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"SWAPPING" OF DRUGS USED IN DIFFERENT SPECIALITIES
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The doctors have started following the shopkeepers. In most of the foreign shops, swapping trousers of different sizes and colours is not allowed, but it continues to be done illegally.
In medical practice, swapping is done always for the benefit of the patient and without any element of malpractice. Swapping seen in medical practice can reduce the practice of one super specialist and increase the practice of other super specialist.
As against this, the pharmaceutical companies manufacture drugs which always bring additional income because the indication of the drug increases. Following are a few examples:
When the syndrome of sleep apnoea was described, the treatment was C-PAP throughout the night so that the palate remains lifted preventing snoring and apnoea. The pulmonologist then extended the use of this C-PAP treatment to patients of heart failure who at night used to have "Chyene Stokes Breathing" causing insomnia and soon it was shown that the Cardiologist must take the help of a Pulmonologist to treat the patient of heart failure in such a situation. Lately, it appears that the Cardiologists have over-taken the Pulmonologists because they have now shown that to treat sleep apnoea "cardiac pacing" is as effective as C-PAP treatment.
For the last number of years Cardiologists have used IV Xylocaine as a bolus treatment of ventricular tachycardia. Today, the Hepatologists are using the same drug in one of the best liver function tests known as "Megax" test, which is often done in patients who are undergoing Liver Transplant.
Many cardiovascular drugs used in hypertension are being used in a CNS (Central Nervous System) disease like migraine, or a gastro-intestinal condition like motility disorder of the oesophagus. Thus, drugs like Betablockers, Nifedipine, etc are used to treat frequent attacks of migraine. Nifedipine even in large doses is used in motility disorders. GTN (Glycerine Trinitrate) which is the best drug for angina pectoris is also used in motility GI disorders and treatment of the disease of the lower end of the GI tract i.e. anal fissure.
Anti-epileptic drugs used for the diseases of CNS are also being used in migraine, e.g. Carbamazepine, Sodium Valporate - these being the examples of swapping done in the drugs used in the same system.
Similarly, another example of the same is when Adenosine injection was used as the best treatment to break the attack of "supra-ventricular tachycardia". The same drug is now used in Nuclear Medical Dept during myocardial perfusion scan to study the metabolism of myocardial tissue to diagnose the viability of the myocardium to decide the procedure of angioplasty or bypass surgery.
Another example where the drug which was used for treatment by a hepatologist is now used by the Nuclear Cardiology Dept. Intravenous Acetyl choline is now being used in the treatment of hepatic coma. But now, the Cardiology Pandits are using the same drug which is injected into the coronary artery during coronary angioplasty to study the endothelial dysfunction which ultimately decides the prognosis of the patient having coronary heart disease.
I can give you many more examples. One thing is definite that the research work in allopathic medicine is exciting, and for the clinician the prescription of the same drug becomes handy in your clinic when you are short of time.
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