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Bad medicine


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A patient’s hand is blackened after using the tainted drug, one of the many mysterious symptoms. -Photo by author

“My father died last week, and now my mother has been hospitalised with the same problem. I swear to God, if something happens to her, I will burn this hospital down,” says Yasmin, as her eyes well up with angry tears. She is among the hundreds of people whose family members have been affected by the contaminated drugs doing the rounds at Lahore’s hospitals.

The news of these mysterious deaths has been doing the rounds since early January, and the current death toll (at the time of reporting) stands at 75, with over 200 patients (from all over Punjab) admitted in Lahore’s Mayo, Jinnah, Services, General and Ganga Ram hospitals. Medicines issued by the Pakistan Institute of Cardiology (PIC) remain the common link among these patients.

While it remains to be proved, common consensus is that the December 2011 batch of the medicine was the main cause of these mysterious deaths. It is feared that of the 46,000 patients to have been issued the medicine (from the latest batch), a large number could have fallen sick and died at home, with the number of hospital cases also feared to rise.

The Services Hospital has, in fact, seen an increase in the number of bereaved relatives, who have been filing in papers for their deceased family members. Coming to terms with the tragedy at hand, carrying certificates of death, they stand around confused and muddled. No one, they say, comes to their help.

Puzzling symptoms “My father was admitted on January 1, after he started throwing up blood,” says Saquib. When his father was admitted, Saquib believes there must have been at least 50 other patients with the same symptoms at the Services Hospital.

“My mother began bleeding from the nose and mouth,” adds Shazia.

“Her face was dark like coal, she couldn’t eat or drink anything, she kept complaining of a dry throat, and her mouth smelled like a decaying corpse…as if something inside her was dying.”

Shazia is back at Services Hospital now, seeking a death certificate for her mother. The registration of her mother’s death may also allow her to receive the compensation money announced by Chief Minister Shahbaz Sharif. The hospitals, however, seem to be avoiding registering any more deaths over the next few days, especially those caused by this mysterious illness. Officials at the hospital, she alleges, are misleading her.

Several grieving relatives have not received death certificates, while others complain that their loved ones were forcibly discharged while they were still seriously ill.

“My father was very sick and weak, with blood in his urine and a constant nose-bleed,” says a young man, requesting anonymity. “But they administered a drip which stopped the vomiting for some time and told us to go home and carry on with the medication. No one bothered to check what was actually wrong. Some days later, my father died.”

Nothing, really, was meant to be wrong with medicines being used by the heart patients since they had been using the same pills for, in some cases, decades. Nothing had happened then, and they fail to understand what is happening now.

Saquib’s father had been admitted by early January, with the symptoms. By mid-January, the death toll had climbed up to 27. Only after January 20, 2012, did the constant media coverage wake up a slumbering Punjab Government and bring it on the forefront, unprepared. At first, tests conducted at a government-run lab showed no irregularities in medicines. However, with increased media coverage, a further test proved the presence of a toxic chemical.

Fatal formula According to sources, a blood-thinning drug called ‘clopidogrell’ was initially believed to be the cause of the mysterious illness. However, reports showed that four to five of the affected patients were not using this drug. Later, it was strongly suspected that “cardiovastan” (brand name, drug formula: Simvastatin), which is a cholesterol-lowering drug was the reason.

The drug, which was being distributed to the patients, is being locally manufactured by Mega Pharmaceuticals.

Drugs, sources say, are tendered by private companies but only after being tested by labs for pre-qualification and are then re-tested before they are paid for – a procedure followed by the manufacturing company.

“Usually drugs are only assembled in Pakistan, with the raw materials being imported from abroad,” says the source. “The raw material used for this batch was perhaps not imported and was instead produced locally, making it sub-standard. Or, the arsenic used in the paint on top of the pill was in excess and resulted in poisoning. We are not sure what the cause is.”

Catching the culprits Among the owners of the factory, who have been sent arrest warrants, one name that is repeatedly emerging is that of a PML-N parliamentarian, who is allegedly the ‘real’ owner of Mega Pharmaceuticals, while the ‘paper-owner’ is someone else, who is also involved in the chemicals business. While the matter remains puzzling, if the allegations are proven to be true, it may turn out to be a case of the Punjab Government trying to cover up the involvement of their MNA. In a more serious development, it has been discovered that another medicine, manufactured by the same pharmaceutical company, is being sold in the same packaging by the name of Megasar (formula: Losartan potassium, with international name Cozaar), which is prescribed for hypertension.

Two drugs, one of which is among the spurious medicines, are sold in the same packaging by the same company – leading to confusion among the patients. -Photo by author

Packaging two drugs in a similar manner is dangerous and misleading, according Dr Asma Zaman Faruqi, one of the United Kingdom’s (UK) top consultant pathologists.

“The two drugs are not similar in their actions and should not be packaged identically,” she says. “Both simvastatin and cozaar have been associated with haematological disorders, one of which isthrombocytopaenia – a condition in which the platelet-count falls, leading to bleeding disorders. It is a rare complication in both the drugs. It also needs to be investigated whether the patients involved were taking any other medicine or substance, which could have interacted with their medication.”

“The patients,” Dr Faruqi says, “could have been taking blood-thinners such as aspirin” and recommends a close study of the outbreak.

Mysterious moves Earlier this week, the Medical Superintendent (MS) at Services Hospital, Dr Rehana Malik was stressing out in her office. Stealing a few minutes away from the pressures of the work outside, Dr Malik was in her office faxing figures to the health secretary of the Punjab Government and arranging for more beds and blankets for the medical wards, where the PIC patients were admitted.

However, in a swift and sudden action, Dr Malik was removed during the night shift by the chief minister, without announcing any replacement.

PML-N spokesperson Khwaja Salman Rafique, who arrived at Services Hospital on Wednesday morning, told reporters that the CM removed Dr Malik since he was not satisfied with the regulation of the wards and believed there monitoring was not up to the mark. Without any further explanation, the MS was nowhere to be found, even by aggrieved relatives, who wanted to carry out the paperwork.

Samples of the medicine, Salman said, had been sent abroad for testing, under the directives of the CM, who had taken ‘serious notice of the situation.’

A police FIR was lodged at the Shadman Police Station under Section-321, and the FIA have already caught four manufacturers, who are currently on remand.

“We must also note that more than 100 people have left and have recovered,” Salman insisted.

Waheed shows the medical report of his wife, who suffers from low platelet count and bruises, among other mysterious symptoms. -Photo by author

Meanwhile, another order issued by the chief minister – to serve the patients free of cost – has gone unnoticed by officials.

“I have to run around to get this injection for a bone-marrow,” says Waheed, whose wife is ill. “It costs about 60 rupees, but with the way things have gone, these people should not charge us with even a paisa.”

His wife has suffered from severe bruises on her skin, and her platelet level is below normal. Many other patients complain of chest pain and lack of oxygen.

Blame game The President of Pakistan Medical Association Punjab Dr Ashraf Nizami, has condemned the CM for his carefree attitude towards health-related issues in the province.

“He (Shabaz Sharif) holds a portfolio of Health Minister, when there should be a separate ministry for this purpose," says Dr Nizami. “He has failed to make any improvements in the health standards in his province. In fact, this is the second epidemic outbreak during his tenure, where people are dying in dozens,” he adds, referring to the dengue outbreak from last year.

The enquiry committee set up by the CM is headed by Dr Javed Akram, who also owns a pharmaceutical company, called Don Valley Pharmaceutical. “It is technically owned by his wife, but how can we exclude him from the issue?” questions another doctor at PMA.

The 48-member committee’s other members include PIC Chief Executive Professor Muhammad Azhar, Services Institute of Medical Sciences (SIMS) Principal Professor Faisal Masood, Professor Irshad Hussain, Professor Farzana Chaudhry, Professor Bashir Ahmad, Professor Farkhanda Kokab, Additional Secretary Health (Technical) and Dr Muhammad Anwar Janjua.

The hospitals are making attempts to retrieve the contaminated drugs, but some patients or mourning relatives are not complying.

“This is proof that we have in our hand,” says Waheed, pointing to the medicine. “We are going to keep it.”

PPP MNA Uzma Bukhari has vowed to keep the issue active and predominant during national assembly sessions. “We want an unbiased inquiry,” she says.

“It is disgusting the way the CM simply puts price tags on lives by compensating them with money. The man holding both portfolios should at least face the assembly and be held accountable for this crime. He never bothered to attend assembly sessions during the dengue epidemic, and he is still acting as if nothing has happened. The figures are simply alarming,” she adds.

Meanwhile, at the hospitals, patients and their relatives are left in the lurch - not knowing whether to remain hopeful of seeing their loved ones recover from the mysterious, or, to expect the worst.

The author is a freelance journalist.

Comments (14) Closed

kanwal Jan 27, 2012 08:21pm
Shahbaz Sharif should resign. This is his responsibility. If it was his personal health issue, he would have been in London the very next day. Common people can die in hordes. Who cares?
Mian Amir Hakim Jan 27, 2012 08:53pm
I congratulate Dawn for such a bold & thorough report. The Media has again done very well in exposing these culprits. Alas; nothing is going to happen. Like all previous tragedies this issue too will soon be forgotten. Where is the Supreme Court. I wish Justice Iftikhar could feel the pain of the kin of those 100 dead. The big guns and real culprits who own the pharmaceutical companies should be punished not the paper owners. But who will bell the Cat. The fat, corrupt, strong and lethal CATS.
Adnan Qazi Jan 27, 2012 09:23pm
While the enormity of this tragedy has sympathies of most Pakistani people, it seems that once again politicians are using this unfortunate event for their own gains. In doing so the Pharmaceutical companies have already been identified as the guilty parties and a number of vital issues have been sidelined: • Why are the patients all from a specific area? Surely the five companies must have supplied their product in other regions too. It is worth keeping in mind that people in this area have recently been suffering from loss of platelets due to dengue fever. Is it possible that ordinarily this drug would have been fine but if prescribed to a patient who is already suffering from a decrease in platelets, it may have terminal effects? • Assuming that the drug is directly responsible for this loss of life, surely the responsibility goes way beyond the manufacturer. We are informed by our ‘honourable politicians’ that the drugs have been sent to other countries for testing. If there is no facility for the medicine to be confirmed safe then whose is to determine what is safe? Surely not just the party who made it. The government has a responsibility to ensure safety before the drugs can be sold to hospitals. • Another snippet of news relayed that there was no expiry dates on some of the medicine. If so, why was it accepted by the hospital? Why was it dispensed from the pharmacy? • Drugs that are consumed by the patients in Pakistan are tested for ‘pre-qualification’ and then tested again before payment. This gives rise to two questions – 1. The final responsibility for safety is with the testing agency and why are they running free when the manufacturer has been arrested? 2. How valid are these tests if now we are looking to other countries for testing? • In the absence of the testing facilities in this country and with so many other bodies of responsibility, is it right to show expedience by these quick arrests? We all want to get to the bottom of this issue, but let us have a true review and get to the real root cause rather than expressing satisfaction with the politically convenient scapegoats’ and leaving the real issue where it has always been – under the carpet.
adnan shahidullah Jan 27, 2012 10:53pm
the procedure involving arrest of the owners is not according to the law, also the crime is yet not proven, i wonder how these five brands used the same ingredients... in my opinion the problem is with one of the excipients which may be locally manufactured or stored under conditions which leads to the deterioration of the ingredients.. a view of a Pharamcist
abdul j sheikh Jan 28, 2012 01:26am
Why dawn did take that long to write about bad medicine. It should be publshed very next of the first incident. And what about concert stempede in lahre. I asked dawn many time through my comments. Every time dawn kill my comments in the name of moderation. Journalism about bring the truth not protecting the criminal.
koray Jan 28, 2012 04:27am
These people will one day stand infront of the Creator and they will be judged....
Umer Islam Jan 28, 2012 12:35pm
Complete article. Excellent work
Dr. Azhar Sherkheli Jan 28, 2012 01:04pm
The fundamental reasons for such tragedies in countries like Pakistan is professional incompetency on part of health professionals, lack of public awareness, no consumer protection laws and above all a greedy and criminal mind set of so called industrialists doing business in the pharmaceutical field . Whether the drugs are manufactured, processed, distributed or managed; the key handlers and decision makers are non professionals (non pharmacists). On the first hand there is a severe shortage of professionally competent and morally sound pharmacists and on the other hand there is surge of private sector universities in Lahore and elsewhere where pharmacy-quakes ( with the degrees of Doctors of Pharmacy) are produced. These pharmacy-quakes can manufacture only substandard and toxic drugs as they hardly know the basics of innovative, rational and effective pharmaceutical drug designing. Such people are an easy hunt for criminal mentality of greedy-industrialists who use degrees of these pharmacy-quakes to get registered with drug regulating authorities. The result is what we see in as present tragedy, a huge loss of human life. The corrupt political elite of Pakistan does not need the health system of the country, as they go abroad even for their routine check-ups, so they think that they are immune to a variety of quakes dominating the health profession in Pakistan. Thus the responsibility of those who believe in the dignity of human life and know what it means to save a human life is many fold. The media can play a very constructive role in creating public awareness, civil society (if it exists in Pakistan!), must also play an active role in forcing the political elite to formulate and implement appropriate drug laws. The most critical part is to have enough numbers of professionally qualifies and competent pharmacists in the society at each and every level of health profession, be it a manufacturing, distributing and storing or dispensing to patients stage. Drugs must be supervised by a pharmacist as is done in any civilized society of present time. There must be a proper licensing exam for Pharmacists and medical doctors instead of only having a paper degree from degree selling colleges and universities of Pakistan. If there is no quality health system you cannot have quality health services!!! The only result will be tragedies like this one.
Muhammad Arfat Jan 28, 2012 02:46pm
It is very informative article and excellent work. It helps me to fid actual issue.
sima Jan 28, 2012 04:25pm
Excellent article! Dawn and the reporter should be congratulated. Well done! On another note -- all govt officials and employees must be legally forced to get their treatment in Pakistani hospitals -- things will improve automatically !
Sarwat Jan 28, 2012 06:14pm
Excellent article. A genuine work.
sherie Jan 28, 2012 06:41pm
This is how u report recall of a drug: all recent news... it happens. question is why, for days, no one could speak the name of the drug in question... and why the media(with power to reach everyone as they claim) did not tell people to go to their pharmacy or doctor to confirm if they have the defective batch. the first thing i did was to call all relatives on cardiac medicines and advise them to chek with their provider what they have and if it is the faulty batch. isnt public health and safety above the value of some influential persons name?
Arshad Jan 28, 2012 08:10pm
very nice and complete work, well done Xari
starnebula Jan 29, 2012 01:48am
In Pakistan lot of things go awfully bad, an inquiry is ordered and everybody goes to bed as if nothing is wrong. Does anyone in Pakistan demand to know the results of an inquiry? If not, why blame the govt, blame yourself for being inactive.