IN the last week of November a number of persons died after ingesting a cough syrup marketed under the label Tyno in Lahore’s low-income Shahdara area.
The thrust of the media coverage rested on the narrative of habitual addicts overdosing on otherwise medicinally safe syrup. This shunts blame on to the victims without focusing on the underlying issue of substandard and spurious medicines.
How was it that the ages of those who died ranged from 15 to 45 years? Were they all addicts who had made a pact to die within a week of each other? It cannot be right that all of them were addicts; they would after all have presumably been taking overdoses of the syrup for some time, so why should they all succumb within a week?
There must have been something wrong with the medicine, but we are no wiser as to what ingredient caused so many deaths.
The twin issues of unsafe drugs and poor regulation/ enforcement are intimately bound up with drugs-related deaths. The tragedy at the Punjab Institute of Cardiology (PIC), which claimed more than 200 lives last year, is instructive in this regard.
Those deaths resulted from the ingestion of Isotab tablets dispensed by the healthcare centre to poor patients. The test undertaken in London showed that the ingredients included anti-malarial components. One year on, the inquiry report into the tragedy has yet to see the light of day and no one has been indicted.
The furore over the Tyno tragedy will also die down soon. In both cases, from the way things appear, no lessons have been learnt. Yet both instances have underscored serious issues with the existing policy and legislative framework on drugs’ registration, safety and the menace of spurious medicine.
In some regions, such as Latin America, Asia and Africa, estimates of the availability of spurious medicines range from 10 to 30 per cent according to a report produced by the International Medical Products Anti-Counterfeiting Taskforce in 2006. In 2010, the Centre for Medicine in the Public Interest, a US-based non-profit organisation, estimated the worldwide volume of counterfeit drugs’ trade at $75 billion. Like other developing countries, Pakistan also suffers from this scourge in a big way.
While estimates vary regarding the extent of the problem in Pakistan, Interior Minister Rehman Malik put the percentage of spurious drugs being sold at between 40 and 45 per cent of the total. Mr Malik’s frank admission, though later withdrawn, hints at the magnitude of the problem.
Counterfeit or spurious medicine is an imitation of a genuine medical product. Apart from resembling genuine drugs by artful packaging, counterfeit medicines contain either less than required active ingredients or altogether substandard ingredients, both with serious health consequences.
Spurious or substandard medicines often fail to cure the patient or achieve the result desired (in these cases, consumers switch to other medicines without the counterfeit nature of the drug being exposed); second, they can cause unexpected adverse reaction which can be fatal; third, they can kill the patient, something that is often put down to negligence on the part of doctors.
This brings us to why the problem exists in Pakistan and how it has grown. Again, many reasons can be adduced. These range from lax regulatory and enforcement mechanisms to the lack of punitive deterrents, the absence of health literacy and inadequate laboratory testing facilities.
Although there are many legislative and policy instruments in place in this context, they have failed to have any appreciable impact. The most notable instrument is the Drugs Act 1976. With a limited ground force of drugs inspectors, it has failed to dent the volume of the trade in spurious/ substandard drugs. The act is riddled with loopholes which have allowed tragedies to occur. The number of inspectors envisaged is patently inadequate to addressing proliferating medicines in the market.
Moreover, the act has failed to deter offenders due to lengthy court processes and a lenient sentencing regime.
In order to stem the occurrence of the tragedies such as those in Lahore, the following measures can go some way in starting the process.
First, the Drugs Act 1976 needs to be upgraded and vigilantly enforced by increasing the inspection force and speeding up court processes, and handing out tougher punishments. Second, the recently established Drugs Regulatory Authority of Pakistan (Drap) can be made more effective and independent by bringing health watch groups on its board and reorienting the body more towards patients’ and drugs’ safety concerns.
Third, it would be useful to set up a network of modern drug testing laboratories at all levels so that incriminating ingredients can be identified. Fourth, putting in place a proper reporting centre where spurious drugs can be reported to Drap is essential. Fifth, we need the registration and regulation of drugstores where counterfeit medicines are suspected of flourishing due to a mixture of low levels of health awareness, poverty and lax control. Then the easy availability of medicines should be curbed through prescription-only regulations to prevent fatal accidents through over-ingestion. Lastly, a system of generic medicine needs to be urgently introduced to overcome the proliferation of unsafe and expensive drugs.
Both the PIC and the Tyno tragedies serve as a wakeup call. The case for bringing in tougher regulation and beefing up the current loophole-riddled legislation to keep drugs and consumers safe in the larger interest of public health has never been more urgent.
The writer is an Islamabad-based development consultant and policy analyst.