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Background A vital method used by pharmaceutical companies to make physicians aware of new drugs and increase the prescription and sale of the same is through drug promotion literature (DPL) published in scientific journals and distributed in outpatient departments (OPDs). It is important that drug promotion is done ethically to avoid the spread of false information for which guidelines are available at the international level by the World Health Organization (WHO) and at the national level by the Organisation of Pharmaceutical Producers of India (OPPI). In this study, we aim to review the DPLs used for promotion by market authorization holders (pharmaceutical business entities) in scientific healthcare journals and OPDs for their compliance with the "Ethical criteria for medicinal drug promotion" of the WHO and OPPI Code of Ethics Practice. In addition, we compare the ethical standard of the DPL available in scientific journals and OPDs with respect to existing norms and guidelines. Methodology A cross-sectional, observational study was conducted at a tertiary care teaching institute in Navi Mumbai, India. DPLs were collected from journals available at the institute library nearby published from January-June 2022 and from the outpatient departments of our hospital and other clinics nearby during the same time duration. Analysis was done according to the criteria given in WHO and OPPI guidelines. Each point in the criteria was scored as 1 or 0 based on whether the DPL was compliant or not respectively. DPLs were graded into 3 categories based on percentage compliance: Grade A (>70%), Grade B (35-70%), and Grade C (<35%). Results A total of 370 DPLs were collected, of which 191 (51.6%) were collected from scientific journals and 179 (48.4%) from OPDs. DPLs collected from journals showed that only 7.85% belonged to Grade A (WHO guidelines). According to the OPPI guidelines, 57.59% of the same DPLs belonged to Grade A. DPLs from OPDs showed similar results by both guidelines with >90% belonging to Grade B. Approximately less than 5% of the DPLs belonged to Grade C from both scientific journals and OPDs. Conclusions None of the DPLs were found to be entirely compliant with either of the guidelines. Most of the DPLs from both sources belong to Grade B, with information about adjuvants, adverse drug reactions, contraindications, drug interaction, and references to scientific literature missing from them. DPLs belonging to Grade C even had information about active ingredients missing from them which can lead to serious harm due to the wrong prescription of drugs.
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Introduction One of the major health problems in many countries including India is type 2 diabetes. Yoga is being explored as an alternative therapy for the management of diabetes. Methods Among the total of 137 participants who successfully completed the 'Living Well' workshop by the Art of Living, 84 with type 2 diabetes were assessed for change in random blood sugar levels, systolic and diastolic blood pressure levels (SBP/DBP), and pulse rate over seven days. In the Living Well workshop, the participants performed a comprehensive Yogic Breathing Program that included yogic movements and postures (Asana), relaxation practice, three-stage Pranayama, Sudarshan Kriya Yoga (SKY), breathing techniques, and discussion of stress relieving principles over those seven days. The parameters were recorded at the time of enrollment and after the completion of seven days of the workshop. Results There was a greater (p<0.05) percent reduction in the mean blood sugar level in diabetics as compared to non-diabetic individuals. However, the reduction in SBP and DBP were similar (p>0.05) in diabetics and non-diabetics. The percent reduction in the pulse rate however was greater (p<0.05) in diabetics than non-diabetics. Conclusion Comprehensive yogic breathing practices comprising SKY may be beneficial in patients with type 2 diabetes mellitus.
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Nearly 65%-95% of chronic kidney disease (CKD) patients have hypertension. Calcium-channel blockers are the first-line drugs for the treatment of hypertension, including hypertension with diabetes. This study aims to estimate the effect of an L-type calcium channel blocker (CCB), cilnidipine, on the renal function of hypertensive patients. Randomized control trials were selected from PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), Science Direct, Elton B. Stephens Company (EBSCO), Springer, Ovid, Cochrane Library, Medline, VIP, and Wanfang databases (from the date of databases' establishment till January 2022). Data were independently evaluated following the Cochrane risk-of-bias tool. The changes in serum creatinine (SCr), urinary protein excretion (UPE), urinary protein/creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) before and after treatment, in percentages, were extracted for the meta-analysis. The mean difference (MD) and a CI of 95% were determined using RevMan 5.3 software. A total of 11 studies were analyzed. The standardized mean difference (SMD) between cilnidipine and L-type CCBs was -0.022, suggesting a reduced SCr with cilnidipine. For UPCR, the SMD value is 1.28. Although cilnidipine reduced UPCR in all four studies, the L-type CCBs reported a slight increase in UPCR. For eGFR, the SMD value was found to be 0.693. Cilnidipine had a more favorable effect on eGFR when compared to the L-type CCBs. While cilnidipine had similar effects on SCr to that of L-type CCBs, cilnidipine showed greater improvement in UPCR, UPE, and eGFR values.