WITH 120 patients already dead from drug reaction in Punjab, it is important that we look into the possible causes of the debacle.
The Pakistan Pharmaceutical Manufacturers Association (PPMA) has blamed doctors for not taking proper histories of patients before putting them on drugs.
They quite rightly pointed one cause but then there are other causes which we need to discover. When I looked at it, and I have been Director of the JPMC, the largest tertiary-care hospital in the country, I see four other important factors responsible, namely:
a. The tablets WHO supplied were in jars and not in some form of standard packing.
b. Blue/green discoloration of the tablets. One of the tablets supplied changed colour within two weeks.
c. Expiry date in February 2012. It is a standard practice that you stop marketing a drug six months in advance of its expiry date.
d. 80mg dose. Normally Atrovastatin is given in 20 to 40 mg dosage.
e. Other drugs being used simultaneously, eg. Aspirin/ soluprin etc.
I suggest that we keep all this in mind and advice doctors and the PPMA to avoid these breakdowns when using any drug, espacially on cardiac patients.
PROF( Dr) M. JALISIJ.J. HospitalKarachi
Testing the qualityTHIS is with reference to reports in newspapers about drug reactions at the Punjab Institute of Cardiology, Lahore. Being a student of pharmacy and law, I am surprised to see how people come to know about the quality of medicines just by looking at the drug.
There is no litmus test to tell the quality of drug in a few minutes. There is an elaborate procedure for drugs testing which may sometimes take months to reach a conclusion. It is unfortunate that all non-technical people are giving their ‘expert’ opinions who do not even know the ABC of drugs.
Such strange theories are propounded as makes a person laugh. This situation is very unfortunate and needs cogent approach.
Just sealing a few factories and apprehending a few drug manufacturers may please the public but is not the solution to the problem.
At one place the government itself claims that drugs are of standard quality whereas different departments of the federal and the provincial government have jumped into the fray to complicate the situation.
Any drug without active ingredient (i.e., spurious drug) is never able to cause any untoward/adverse drug reaction. A drug without active ingredient may contain lactose as an inert substance which could not cause drug reaction.
There is a need to form a committee comprising clinical pharmacists of Shaukat Khanum Memorial Hospital, Lahore, and pharmacists of the public sector, professors of pharmacy/pharmacology, PCSIR scientists and professors of medicine to probe, inter alia, the root cause of these reactions.
These persons may also check possible drug to drug interactions, dosages to single out the main culprit drug, besides checking the pharmaceutical raw material of these factories for toxicological studies to check their safety and efficacy, besides other factors.
There is also a need to augment drug testing laboratories to establish as a benchmark for drug testing. We must stop calling any drug fake without scientific evidence.
FAROOQ BASHIR BUTTLahore
Govt negligenceIT is unfair to criticise the Punjab Institute of Cardiology for what has happened recently as it is one of the premier cardiac care hospitals of Pakistan which has served hundreds of thousands of poor citizens, not only from Punjab, but also other provinces, including KP, Balochistan and even parts of north Sindh, apart from AK and GB.
If spurious and contaminated medicines are being manufactured in Pakistan, the responsibility lies solely with the state, which includes both the federal government and provincial governments.
The basic imported raw material required for drugs, if substandard or expired, is the responsibility of Customs and the FDA which should check these before allowing them in.
Unfortunately the cancer of corruption and its unchecked political and bureaucratic patronisation is the major cause for thousands who have died of various treatable and preventive ailments.
The problem with Pakistan’s healthcare is the lack of resources and priority that the federal government has over the years provided for this basic need. Apart from this, placing the health ministry and its regulatory and administrative executive under control of civil bureaucrats has contributed to its decadence.
Principles such as conflict of interest are not an issue in Pakistan, which is why powerful pharmaceutical owners and importers are represented on major committees whose task it is to regulate and frame policies that control quality of drugs that are being sold and consumed within Pakistan.
Even when the Federal Drug Regularity Authority was under the federal government, as it is today, there were major scams involving massive corruption and irregularities in awarding licences to pharmaceutical groups, without credible scientific scrutiny, at the discretion of either the minister for health, or bureaucratic and political intervention.
The Federal Drug Regulatory Authority and their inspectors must strictly be run and managed by senior qualified pharmacists from internationally recognised institutes, and the CEO must have constitutional protection with strict auditing and laboratory testing capability within Pakistan for checks and balances.
Unfortunately, in a country where the political or bureaucratic elite have never placed any confidence in getting treatment within the country, this area has been criminally neglected, resulting in epidemics like hepatitis, TB, Congo Fever, dengue, etc.It is not that our doctors or pharmacists lack professional capabilities, but the failure of the state to provide basic infrastructure and incentives for vital quality service to human beings.
ALI MALIK TARIQLahore