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Pills that kill

December 06, 2017

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A LITTLE over a month ago, the intelligence branch of the Lahore police carried out an investigation into the drug inspectors charged with the task of ensuring that medicines sold to the public were safe for consumption and were not counterfeit or beyond their expiration dates. The result of the investigation, published in a report provided to various news agencies, revealed that 64 of the 121 drug inspectors were involved in some level of corruption.

The consequences, of course, can easily be guessed: hundreds of thousands of Pakistanis consuming medicines they think will make them or their children or their elderly family members healthier, are being duped. The medicines are either not what they say they are, or are old, or doctored in some other way. They will not make the patient better; they may well make the patient much sicker.

This is not an old problem in Pakistan. Many will remember the catastrophic debacle that took place at the Punjab Institute of Cardiology (PIC) in January 2012, when at least 100 cardiac patients at the institute died because they had been administered wrongly constituted anti-hypertensive medications. The faulty ingredients lodged in the patient’s bone marrow, reduced their ability to produce white blood cells, and hence the ability to fight infection.

A WHO report reveals that 10pc of all medicinal products available for sale in poor and middle-income countries are either expired, tainted or unsafe.

Several drug brands were involved. By the time the cause was discovered, and the usual kinds of inquiries ordered, the affected patients, most of whom were poor, had already died a horrendous and needless death.

Not much, it seems, has improved. If the police report is to be believed (such are the options in Pakistan), and a good half of the drug inspectors entrusted with the task of ensuring that catastrophes like the one at PIC do not recur, are corrupt, then we are all playing a game of Russian roulette. Past incidents are not the only cautionary tales in this regard; recent statistics back up the sordid nature of these scams.

A report released by the World Health Organisation just last week revealed that 10 per cent of all medicinal products available for purchase in poor and middle-income countries are either expired, tainted or unsafe in some way. The most frequently problematic drugs include antibiotics and anti-malarial drugs, so everything from a bad case of bronchitis to life-threatening malaria can expose unsuspecting patients who put their faith in the pills that kill, or at the least, fail to cure. Unsurprisingly, children, smaller in size and weight, are the most vulnerable to the dangers of contaminated or counterfeit or expired medications. What grown-ups may be able to endure often kills them.

None of this seems to be much cause for concern for the Drug Regulatory Authority of Pakistan (Drap). Not only is there no system via which the public can be informed of advisories or warnings about the possibility of counterfeit or contamination issues, there seems to be no oversight of drug pricing either.

A case in point is that of a certain cancer drug. A news report published last month revealed that the sale price of 100mg capsules of this drug was Rs31,000. This is despite the fact that the import price of the drug is stated on official paperwork to be Rs7,225. Even though the matter has been raised before Drap by the federal drugs inspector, there has been no resolution. The situation, obviously, is ripe for even further exploitation, for someone to come in and sell fake or faulty pills for a cheaper price.

In the meantime, those already suffering, the cancer patients forced to buy the drug at inflated prices, are made to suffer more because of delay and corruption and gross ineptitude. Many others undoubtedly cannot purchase the drug at all, and will die.

If the pills don’t kill directly, it seems they do so by their prices, which render medication inaccessible to many who cannot afford to pay more than five times their actual price. While the case of this cancer drug is one that actually has come to the attention of the authorities, there are likely thousands of others being similarly sold at prices beyond the maximum stated on the import paperwork.

In such circumstances, when regulation agencies look the other way, corrupt inspectors don’t care about lives, and suppliers search for every chance to adulterate content and inflate prices, all consumers must look out for themselves. Some strategies suggested by WHO to detect whether a drug is legitimate include analysing labels to note grammatical errors and spelling mistakes, looking at all dates available on packaging to ensure that they are not expired, looking at pills to ensure they are not discoloured, degraded or smell unusual, and ultimately discussing with your pharmacist or doctor if you feel a medicine is not working. Feeble as they may seem, these strategies may end up saving time and possibly lives.

As far as regulatory authorities and the government itself is concerned, there seems to be little cause for hope. If there is anyone at all at Drap who cares about the vulnerable position of consumers, the 64 drug inspectors found to be corrupt in Punjab must immediately be fired. In addition, Drap must immediately develop a system via which information about medicines suspected to have been adulterated, counterfeited or subjected to tampering is shared with the public via advisories on television, radio, and the social media.

In an age where everyone is carrying around a mobile phone, this regulatory agency can quite easily provide such information to millions of consumers who are currently in the dark. As for the patients themselves, those taking medicines for heart trouble or diabetes or really any medical condition at all, they must remember that everywhere on the market are pills that kill.

The writer is an attorney teaching constitutional law and political philosophy.

rafia.zakaria@gmail.com

Published in Dawn, December 6th, 2017

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