medico friend circle bulletin
NOVEMBER 1976
Tonics: How Much An Economic Waste
KAMALA S. JAYARAO* MONG the pharmaceutical preparations that are indiscriminately prescribed are the vitamins, particularly those of the B-complex group. "Probably no single class of drugs (Sic) has been the target' of as much quackery, misunderstanding, misrepresentation and misuse as the 1 vitamins………" . There are however a number of reasons for this, some in my opinion condonable. Patients often come with vague symptoms which can be correlated to no known disease. The complaints may be genuine or psychosomatic, but the patient expects treatment. For example, a common complaint is pain in the back or pulling sensation in the legs. Or, it may be a simple complaint of general fatigue or loss of appetite due to no organic cause. What is one to do One usually prescribes a multivitamin or a B-complex preparation. This may be done for three reasons. The physician may sincerely believe that vitamins will help the patient or he may feel compelled to prescribe something. Thirdly, the patient himself may demand some medicine, generally a 'tonic'. What does a tonic mean, anyway In general parley it has come to mean a liquid preparation. However we do come across advertisements of ' nervous tonics' 'tonic for muscle strength' 'for energy' etc... This is pure baloney. One of the definitions given by the Webster Dictionary for tonic is 'something that invigorates, restores, stimulates or refreshes'. Could it be the generous quantity of alcohol in these preparations If the physician believes that B-complex would be beneficial even if he has no scientific evidence or therapeutic basis, he need not in my opinion be castigated. We still do not know all the metabolic functions for which one or more members of the B-complex
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may be needed. Hence, we are probably not in a position to recognize all situations which may respond to vitamin therapy, though severe deficiencies of single vitamin have been well characterized in most cases. The trouble arises with the dose that is prescribed. The physician should realise that in such undefined situation, the therapy is purely empirical. The burden rests on him to know whether he is prescribing the right amount, less or more. This brings us to the question of what the right amount is. Here we must differentiate between vitamins taken as nutrients to ward off deficiency and taken for therapeutic purposes, in established deficiency. The latter dosages are not based on as careful a scientific scrutiny as the former. They are prescribed for acute and severe, single deficiency states like beri-beri, pellagra, keratomalacia etc. Since water-soluble vitamins are considered to be relatively innocuous, the amounts prescribed are very high, the main aim being to tide over the acute situation. On the other hand, we have these various undefined situations which we attribute to vitamin deficiencies or anaemia. These are neither acute nor proven states of deficiency. If the condition is due to a nutrient deficiency, the deficiency is probably chronic and marginal or moderate in nature. Here the implication probably is that the individual is unable to meet his nutrient requirements. This is perhaps a justifiable premise since the prevalence of B-complex deficiency in our country is relatively high. According to certain surveys the prevalence rate is 5 per cent in pre-school children and 17.8% in pregnant women (assessed by the presence of 2 angular stomatitis and glossitis) . The percentage of those with less severe deficiency is expected to be higher.

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