Selling toxicity

Published: December 31, 2012

The writer is associate professor in the departments of Biomedical Engineering and Medicine at Boston University

In November 2012, a number of people died in Lahore after consuming a particular cough syrup and we were quick to blame the dead. It is always them, never us, remember? They were drug addicts, habitual abusers, etc. We even came to the conclusion well before there was a detailed analysis. Later reports have cast doubts on the government claims about the addiction and overdose theory. This past week, a similar incident unfolded, this time in Gujranwala. The same brand of cough syrup seems to be involved and we have not found a scapegoat yet. The several dozen lives lost is a powerful and extremely tragic reminder of the persistent problem of drug quality in the country.

Almost exactly a year ago, one of the worst public health crises of the country unfolded in Lahore and nearly 200 people died. The causes of the problem remain unknown to this day.

Here, let me first dispel a few misconceptions and rumours circulating in the media. First, this idea that the deaths due to toxic or poor quality drugs somehow happen en masse is absurd. Countless people die in the country due to poor quality drugs but we accept them through our fatalistic beliefs or find other scapegoats. People who are already sick or vulnerable are much more likely to suffer the ill consequences of poor quality drugs but we often do not attribute the worsening of their condition or their death to the fake, counterfeit or substandard drugs. Second, this idea that somehow this is a Punjab-only problem is also equally naïve. Lack of quality control in drugs is not a provincial issue and certainly other provinces do not have better mechanisms of testing and regulating their drugs. Additionally, the licence to sell a particular brand is often not associated with a specific province but typically provided for the whole country.

Now, let us also analyse what the government — in this case the Government of Punjab — typically does in these situations. The typical knee-jerk response is to set up a committee for inquiry and confiscate the stock of the drugs followed by sending samples to a lab in the UK. The same routine is followed every time. Personally, I think all three of these steps are fine in their own right and are steps in the right direction. But I also think that none of them will ever solve the problem completely or comprehensively. The solution to the problem lies in improving the quality control mechanisms and developing thorough checks and balances at multiple levels of the supply chain and not just testing one particular drug. Second, we need to develop our own capacity to test drugs and test them routinely, not wait for a disaster. Sending samples to the UK is fine once in a while but it is extremely time consuming and requires significant resources which we simply do not have. If we want our manufacturers and suppliers to adhere to best practices, then we need to test their products routinely, rapidly and thoroughly to avert any future disasters and for that we need to develop our own capacity in testing and ensuring quality control.

It is also important to realise that when bad drugs are sold in Gujranwala, people in Karachi, Peshawar, Quetta and all other cities also get affected. It is because poor quality drugs allow the development and proliferation of resistant strains of pathogens that would not respond to our existing arsenal of drugs. The development of Multiple Drug Resistant TB and other high impact infectious diseases have been greatly influenced by the availability and usage of poor quality drugs.

As I have argued before, I would strongly urge that we need to take national initiatives, involving our researchers, students, doctors and pharmacists to tackle the problem of poor quality, fake and substandard drugs. This is an amazing opportunity for us to create high impact, low cost and innovative technology and demonstrate its efficacy in solving one of the most pressing public health problems not only in Pakistan but also in the world. A quick Google search on counterfeit or substandard drugs would show how grand this challenge is and we, as the victims of this menace, have the opportunity and the responsibility to change the course of public health for the better.

Published in The Express Tribune, January 1st, 2013.

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Reader Comments (7)

  • Maliha Ahad
    Jan 1, 2013 - 12:09AM

    As a mother of two growin g children , I have a mini pharmacy at home consisting of common otc and some prescription drugs (not that the latter is of any concern in Pakistan). Over the courae of seven years my chilsren have tried out at least 10 different cough syrups and as manyndifferent antihistamines. Everytime we find something that works it becomes unavailable in the next fewbmonths! And we’re talking about local meds here. Does the problem lie in supply chain, govt licensing policies or just marketing ploys o competin g pharmaceutical companies? Isnt this problem just as serious as poor quality drugs?

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  • Mehreen
    Jan 1, 2013 - 1:21AM

    Its really sad — how many more need to die before we will do something?

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  • Alchemisto
    Jan 1, 2013 - 1:32AM

    Dr Sahab I hope some day u ll come back to Pakistan to teach students here how drugs should be checked!

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  • Mehreen
    Jan 1, 2013 - 2:05AM

    @Maliha, well said. I am in the same boat. I think the problem is really deep and pathetic that the CM would not take personal responsibility. I do not think it is appropriate of him to have the health ministry for himself and then let these things happen on his watch. We need more quality assurance and more accountability.

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  • Its (still) Econonmy Stupid
    Jan 1, 2013 - 4:06AM

    No one in right mind starts a business to sell toxicity. Paracelsus, sometimes called the “father” of toxicology, wrote: “The dose makes the poison.” So taking too much of cough medicine can kill you.
    Things do go wrong either at the company or at the personal level. If quality control is not followed some other chemical comes out at the end. Prime example Person who was trying to make heroine heated the chemical at one step 10C below the required temperature and came up with a chemical, MPTP, that cause0d Parkinson’s disease in very young people. This is why company has to be audited for GMP (Good manufacturing practice). On the other hand people who take cough medicine containing DM (Dextromethorphan) and drink grape fruit juice or Kinnow juice can increase the level of DM in the body to a dangerously high level and even death. This is true for number of other medicines too. Is it possible that these people were taking cough medicine and drinking Kinnow juice too? Or taking herbal medicine? People in west such as USA where FDA has strict quality control over drugs number of people are dying from Oxycodone pain killer due to dissolving tablet for iv injection or overdose or quick release. Now companies have changed the formulation. CM should call US FDA audit of the company.

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  • Incompetence aplenty
    Jan 1, 2013 - 7:47PM

    @Its the economy: Points well taken — but it is not just GMP, but also management of the supply chain in all areas. For example, things that need to be stored in fridges are often left out in the open, making them, at best useless, and at worst simply toxic. So it is a comprehensive process. I agree, we should ask CM to ask FDA or CDC or a Pharmacopeia to audit.

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  • Foolitics
    Jan 3, 2013 - 12:25AM

    @Alchemisto:
    “Dr Sahab I hope some day u ll come back to Pakistan to teach students here how drugs should be checked!”

    You are asking too much of him. Maybe he can teach through Internet from wherever he is.

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