In today's Finshots we talk about Oral Rehydration Solution
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The Story
If you’ve ever had a bout of diarrhoea, then you’re likely familiar with ORS. Or an Oral Rehydration Solution — a simple mix of salt and sugar. It doesn’t treat the diarrhoea itself, but it does replenish essential salts and fluids your body needs. And while it may seem like a trivial concoction, it has been a lifesaver. It is the simplest way to deal with dehydration.
According to some estimates, ORS has saved more than 70 million lives since its first use in the 1960s.
Sadly, Dr Dilip Mahalanabis, a doctor who pioneered the widespread use of ORS passed away this week. And as a tribute, we thought we’d do a small story on ORS — how it became so ubiquitous and the roadblocks preventing its uptake.
Let’s dive in.
The story begins in 1971. Bangladesh (then East Pakistan) was seeking liberation from Pakistan and the ensuing war had left many homeless. They fled their land and migrated across the border to the many refugee camps set up to rehabilitate them. Unfortunately, the camps weren’t the most sanitary places available. People didn’t have access to clean water and hygiene wasn’t the top priority. Needless to say, diseases were commonplace — most notably water-borne Cholera which in turn induced severe diarrhoea. And the common treatment prescribed at the time— the intravenous fluid saline (IV) was in short supply. The camps were understaffed too.
And Dr Dilip Mahalanabis — a supervisor at one of these camps felt like he had to do something. Something that didn’t need trained medical staff. Together with the Johns Hopkins International Center for Medical Research and Training, he created a solution of table salt (four teaspoons), baking soda (three teaspoons) and commercial glucose (20 teaspoons) that anybody could administer.
And it worked. The fatality rate dropped from 30% to 3.6%.
That was just the start. Once scientists realized the efficacy of this simple solution, the WHO made ORS its mainstay in the fight against cholera and diarrhoea. And its use exploded. It was cheap, effective and cost less than $0.50 per treatment in most countries. Today, the global ORS market is valued at $660 million and is expected to reach $1.2 billion in the next 5 years.
In India, the use of ORS to combat diarrhoea has grown manifold too. For instance, in 2005–06, as per the National Family Health Survey, only 26% of children with diarrhoea received ORS packets. But by 2015–16, this had risen to 51%. And by 2019–21, 61% of children began receiving ORS packets.
In the meantime, the death count attributed to diarrhoea among children under 5 dropped from 212,000 in 2005 to 55,000 in 2019.
Having said that, there’s still a long way to go to bridge that gap. Although 94% of all women now claim to know about ORS packets, it still hasn’t found its way into every household. As a consequence, diarrhoea still remains one of the leading causes of death in children in India.
There’s also the fact that ORS packets alone won’t help alleviate this crisis. We still need to address the root cause — inadequate sanitation and unsafe drinking water.
And finally, there’s the issue with copycats.
The WHO prescribes a formula for ORS. It contains a mix of Glucose, Sodium chloride, Potassium chloride, and Trisodium citrate. But there are other similar solutions — more expensive and those that don’t always address the root cause.
Take for instance ORSL — an energy drink that comes in easy-to-consume tetrapack marketed by pharma giant Johnson & Johnson. Now you’d think that it’s the perfect substitute to treat diarrhoea since it has ORS in its name. But…it’s not. This is a product recommended to replace water and salt loss during exercise. It’s a sports drink. But ORS is a formulation that is used to treat dehydration caused by diarrhoea. It’s not the same thing.
And yet, the unassuming customer will probably substitute one for another, which in some cases, could make your symptoms worse.
According to Dr Ashwani Koul, a Bengaluru-based paediatrician, “I’ve had many patients coming to me with persistent diarrhoea and the only intervention needed was to stop their ORSL intake.”
Now J&J has explicitly noted that it doesn’t market it as an ORS solution for diarrhoea. But, that’s not stopped pharmacists from recommending it to patients almost routinely.
In fact, there’s even a Public Interest Litigation in India’s courts attempting to ban pharma companies from selling these alternate ORS products. And despite an order from FSSAI in April 2022 prohibiting such drinks from carrying the word ORS on their labels, the practice continues unabated.
So yeah, while ORS continues to save lives across the world, there’s still a lot of work we need to do to keep Dr Mahalanabis’ legacy alive.
Until then…
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PS: While Dr Mahalanabis is credited with the widespread use of ORS, in 1953, Dr Hemendra Nath Chatterjee had shown that a mixture of salt and sugar could rehydrate 186 cholera patients who suffered from dehydration. But since he didn’t apparently record his experiment scientifically and also used a mix of Indian plants to treat the disease, his findings didn’t gain popularity.
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