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The merchants of death

February 16, 2017

THE scandal relating to the use of substandard stents to treat heart disorders has underscored the urgency of addressing serious threats to citizens’ health caused by the circulation of spurious medicines, including life-saving drugs, and the menace of food adulteration.

The first reports about the stent affair only disclosed the use of unregistered stents. Later on, doctors were blamed for using stents marketed by ‘unrecognised’ manufacturers. The other day, a spokesman of the Drug Regulatory Authority told a Senate Standing Committee that not only substandard but “expired” [sic] stents were being used.

It seems that the system of registering stents, introduced only some months ago, is yet to be properly enforced. The majority of those who need stents cannot afford the supposedly most reliable device (costing around $5,000), and they settle for less expensive varieties and hope that the ‘number 2’ device will be as effective as the genuine one. Patients’ exploitation has been made easier by the failure of manufacturers/ distributors to print the sale price of stents.


The rise of the hydra-headed monster of corruption has fuelled the surge in spurious drugs.


The magnitude of the problem can hardly be exaggerated. Cardiac disorder is no longer the disease of the old and indolent rich; now cardiac clinics are attracting an increasing number of people of all ages and from all socio-economic groups. The demand for stents is estimated in six figures.

Since stent is a life-saving device, the urgency of ensuring that only duly tested and certified products are used is quite clear. No more should be said about stents as the Supreme Court is seized of the matter and it is expected to decide how the use of stents should be regulated and how the relevant autho­rities can be awakened to their respon­­sibilities.

However, the stent affair is only the tip of a wider malaise in the drug sector. There is a glut of spurious and substandard drugs in the market. Pakistan’s eminent authority on public health, Dr Sania Nishtar, made the following observation on the subject in her 2010 publication, Choked Pipes: Reforming Pakistan’s Mixed Health System.

“Spurious and counterfeit medicines are part of a multimillion dollar international drug business — six to 10 per cent of all medicines distributed across national boundaries are found to be counterfeit. Pakistan is known to be amongst the 13 countries of the world where manufacturing of spurious medicines has been reported. Earlier reports by the Association of Pharmaceutical Manufacturers of European Union and the US Trade Office alleged Pakistan markets as having 50pc substandard and spurious medicines. The Ministry of Health official reporting of the magnitude of spurious medicines in the market is in sharp contrast to this and has been reported at 0.4pc.”

There is no evidence that the spurious drugs market has shrunk over the past six years. Nor has the duty of the health authorities to make a realistic assessment of the trade in spurious drugs become any less important. It will take extraordinarily efficient and alert drug control agencies to rid the market of the bad habits it has acquired over many years, aided by state authorities’ muddle-headedness.

Special effort is necessary to check the sale of substandard drugs. In spite of attempts made sometime ago to oblige chemists to employ only qualified personnel as salesmen, many of the latter might not be aware that they are selling poison under the label of cures. They need to be told that besides being able to correctly read the prescriptions they have an important role in preventing fellow human beings’ coming to grief by using substandard medicines.

Unfortunately, we are discussing threats to people’s lives and health presented by substandard drugs at a time when the supply of contaminated water, and poisonous and adulterated foodstuffs has reached alarming levels.

The non-availability of safe drinking water, especially in big cities, is old hat. The pipes are old, rusted and broken; clean water cannot be supplied to consumers even if it is free of impurities at the source. Many were forced to switch over to the more expensive bottled water but their confidence in it has been shaken by reports that some of the bottlers lack the capacity to supply pure water. Similar complaints have been circulating about packaged milk and this has affected the reputation of even companies that are considered above reproach.

Almost every day, the media reports destruction of huge quantities of meat of donkeys or sick animals and rotten meat, and the seizure of thousands of litres of unsafe milk in Lahore alone. What is happening in the countryside is anybody’s guess. Reports of people dying or falling sick in droves after consuming contaminated food are accepted as unavoidable hazards to the people’s lives.

This reminds one of the campaigns against food adulteration in the 1960s, when shopkeepers were caught, and sometimes punished, for selling brick powder as chilli powder or for mixing fertiliser with sugar and discarded engine oil with cooking oil. These campaigns petered out before the problem was solved and its recurrence blocked. Thus, the present drive against spurious drugs and food adulteration has not come a moment too soon and one hopes it will be carried to its logical conclusion.

That the rise of the hydra-headed monster of corruption has fuelled the surge in the circulation of spurious drugs and adulterated food is obvious. The state, instead of earnestly fighting corruption, seems to have become a trendsetter in this nefarious business. Particularly damaging has been the collapse of the inspection mechanism in all areas. Besides, in an environment dominated by terrorism and reliance mainly on force to counter it, human life has suffered a massive devaluation. Ordinary men and women are dying of preventable causes and not many people’s conscience is stirred.

The question as to what has turned a large number of people into purveyors of death and disease demands a separate discussion.

Published in Dawn, February 16th, 2017