IN Pakistan, where millions of people rely on medicines for daily survival, people often live with high uncertainty. Quality can feel unpredictable, blind spots are common, and patients frequently wonder whether the drugs and the affordable generics they are taking are truly as safe and effective as they claim to be. Stories of substandard drugs, sudden shortages and varying responses to different brands create anxiety for families, pharmacists and doctors alike.

In this environment of limited trans-parency and strong regulatory challenges, building genuine trust in affordable medicines has become not just important, but essential for public health.

This uncertainty, however, is not unique to us. In the winter of 2007-08, patients undergoing dialysis in the United States suffered sudden and frightening reactions that included nausea, breathing difficulties and sharp drop in blood pressure. The cause was traced to contaminated heparin, a critical blood thinner, where an adulterated ingredient from overseas suppliers had slipped into the supply chain, resulting in hundreds of adverse events and tragic loss of lives.

The tragedy exposed vulnerabilities in medicine manufacturing processes, and reminded us that even advanced systems can fail when quality is compromised. At the same time, it highlighted the indis-pensable role of medicine and generic drugs in patient care. When produced with care and scientific rigour, they deliver safe, effective treatment to millions who would otherwise be unable to afford life-saving medicines.

Today, generic medicines dominate prescriptions in Pakistan and elsewhere, offering the same therapeutic benefits as branded originals at a fraction of the cost. They help stretch limited household and national healthcare budgets. However, true progress demands recognising that one policy cannot fit all generics. Different products require different scientific logics and tailored approaches.

A simple pain-killing tablet cannot be evaluated the same way as a complex injectable, an inhaler, a biosimilar or an ophthalmic emulsion. Both regulatory authorities and manufacturers must, therefore, apply a totality of evidence approach, carefully adapted to each product’s unique characteristics covering formulation, manufacturing quality and bioequivalence studies. This product-specific wisdom is crucial to reduce blind spots and to build real confidence among the patients.

A powerful success story is the approval of the first generic version of enoxaparin, a complex injectable anticoagulant. After detailed scientific characterisation and demonstration of sameness using advanced analytics, patients worldwide gained affordable access to this vital medicine for preventing dangerous blood clots.

Wisdom from pharmaceutical quality experts teaches us that approval is only the beginning. Real-world consistency depends on designing quality into every step of production, understanding product-specific critical attributes, and maintaining robust supply chains. In Pakistani market, the pressure for the lowest price must never override patient safety.

Building a lasting trust in affordable medicines requires a thoughtful balance, never sacrificing quality for cost, or access for perfection. When science, integrity and product-specific wisdom guide every step of the way, generic drugs truly become reliable partners in care, protecting both health and household budgets for families.

Roohi Bano Obaid
Karachi

Published in Dawn, June 9th, 2026