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Vulnerable to fraud

July 04, 2012

THE healthcare fraud in the US involving the British drug-maker GlaxoSmithKline places before Pakistan a worrying picture of its own pharmaceutical industry. While the Glaxo fraud vindicates the worldwide scepticism regarding the operating of profitable pharmaceutical businesses, in the Pakistani context the concern runs much deeper. As the culture of not questioning the quality and purpose of medicines persists here, Pakistanis are dangerously exposed and liable to submit to unscrupulous agents of the market who are at their most efficient in places where public awareness and resistance are low.

GSK pleaded guilty to misdemeanour in the biggest such case in US history and agreed on a settlement. It will have to cough up $3bn — $1bn in criminal fines and $2bn in civil fines. The agreement “would resolve allegations that the British drug-maker broke US laws in the marketing of several pharmaceuticals”. The company was further accused of failing to provide the concerned US department with safety data about a drug and of underpaying money owed to Medicaid, the healthcare programme for the poor. Compare this with Pakistan where pharmaceutical companies have few checks to contend with. In the US case, doctors were bribed with spa treatments and meals for endorsing illegal drugs. This type of unfortunate marketing can almost be described as the foundation stone of the strategy adopted by pharmaceuticals that operate in Pakistan. There is no accountability of doctors who may not always have a good medical reason for prescribing or promoting a certain drug. Against a developed American system that is on trial for its failure to effectively check malpractice, Pakistan is still struggling to create a beginner’s guide on hauling up drug-makers whose products are questionable. One has only to recall the tragic deaths of 130 heart patients who were administered defective medicine by the Punjab Institute of Cardiology only a few months ago to gauge how grave the situation is.

The fake drugs racket thrives in a set-up where raw material quotas for qualified manufacturers are not that easy to come by and drug-makers are loosely regulated. Unhealthy marketing practices are routine with the federal government and provinces still attempting to define jurisdiction and responsibilities. Theoretically, the enforcement of many of the drug laws has been devolved to the provinces. But practically, there is utter confusion, which, among other things, makes the proposed Drug Regulatory Agency a distant dream. Given the examples at home and abroad, it is necessary to sound the alarm bells. An evaluation of the way medicines are manufactured, marketed and distributed is urgently needed. But can that happen without more clarity on devolution?