Subhadra Neupane underwent surgery to repair uterine prolapse around four weeks ago at a private hospital in Kathmandu. The hospital had organised a screening camp at her village in Kalika Rural Municipality in Rasuwa district where she was told she needed surgery. The good news, the hospital staff told her, was she wouldn’t have to worry about the operation fee or the medication because a commercial bank was financing it.
As promised, Neupane, 45, did not have to pay for the operation, nor for essential medicines. She was discharged and advised a follow-up after a week. The follow-up went well, she said, but doctors at the hospital prescribed her vitamin doses worth thousands of rupees.
“When my daughter went to buy medicines at the hospital’s pharmacy, she discovered that vitamin supplements worth Rs7,800 had been prescribed,” she told the Post. “We did not have that much money to buy medicines.”
Her daughter, Laxmi, told the Post that the pharmacist insisted she buy the prescribed medicines when she inquired about the importance of the drugs when the wounds had already healed.
“The medicines included supplement vitamins, massage oil and some types of cream,” she said.
Like Neupane, patients across the country are handed a long list of prescriptions of vitamin supplements while experts around the world still debate if vitamin supplements are just hype or of any help at all. Some doctors also prescribe vitamins even if the cause of ailments has not been established.
Patients also say they are forced to buy vitamin supplements, which most of the time are more expensive than regular drugs.
“We cannot say patients do not need vitamin supplements but there is a tendency among doctors to prescribe unnecessary supplements. This is a wrong practice and exploitation of the poor,” said Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division.
Marasini said that some doctors and dispensaries have been taking undue advantage of the poor patients by forcing them to buy additional vitamin supplements. “A majority of patients are unaware and cannot ask if the supplements are necessary,” he said.
What is more worrisome is that some of these vitamin supplements prescribed by doctors and sold openly in the market—oral liquid vitamins, vitamin A, vitamin D, vitamin B1 and vitamin B2 among others—are banned by the Department of Drug Administration.
“We have filed a petition at the Supreme Court seeking an order to cease the import of banned drugs. The court is yet to fix a date for the hearing,” said Narayan Prasad Dhakal, the department’s director.
Former secretary at the Ministry of Health and Population Dr Senendra Upreti said it has become a ritual among doctors to prescribe additional vitamins for patients, and that is not a good practice. “Most ailments can be cured by medicines worth Rs100 to 200 but patients are forced to buy vitamin supplements for several hundred rupees,” said Upreti.
Medical experts say that supplementary vitamins are needed in exclusive conditions but most doctors prescribe unnecessary drugs for their patients. According to Dr Aruna Upreti, a nutritionist, a balanced diet consisting of green leafy vegetables, whole grains, eggs and dairy products and sesame and mustard oil offers most of the vitamins and calcium.
“But doctors do not advise patients on the importance of nutrition and serve the interest of pharmaceutical companies by prescribing nutraceutical products,” said Upreti.
Meanwhile, officials at the department, the national regulatory body of the drug market, said it did not have the capacity to examine the claims made in product labels by nutraceutical products. “We do not examine those components,” said Dhakal, the department’s director. He said they’d need a highly sensitive laboratory to examine all components of the nutraceuticals, something the department does not have.
According to Dhakal, pharmacy operators show permission issued by the customs office and the Department of Food Technology and Quality Control when the department tries to curtail unnecessary vitamin supplements.