Selling toxicity

We need to take national initiatives to tackle the problem of poor quality, fake and substandard drugs.

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 1^st, 2013.