‘Dr Combiflam’

Combiflam is one of the most widely used painkiller medications in India. It is manufactured and marketed by the French pharmaceutical company Sanofi’s Indian branch, being one of its five leading products there. It is a combination of the painkiller paracetamol (Panadol) and the anti-inflammatory ibuprofen, and like Panadol is used to relieve several types of pain, especially by general practitioners. It is even, like Panadol, sold over the counter, i.e. without a doctor’s prescription.

It may be recalled that we have ‘Dr Panadol’ in our local context, to refer derogatorily to doctors in hospital who prescribe Panadol on a daily basis for pain relief. It is not uncommon to hear patients who have attended for consultation at hospital or health center complain that they have received ‘nek (only) Panadol’. And in 1982 a Minister of Health created a hullaballoo in hospital because doctors were prescribing ‘too many Panadols’. I was then the secretary of the doctors’s union, GMDOA, and we had to issue a communiqué to establish the facts. Amongst others, that in those days there were not many other painkillers that were available in our hospitals.

All the minister did was to expose his ignorance, because Panadol if used in the prescribed manner is the safest painkiller known. It is practically always the first line of treatment for any type of pain, especially if the cause of the pain is not yet determined with certainty, and that is why general practitioners resort to it regularly, and it is listed as an OTC (over the counter) drug. Once a proper diagnosis has been made, then we may switch to the ‘stepladder’ of painkillers, going progressively as the case may be to more potent painkillers either singly or in combination, that may be administered by different routes (oral, intramuscular, intravenous, etc.) depending upon a number of factors. Painkiller drugs, however, are only one of different modalities available for the management of pain, many of which require specialised training, and are therefore meant to be used by specialists only.

Not having practised in India since I last was there as an intern in 1971-72, I have to presume that the term ‘Dr Combiflam’ is the equivalent of our local ‘Dr Panadol’. I was therefore interested and somewhat amused when I heard this term being flagged in a TV programme reporting on the Indian participation at the Rio Olympics. In fact, ‘Dr Combiflam’ was the nickname that the Indian athletes had given to the doctor who had accompanied the team as their Chief Medical Officer. They had tagged him thus because it seems that he was prescribing Combiflam liberally as the only painkiller for whatever problem they were consulting him for.

And that’s where the rub lay, according the details that transpired during the programme. ‘Dr Combiflam’ had no reason to be there because he was a radiologist, whereas the 110-strong team ought to have been accompanied by a sports medicine specialist. He had been chosen to go to Rio because he was the son of the Vice-President of the Indian Olympic Association (IOA), and in interviews of the latter shown on the programme of ‘Headlines Today’, he defended the decision. But this was vehemently countered by two other professionals, one of whom was a sports medicine specialist. Whereas the anchor was trying to put the onus on the Indian government for its lack of oversight in the selection of the appropriate medical specialist who ought to have accompanied the Indian team, the answer he got was that the IOA acted autonomously under the umbrella of the International Olympic Committee, and that therefore the responsibility lay on them.

Of course this is an internal Indian matter, but there is certainly a matter of general principle here, and that is relevant to any country including Mauritius. Who would deny that a radiologist, or any specialist other than a sports medicine doctor (with or without an orthopaedic surgeon), is not the right one needed to attend to the medical problems that athletes may encounter? Besides issues of a general medical nature (nutrition, exhaustion, dehydration, minor heart or other systems ailments) which a sports medicine specialist would be able to identify and handle, the acute problems faced by athletes would mainly be those concerning the musculo-skeletal system, that is the muscles, bones, joints, tendons, and bones. Simple afflictions could be handled by the sports medicine doctor, but ideally an orthopaedic surgeon as part of the team would certainly be desirable. Especially for such a big contingent.

Of course the Brazilian authorities had put up a fully-equipped medical facility to cope with any medical problems that the athletes could have faced during the mega-event, and there is no doubt that they had all the qualified and competent professionals to provide assistance and treatment. But it helps morale to have one’s own people in such crucial moments, and that is why such teams need to be accompanied by the right professionals. Certainly there was no need for a radiologist, for the Brazilian ones would be more than adequate, and any sports medicine doctor who knows his job would be able to read an X-ray relating to his speciality, and be in a position to seek local, competent help where this was required.

So along with the doping scandals that have tarnished these Olympics, and which involved Indian athletes also — though to a far lesser degree than, for example, the Russians – here come accusations of nepotism and incompetence (or at least inappropriateness) in the matter of medical support to the Indian delegation to Rio. The Indian sports reporter covering the event stated in as many words that the radiologist was spending his time there as a tourist, watching every event, rather than attending to his medical duties. Which in any case he was not qualified for. So the easy way out was to dish out Combiflam…

We must not think that we are immune to such nepotisms and misrepresentations across the broad. We only have to keep our ears and eyes open and we will get loads of examples to add to our own personal experiences. No wonder we lag behind on so many fronts…

RN Gopee

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