted movement of the Peer Team members within campus who had to visit almost each and every department and research centre of the University, within a short span of three days for the sake of their performance assessment.

Once the orders were translated into action all of a sudden, teachers, employees, scholars and students of the university could feel a fresh lease of life in the campus. Abruptly irritating honking of horns turned silent, zooming bikes disappeared, dust and noise got vanished and amidst all this soothing silence, serenity, tranquility and pollution free ambience of the campus that left an indelible impression upon one and all, people witnessed new beauty of their campus which is flanked by the world-famous Dal Lake on one side and towering Zabarwan mountain range on the other. Lush green Naseembagh reincarnated in its glory and the whole campus presented altogether a new look in its landscape. These three days provided an all new experience to the residents as well as non-residents of the campus.

However once the NAAC visit got over, majority of teachers, employees and students wanted to enjoy this newly found beauty and serenity of the campus for all times to come. They offered their full support to the administration in continuing with the restrictions even though no alternative means of eco-friendly transport within campus were immediately available nor other modalities required for regulation of parking slots and management of exigencies were in place. This decision was supposed to be a temporary and transitional one at the first place but all stakeholders pinned their hopes upon the university administration to make it a long-lasting one in their quest to see their campus getting gradually transformed into a vehicle-free, plastic-free, carbon-free, eco-friendly, sustainable, green campus in view of its sensitive and fragile ecology and surroundings. This was just a very humble and modest beginning towards that lofty goal and nobody wanted to lose it just like that.

Some of the teachers as well as other employees having health-related and other genuine concerns faced many difficulties on this account and therefore were not happy with this decision. In absence of adequate alternative arrangements they demanded removal of restrictions and were well within their rights to do so. However this demand posed a big challenge to the administration in balancing the move in a manner that simultaneously addresses the aspirations of pro-ban people as well as the grievances of anti-ban employees. Though all the three associations of teachers, officers and non-teaching staff offered full support to the administration in this endeavour, they recommended issuance of vehicle entry passes on need-basis to the desirous employees of the university till adequate alternative arrangements are made, subject to the condition that they will park their vehicles only at the parking slots to be designated for this purpose. This very provision was supposed to be revisited and reviewed once all modalities for an effective and hassle-free implementation of the provision are kept in place by the administration. This relaxation however was necessitated by the fact that all visitors to the campus have their inherent rights that cannot be violated or compromised for the sake of others. Fundamental rights of proponents as well as opponents of the restrictions need to be respected and safeguarded for a successful and long-lasting implementation of this initiative.

Sustainable green campus initiative is actually a long-term project that in addition to vehicle-free campus includes many other components like paperless work culture; waste segregation, disposal and management; installation and use of solar energy and other renewable resources; water and electricity conservation; non-use of plastics; organic floriculture practices; no use of coal bukharis and electric heaters during winters and its replacement with central heating systems; no burning of chinar leaves during winters; no use of diesel generators; rain-water harvesting etc. University needs to have a comprehensive green campus policy with crystal clear objectives, plans and provisions besides an enforcement committee in place to work out all modalities for their effective implementation. Services of some experienced environmental consultant could also be availed, if required for this purpose or else the Dept. of Earth Sciences could provide the lead in collaboration with the Dept. of Environmental Sciences of our University.

If the University starts working now on a vehicle-free, plastic free, carbon-free, green campus it is not impossible to achieve that goal before the next NAAC inspection which is scheduled after every five years. We can submit a prospective project to UGC or other national/international environmental agencies for funding on the basis of fragile ecology and lush green surroundings of our campus. Kashmir University campus best qualifies to be among the first green campuses of the country and there will be good number of agencies ready to fund this initiative. We could be the role model for many other universities and institutions of the country wherein our model could be emulated by them. We need not always look upon others to copy their best practices. We can provide lead in this respect to others. There are numerous such university campuses from which we can draw enough inspiration for such an initiative like the Simon Fraser University of Canada, University of Alcala, Spain, Universities of Oxford, Nottingham and Sussex, UK, Universities of Connecticut, California, USA, Brown University, Colorado State University, University of North Carolina, Stanford University, Georgetown University, Cornell University, USA etc. Even within India Symbiosis Institute, Lovely Professional University, Pondicherry University, Indian Institute of Science, Punjab University and RNB University, Rajasthan have made considerable progress in this direction so far.

Nowadays more and more educational institutions across the world have started paying attention to the importance of incorporating sustainability as a part of their organization, culture and even their architecture, so that students, scholars and teachers live sustainable actions as part of their daily practices. We have been teaching and preaching environmental sustainability and ecological conservation in our university since decades now. It is high time that we start practicing those values ourselves. Some people argue that our university ecosystem is a minute one having little bearing upon the larger ecosystem outside the University. May be this is true but somewhere we need to set an example by our actions that we care for our ecology and environment and are ready to sacrifice our little comforts and convenience for the sake of this large public and environmental good.

In order to make this initiative a successful one, adequate measures need to be taken by the university administration to ensure smooth and effective implementation of this move that inter-alia include making eco-friendly transit facilities available to the University staff within a lag time of maximum five minutes at any location within the campus; procuring adequate number of  battery operated vehicles and bicycles for staff and students within the shortest possible time frame; regulation of existing parking slots using token system; establishing a helpline and control room for making instant transit facility available to teachers particularly in times of some emergency; making sufficient battery charging points available and issuing entry-passes to those having genuine health-related or other issues. Students can also be offered subsidies on loans for purchasing battery-driven two-wheelers. J&K bank has already donated three battery-driven vehicles and some 100 bicycles under its CSR initiative to the University. They can also be approached for more such help now that the University has got more serious about it. In nutshell this initiative has its own starting trouble but can be turned into a reality by the constant support, cooperation and sustained voluntary efforts of all stakeholders including teachers, employees, scholars and students.  

(Author is General Secretary, Kashmir University Teachers Association)


Sunday, August 12, 2018

CAN WE GET RID OF SPURIOUS AND SUBSTANDARD MEDICINES?


Once again sale of spurious and substandard drugs in the valley is grabbing headlines in the local newspapers, occupying prime slots in current affairs programmes on the electronic media and taking the social media like Facebook and WhatsApp by storm with heated exchanges, hard hitting videos, allegations and counter-allegations. We have earlier witnessed all this in 2013 when spurious drug scam was unearthed and the Union Health Minister and Drugs Controller General of India had to land in the valley in person only to make several tall promises that were never ever fulfilled. Given the fact that the Drug Control Organization is in complete mode of denial about the existence of spurious medicines both in the state as well as at the centre, does the menace exist in reality at the first place and if it does, big question is will we ever get rid of this scourge? If yes, when and how? These are some of the intriguing questions lurking in every citizen’s mind that this write-up would seek to answer in spite of the fact that scores of articles have been written and published earlier by this author on this very topic.

While people are fast losing patience on this issue and blaming the government and drug regulatory authorities for not doing enough to curb this menace, in its defense drug control authorities have been citing the results of various national quality testing surveys besides the outcome of drug testing done by govt. testing laboratories over years which reveal the percentage of spurious medicines anywhere between 0.01 – 0.025% and that of the substandard (NSQ) drugs anywhere between 3.4 – 8.37% only both at the state and national level. Thus official data is in a complete denial mode vis-à-vis spurious medicines whereas there is some acknowledgement of drugs that are not-of-standard-quality (NSQ) though nowhere near to the level general public perceives them to be below the prescribed standards of quality. Truth lies somewhere in the middle. Neither all the medicines available in our markets can be labeled to be altogether spurious or substandard nor can all of them be declared to be of paramount standard quality. Without challenging the reports furnished by drug testing laboratories public perception about quality of drugs can also not be rubbished as completely untrue since common masses consume these medicines themselves and they have got a first-hand experience about their quality and effectiveness. So if they are not satisfied with the quality of drugs, something is wrong somewhere that needs to be addressed rather than adopting an ostrich approach and burying our head in the sand saying that nothing is wrong at all.

global meta-analysis study published in JAMA recently reports that the prevalence of substandard and falcified medicines is 13.7% in Asia. So the problem is there that needs to be studied well and addressed in time rather than adopting an ostrich approach and living in a complete mode of denial. This study concludes that "poor-quality essential medicines are a substantial and understudied problem. Methodological standards for prevalence and rigorous economic studies estimating the burden beyond market size are needed to accurately assess the scope of the issue and inform efforts to address it. Global collaborative efforts are needed to improve supply-chain management, surveillance, and regulatory capacity in low- and middle-income countries to reduce the threat of poor-quality medicines".

If drug regulatory authorities have not been able to detect any spurious drugs in our markets they need to rethink about their drug sampling and drug testing procedure, strategy, designs, quantities and schedules and accordingly devise innovative methods to track down these sourly bitter pills. Have our drug inspectorate been equipped enough to bust spurious drug rackets through intelligence networking cells that provide lucrative incentives to the informers? Are they sufficiently trained in such skills? Do they have the requisite technological and logistic support in terms of mobile drug testing vans laced with sophisticated equipments like Raman Spectrophotometer, Near-infrared and X-Ray Fluorescence Analyser etc that could enable them to test the quality of drugs on spot instantly. In 2013 when spurious drug scam was exposed, Drugs Controller General of India had himself promised an additional drug testing laboratory and two mobile drug testing vans for the state that still continues to remain a distant dream. However as per news reports state government is in the process of setting up a drug testing laboratory at Lakhanpur with a central assistance of Rs 34 crores. 

At present Drug and Food Control Organization carries the testing of drug samples at its Srinagar and Jammu based laboratories that reportedly have a total testing capacity of around 4000 samples annually. For a state that is consuming medicines worth more than 1000 crores monthly, this capacity is too insufficient and meager.  We need to upscale our drug testing capacity to more than 10000 drug samples per year. JKMSCL should establish its own drug testing facilities and rope in accredited private drug testing laboratories from across the country so that each and every drug procured by them gets tested before distribution to the hospitals. Guidelines also prescribe one drug inspector for every 100 drug sale outlets but in our state each drug inspector is on an average looking after almost 300 outlets. First of all we don’t have drug inspectors available at the Block level. Secondly drug inspectors working at Tehsil level at present do not have sufficient accommodation, communication, transportation, legal counsel, security and clerical support available to them for carrying out their duties smoothly in a timely and hassle-free manner and they have not been accorded gazetted cadre too as required under Essential Commodities Act for monitoring drug pricing.

Jammu and Kashmir state drafted its premier drug policy in the year 2011 that was duly approved by the state cabinet and state legislative assembly in the year 2012 but still awaits implementation even after a lapse of more than six years. This is a major hurdle in making standard quality drugs available to the masses on their generic names at all government hospitals throughout the year without any stock-outs. Though some provisions of the policy like constitution of JKMSCL and procurement of drugs on generic names have been partially implemented, other provisions that emphasize seamless quality assurance, scientific demand estimation, pre-and post-qualification of suppliers following cGMP standards, drug storage and distribution in accordance with latest guidelines issued by WHO, their dispensing by qualified pharmacists alongwith patient counseling and continuous monitoring for any adverse reactions still awaits implementation. It is high time when the present state government should revisit, revise and revamp the state drug policy owing to the fact that it was drafted six years back and therefore needs to be redrafted taking all new challenges and changes into consideration. Population of the state has considerably increased so has the consumption of medicines ever since the draft drug policy was approved in 2012. Therefore there is need to take a fresh look at the draft and devise an updated comprehensive drug policy to streamline and ensure quality, efficacy and safety of medicines available in our private and public sectors.

Another big reason for plummeting quality standards of medicines in our markets is mushrooming of drug retailers and wholesalers in every nook and corner of the state. Eversince J&K Pharmacy Council came into being and opened its First Register of Pharmacists thousands of Pharmacy Registration certificates have been issued to every Tom, Dick and Harry irrespective of their educational qualifications. Matriculates in thousands have been registered as pharmacists without any basic know-how of pharmacy and subsequently they were provided drug sale licences by the Drug Control Organization of the state as a result of which today we can see beelines of drug stores not only outside hospitals but along length and breadth of the state which sometimes gives a notion that people living in the state probably eat medicines in place of food also. Worst part of the story is that matriculates with few years of experience in selling medicines were legally authorized to get registered as pharmacists in our state under J&K Pharmacy Act of 2011 (samvat) and subsequently were licensed to sell drugs. This is because J&K Pharmacy Council never bothered to bring Educational Regulations in time that would have restricted the issuance of drug sale licenses only to diploma and degree holders in Pharmacy. They acted like a business corporation making quick bucks over a period of almost 18 years by registering unqualified people as pharmacists. It can actually be counted among one of the biggest scams of this century in our state. This in turn has led to the deterioration of pharmacy services with drugs manufactured by third rate companies being sold for higher profits and that too in absence of any prescriptions which in turn promoted abuse of prescription drugs and psychotropic substances.

Cutting the long story short and returning back to the main question whether we can get rid of spurious and substandard drugs or not: Yes of course we can provided we have the will, wherewithal and the resolve to change the existing scenario rather than continue to live in a complete mode of denial. Way forward is to revise the state drug policy, implement it in letter and spirit, stop issuing drug licences to non-pharmacy professionals, augment the staff strength and infrastructure of drug control department, upgrade the existing drug testing laboratories and open new ones in each division of the state, streamline the functioning of JKMSCL on scientific lines and ensure availability of standard quality generic drugs in government hospitals throughout the year without any stock-outs, incorporate the professional pharmaceutical care services in all hospitals through qualified pharmacy graduates and post-graduates, mandate prescribing of drugs on their generic names only, revamping J&K Pharmacy Council and appointing Pharmacy Inspectors specifically for inspecting pharmacy stores for ensuring drug dispensing in accordance with established guidelines, pressing mobile drug testing vans into service for instant testing of drugs in far flung areas of the state and establishing a pharmacy practice department with adequate qualified staff in each and every hospital of the state. That alone can bring some semblance of order in the chaotic state of affairs existing at present. If journalists blame doctors, doctors blame pharmaceutical companies and regulatory authorities and they in turn blame pharmacists and common people, that is not going to solve the problem. Concerted and coordinated efforts by all of them towards improvement of the system however will definitely solve it.


(Author teaches at the Dept. of Pharmaceutical Sciences, University of Kashmir and has been actively involved in formulation of the first drug policy of J&K state)