Coughing up death in Lahore

Existing policies on medicines are not working, either due to poor enforcement or failure to comprehend challenges.

I had planned to write about the Punjab Institute of Cardiology (PIC) drug scandal next month to mark the anniversary of this dark chapter of our national public health management. The idea to talk about drug quality control was to make sure that we all remain acutely aware of our history and ensure that nothing of this sort happens again. It gives me no comfort that I did not have to bring this reminder to the fore and our own lack of oversight has done the job for me. The tainted cough syrups in Lahore have brought a powerful yet sad reminder of the vulnerability of our drugs and our national public health.

It is irrelevant what underlying conditions the deceased had, or whether the drug was misused here. While drug misuse and abuse is a major problem in Pakistan, that is not the point in this case. The issue of drug toxicity, either due to malicious intent or due to incompetence, paints a very grim picture of the regulation, oversight and enforcement of good manufacturing processes and this demonstrates the inability of our drug testing mechanisms for public safety. It pains me to see that those who are at the economic and social fringes of our society are routinely exposed to poisonous cocktails, sold supposedly to cure the sick and heal the suffering.

The challenges of counterfeit, substandard or inactive medicines are universal and no country, even the most developed ones are immune from these issues. However, what separates us from them is the resolve to address the issues comprehensively and take necessary actions at all levels to eradicate or at least minimise the problem. In the case of Pakistan, it is the unfolding of multiple crises, within the same year and lack of robust responses from the regulators that make the problem much worse. While I laud the efforts by the local government in taking immediate action to stop further proliferation of these tainted cough syrups, I am particularly concerned about lack of efforts in finding the root causes and doing something about them at the systems level. Shutting down an individual company or a pharmacy does not provide a long-term systematic solution to a pervasive problem that can lead to a major public health disaster in the sixth most populous country in the world.

It is also important to realise that tainted, substandard or outright fake medicines are not just problematic because they lead to the loss of life of an innocent few or may cause panic or add to the public health burden on our already-stressed hospitals. These tainted drugs also lead to the long-term resistance that can affect all of us and make our existing drugs worthless in controlling, curing or managing a myriad of diseases for our future generations. Problems like tuberculosis, malaria and other infections continue to acquire drug resistance and if we continue on this road of ineffective and substandard medicines, our next generations will be a lot more vulnerable.

Clearly, the existing policies to safeguard our essential medicines are not working, either due to being poorly enforced or due to the inability of our policymakers to comprehend the deep rooted challenges. What we need is not just the police raid on the pharmacy and the manufacturer, but a national commission and a scientific discourse that is able to create a robust mechanism of drug testing, enforcement of quality control and awareness about the deadly problems due to poor manufacture among pharmacists and pharmaceutical companies. We also need to encourage and provide incentives to our students, pharmacists, entrepreneurs, innovators, scientists and engineers to come up with new and better technologies and solutions to curb the problem at all levels. In the end, this problem, if not dealt with today, will not just affect the poor citizens of Lahore, but has the potential to affect the entire nation. Yet, at the same time, we have an opportunity, once again, to show leadership in solving a problem that affects so many countries and for once, we may be known as those who made an impact in improving the quality of life around the world.

Published in The Express Tribune, November 28^th, 2012.