Heard of LASA? Learn more about Look-Alike, Sound-Alike Medicines...

hello and welcome to Southwest I'm Sumit

J Lassa drugs look alike sound alike

drugs with their similar names packaging

are a major cause of medication ERS

causing serious risk to patient safety

today we have with us Dr par Sharma he

is a community physician and a public

health researcher with whom we will

speak about the confusion caused by

identical or deceptively similar brand

names of the medicines and the dangers

these drugs present particularly in low

income and middle inome countries like

India welcome Dr par welcome to South

First thanks thanks for this opportunity

okay so uh I'll start with very simple

uh question which I also was not much

aware about earlier what is look alike

sound alike Lassa medicine can you

explain this to early people or person

who doesn't know much about the drugs

who might be hearing the term Lassa for

the first

time so like the name itself tells look

Alik sound like drugs so these are drugs

which have names or the way they look

either they look alike the name of the

drug or the way the drug is packaged or

the name sounds alike I'll give you one

example for cancer there is a drug

called wind Christin okay and there's

another drug called wind blastin okay so

they both start with wind they both end

with i and e

okay there was this game that we used to

play even as kids that there'll be

jumbled words in the paragraph and we

can still be able to read the entire

paragraph because the brain has the

ability to to find the right word just

by looking at the starting letter and

the end letter yes or the few

combination of the starting and so this

problem occurs in drugs also when uh the

starting letters are same the ending

letters are same it's easy for a person

to get confused so instead of wi

question somebody might pick up wind

blasting uh so that's a look alike

problem okay okay soundike problem

usually comes in uh certain drugs which

is now common in India because of the

brand name for example medol yes so

there's there are there are many drugs

three drugs which with the same name

medzo which is the company name now this

is a problem because if doctors write

only the brand name in their

prescription and they don't write the

name of what we call the salt uh in the

prescription then the pharmacist doesn't

know what the doctor is actually

prescribing okay so that leads to

another problem because then the

pharmacist can give anything that they

think or they have which is called medol

M so that's a big problem the other

thing is loik when the packaging is same

okay okay so it's possible that an

anti-hypertensive drug and a drug for

diabetes they can look exactly the same

they'll be round they'll be white

they'll come in a brown

cover theil color will be brown on the

on the packaging side so that can lead

to a lookalike problem for drugs when

they are packaged like that so somebody

who is a diabetic person but they can be

dispensed a hypertensive Medicine by

mistake because they look similar if

somebody's not turning the the the

medicine around and reading what the

name is uh that can lead to a problem

because we know majority of a population

is still semil literate or illiterate a

lot of our population can't still read

English and most of them coming from

rural India struggle reading those

complicated medical terms so if they are

not reading the backside usually that's

how people identify that round tablet

I'm having for diabetes that uh long

tablet is my cough tablet like so that's

how people identify their tablets in our

country still yes so that's the problem

that look like drugs create okay so like

that's my next question how do similar

looking drugs uh particularly in terms

of packaging and uh tablet appearance uh

impact patients ability to correctly

identify and use the uh their

medications especially among the with

low literacy levels people and also

people from the rural background how

does it impact their

health so one problem in the country is

that the health system is quite

overburden when we talk about the public

health system so in in poal India we

know that public health system is for

the poor and that's where the poor

people usually

go because private is so unaffordable

and because Public Health System then

become so crowded it's natural that at

the pharmacy there'll be a crowd of

people saying give my medicine first to

the pharmacist they'll all be fighting

because everybody is also very impatient

when they are sick which is natural yes

yes so then we give my tablet first and

so the pharmacist now and and we also

know that our health system is quite

understuffed there is shortage of

Pharmacy pharmacist doctors everybody is

shut and uh so when the pharmacist is

overb into work where they have 30 40

people shouting at him to give their

medicine first it's very it's possible

uh that the pharmacist can give the

wrong medicine because they look similar

okay so this has happened in one place

where a person

actually had hypertension MH which is a

high blood pressure problem the person

was on tan tablet okay but because of

that whole crowd rush and also uh the

the pharmacist was not very careful the

person received a drug called glim Pride

now glimy pride is a drug for diabetes

okay telli San reduces your blood

pressure Glam Pride reduces your blood

sugar okay so if a normal person we give

a drug which reduces blood sugar that

can cause risk to life because suddenly

their sugar will drop and if they are

not aware they won't understand why this

is happening so because to a to a

diabetic person doctors explain that if

your sugar drops this will be the

symptom take this uh take sugar take

some toffee chocolate if you feel like

this but somebody who does not have

diabetes it's very unlikely that they'll

know how low sugar what the low sugar

symptoms are or what they should do when

they have these complaints so that then

for them becomes veryy so who do you

believe is the most responsible for

creating this confusion the doctors who

prescribe the drugs the pharmacist who

dispenses them uh the manufacturers

manufacturers who produces those

medicines or the regulatory authorities

who is here the

problem so I would say it's a very

complex problem and you can't point

fingers at one particular person okay

okay there are ways to avoid this

problem at each level so the first level

at the manufacturing level where uh

there is something called tall man

lettering where The Words which

differentiate two drug names for example

win chrisen and win blastin so the Chris

in wi Christan is different and the

blast is different just all the letters

are the same there's with there is in at

the end Chris in one blast in one so

these letters should be in capital while

while printing in on the drug or the

packaging of the drug the box so that

whoever is seeing it becomes easier for

them to differentiate okay so this is

one method at the manufacturing level

which should be enforced regulat

authorities also have a play to role

role to play because then for them rules

exist but they are not being implemented

they are not being monitored so it's

then it becomes their job because there

are laws in the country where uh

trademark rules are there where two

drugs cannot have the same name they

have to go through checking process

before a brand name decides uh the name

for their own drug

uh so there are a lot of laws but then

it falls becomes a responsibility of the

regulatory authorities to make sure

those laws are being implemented and

those who are not following those laws

they should be penalized okay so SIM for

yeah yeah please

conf say similarly for doctors uh there

are again guidelines in place that

doctors should only write generic names

of

drugs uh so they should not write calpol

they should write paracetamol yes yes

because a lot of drugs can like we have

just I told megol is a name which is not

a drug name it's a brand name but

similar brand name for many drugs M so

then the doctor's responsibility to only

write generic names if they think that

one brand is better than the other and

they feel that their patient deserves

that better brand because there's a huge

problem of substandard drugs also in the

country counter feed drugs also in the

country so if a doctor has more

confidence in one brand then they can

write the name of the generic name in

Brackets under it so that there is less

confusion and similarly at the level of

the pharmacist the pharmacist has to

place similar looking drugs or similar

sounding drugs in different shells so

they know that they can't get mixed so

in our paper which we published in the

landet along with Mur nilakantan and

Ashish Kar we have given these steps at

each level of how these this error can

be avoided okay okay so uh there's this

question then uh why the manufacturer

the drug manufacturer who produces these

medicines let's say that one

manufacturer is producing hypertension

blood pressure medicine and another

producing diabetes are putting the same

name is there any benefit for them or it

is just the brand uh the regulatory

framework which has been created in our

country making them to Brand the name of

the

drugs so there is some benefit also

because usually the brand names become

very famous yes and so they try to sell

their own drug using that famous brand

name for example if you have gastric

problem you know the first name that

comes to mind is Pandy yes uh if you

have fever the first name which comes to

mind is Doo yes these brand names are

famous so there is an attempt to

piggyback on this famous brand name and

sell their own drugs but at the same

time it's also regulatory failure why

these things are

happening okay so at uh policy level

manufacturer Manufacturing healthcare

provider and Drug dispensing level do

you believe uh what are the most urgent

and uh mitigating issue right now is to

regulate these Lassa drugs error what

can be

done so in the current scenario where

policy framework is not being

implemented where the implementation is

very weak I feel currently the only

people who can act on this in the short

interval are doctors and pharmacists yes

so it becomes the responsibility of

doctors and pharmacists to make sure

they're dispensing the right drug

they're writing generic names they're

explaining uh what drug is being

prescribed to the patient they're making

sure that patients understand what drugs

they're getting uh so right now I would

say in the short term it's the

responsibility of us doctors and our

pharmacist who are working with us and

uh in the long term I would say the

policy framework has to be stranded and

the government has taken some some steps

in the recent past where they have said

that certain drugs will have to be given

in blue packets there has to be a red

line uh for uh schedule Edge drugs

schedule Edge drugs are drugs which

cannot be R cannot be bought without a

prescription uh another app or software

has also been made by the government to

see if similar drug names exist so the

government is has started to work on

this but this naturally will take time

this change will not come in a day so

till that change comes I feel it becomes

a responsibility of each pharmacist and

each doctor to make sure that their

patients are getting the right drug and

they understand what drugs they're

getting and I have this question that

recently we have heard in the news and

it was everywhere that cidesco uh put

out not uh nsq and spous drugs list and

there were many common drugs paracetamol

as well as amoxicilline and there were

around 53 drugs which were found to be

spous and nsq so uh and many of these

drugs are quite common it uh is used in

our daily lives people uses it and also

there was a case in nagpur where talcom

powder was also found in uh some drugs

so uh what do you see that when people

are just buying these drugs and even the

our agencies are regulating it how Lassa

can be uh regulated in this principal

and also one thing I really want to know

from you that in which category these

drugs are mostly like in which like if I

have a there are different parasal Doo

or cple these are the parasal but we as

you mentioned that we know by the name

Doo so we just go to the counter and ask

for Doo so is there any particular

category like in which these drugs are

quite

common so when we study pharmacology as

students medical students there each

there are different drug categories for

example antibiotics are there under

antibiotics there are different types of

antibiotics

flocons so different different type of

antibiotics the drugs which reduce our

fever are called antipyretics so these

are drugs which reduce body temperature

so that in that sense there are

different categories which we study for

each drug uh but the problem of Lassa is

very different from problem of

substandard drugs and counter feed drugs

okay these are not issue a Lassa drug is

just two drugs which look same and which

sound same but they can be good quality

so Lassa drugs only lead to Medical

error which is wrong prescription wrong

dispensing so that's the error Lassa

leads to but substandard drugs and

counterfeit drugs is a completely

different issue where if a drug is

supposed to have say paracetamol if you

buy 500 mg paracetamol but it has only

250 mg in it actually the active

compound is only 250 mg that is nsq not

of standard quality okay so because it

is not the amount is not similar to what

it should be there okay counterfeit

drugs are on the other hand drugs which

don't have active ingredient at all so

any say a cancer drug which is supposed

to be a powder of say 200 mg but it has

only talum powder in it so that is

counterfeit drugs which are produced

under the name of a

company but that's it's fake that

country that company has actually not

produced that drug somebody else has

taken empty Wilds of that company fill

with talom powder and they are reselling

it okay so I have a question are these

really a talom powder like I was hearing

reading somewhere on the social media

these are the tal comp poow which are

being used at home are those the tal

comp poow it is of similar quality or

what is this talcom powder here so it I

mean the news reports just say talcom

powder so it's possible it could just be

that tum which is being used at home and

over the this is not the first report

which has come out like this because

previously also from Himachal prades up

these all these such counterfeit

medicines have been busted by the police

okay so this is a huge problem in the

country right now because for diabetes

hypertension medicine one problem is

that okay disease is not being

controlled but when when we talk about

cancer drugs Cancer drugs are very

expensive yes so somebody is spending

8,000 rupees uh the cheap ones in cancer

are like 5,000 8,000 the expensive ones

can go in laks laks 4 lakhs for one

while so there it becomes even a bigger

problem because firstly that cancer is

is not getting the right treatment and

then people are using out on their money

also because these drugs are so

expensive okay so uh coming back to

Lassa uh from a public health

perspective how important is to have a

better regulation of drug names and uh

packaging to avoid confusion is there

need to have different names for each

drug and packaging or there should be

any other regulation which can uh uh

which can say that okay you can have uh

same name but you have to mention

something else or uh just say that like

paracetamol just me like many of the

state drug manufacturers they just write

paraset that can also work in public

domain uh because our health system is

quite fragmented and it is overburden as

you mentioned so how these regulation

can work and what should be there in the

regulation can you mention that

the first thing is that when deciding a

name there should not be any overlap

okay so that is the first part of the

the the solution the second part is that

while packaging each category of drug

could have a different kind of packaging

for example if there is a drug all the

drugs which are given for diabetes could

be packaged in similar color boxes or

similar color

foil uh even if you know the color of

the tablet cannot be changed or the

shape of the tablet cannot be changed at

least the packaging could be if you see

a packet with blue color foil you know

maybe it's diabetes so that could be one

solution similarly for other category

all antibiotics could have a similar

color for yes so that could be one

solution and the like you mentioned

problem for the public health system

it's a huge problem

because uh we know that in our country

every year there is data to show that

5.5 CR people become poor because of

healthcare

expenditure and uh out of these 3.8

become poor just because of expenditure

on drugs now if they're not getting the

right drugs Even after spending so much

even after facing poverty they'll

further go down into poverty their

disease will not get controlled their

productivity will go down uh so this is

a huge problem for our country because a

population if it's not productive and

not healthy the country can't Advance

further so urgent regulatory mechanism

is definitely need of the earth so uh I

have this final question to you that how

do you foresee the future of healthcare

evolving uh minimize the risk posed by

these L of drugs do you think

technological solution such as uh

digital prescription could offer a

viable pathway uh

forward no definitely digital uh the

whole Hospital information management

system uh is definitely one of major

Solutions which can stop this Lassa

problem because it'll be the doctor

clicking on the system and the

prescription from there going to the

pharmacist digitally so there is no

issue of handwriting being a problem in

which drugs are

misread when the doctor is clicking on

the system the pharmacist will know both

the brand name and the generic name of

the drug so that reduces a lot of

problems even though some errors might

still occur because of packaging issues

and dispensing issues okay but uh the

digital Solutions definitely do exist

and even if there are some screening

digital screening method for companies

before they decide the brand name that

also could help so the digital India

movement which is even the aishman

mission which is trying to create

Hospital information management systems

across the country that will definitely

help in addressing this issue okay thank

you thank you Dr P thank you for

speaking to s

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