Of all of the public health threats facing humanity, the loss of our antibiotic armamentarium due to increasing antimicrobial resistance is perhaps the greatest. Each year we see new, resistant, organisms emerge - and each year we draw a little bit closer to a dreaded `post-antibiotic era'.
One where even minor, previously treatable infections, are often deadly (see Chan: World Faces A `Post-Antibiotic Era’).Great efforts are going on by many nations to improve antimicrobial stewardship and help stave off that day (see CIDRAP's Antimicrobial Stewardship Project), but profiteers and quacks operate around the world, jeopardizing everyone in the process.
We've looked at the problem of fake, substandard, or `counterfeit' drugs before, including:
The Lancet: WHO Estimates That 50% Of Drugs For Sale Online Are Fake
AJTMH/NIH: The Threat From Fake & Substandard Pharmaceuticals
Study: Substandard & Falsified TB Drugs
Some of these drugs have none of the promised active ingredients, while others may be less potent than advertised, or are laced with potentially dangerous substitutes or fillers.
Often more money is spent trying to duplicate the packaging of a legitimate product, than is spent producing the medicine itself.While many are sold online to unsuspecting buyers by overseas pharmacies, or dispensed by `quack' clinics in under-developed countries, their packaging is so good that they can also make their way into legitimate pharmacies and large hospitals in some parts of the world.
All of which brings us to a big story breaking today in the Pakistani press, which describes the discovery and removal of more than 100 `substandard' drugs from public hospitals in Punjab.
April 16, 2018
Laboratory tests of medicines being given to patients at government-run hospitals have revealed a high prevalence of spurious drugs. The tests, overseen by the provincial health department, were conducted over a period of six months and revealed that more than 100 medicines were of substandard quality.
The medicines were obtained from 107 government hospitals, drug testing lab director Mohammad Shafiq informed. The provincial drug unit spokesperson said the medicines have been ordered to be removed from the hospitals immediately and the production of specific batches has been halted.(Continue . . . )
Moreover, safety alerts have been issued for 45 of 80 medicines. The medicines include those for treatment of heart problems, hepatitis, body ache, throat, acidity and anti-biotics. The tests were undertaken on the provincial government’s orders.
The above story comes from the Pakistan Observer, but other English language reports with similar details include:
Over 100 substandard medicines used in Punjab government hospitals: Lab Report - Times of IslamabadIn the last story cited - which is the most detailed of the lot - allegations of government `inefficiency' - and some doctor's complicity - in allowing these potentially deadly drugs to be dispensed are lodged by the senior vice President of the Young Doctor's Association.
Punjab lab declares large number of medicines as substandard - The News
A related story comes from the The Express Tribune, which reports on the Punjab governments ongoing attempts to shut down `quack' clinics. A problem so pervasive, that the Punjab Healthcare Commission highlights their anti-quackery website on their front page.
In the ongoing crackdown on quacks, the Punjab Healthcare Commission (PHC) has closed down over 8,557 fake treatment centres of quacks in Punjab so far and imposed Rs68 million fine on them. According to PHC, the teams visited different parts of three cities during the last three days, including Lahore, Rawalpindi and Okara, and sealed 57 more businesses of quacks.Fake drugs and quack clinics can be found almost anywhere in the world, but the problem appears to be particularly rife on the Indian subcontinent (India, Pakistan, Bangladesh, Nepal, Bhutan, etc.), which is home to almost 1/4th of the world's population.
Quacks have been categorised as 29 general quacks, 18 fake dentists, nine hakeems and one bone-setter. In Okara city, 28 quack businesses were closed, which comprised 16 general quacks, seven fake dentists and five hakeems. Nineteen fake treatment centres were also closed down in Rawalpindi, which included nine dentists, six general quacks, three hakeems and a bone-setter. The PHC team had also sealed 10 fake treatment centres in Lahore, which comprised seven general quacks, two fake dentists and a hakeem.
The sealed businesses were: Liaquat Clinic, Amin Clinic and Hospital, Rehman Clinic, Al-Hafeez Homoeo Clinic, Hamza Clinic, Al-Rehman Clinic and Fauji Clinic and Medical Store. Also, two dentists, Surgery Dental Clinic and Gaba Dental Clinic, while one Nusharaf Matab were also sealed.
Add in the easy availability of antibiotics (both real & counterfeit) without prescriptions (see Global AMR Threat: Centrally Approved & Unapproved Antibiotic Formulations Sold In India), and you have a recipe for disaster.As we've seen recently, the problem of `fake' drugs extends into veterinary medicine as well, which can produce similar predictably bad outcomes (see Taiwan's Counterfeit AI Vaccine Trade).
Unless you are buying your prescription drugs from an unscrupulous online pharmacy, Americans are most likely to encounter these fake or substandard medications while traveling to developing countries.
The CDC’s Traveler’s Health website offers the following advice.
Counterfeit, or fake, medicines are manufactured using incorrect or harmful ingredients. These medicines are then packaged and labeled to look like the real thing. Counterfeit medicines are unsafe because they may not work and could harm you.
Counterfeiting happens all over the world, but it’s most common in countries where there are few or no rules about making drugs. An estimated 10%–30% of medicines sold in developing countries are counterfeit. In the industrialized world (countries such as the United States, Australia, Japan, Canada, New Zealand, and those in the European Union), estimates suggest that less than 1% of medicines sold are counterfeit.
The only way to know if a drug is counterfeit is through chemical analysis done in a laboratory. Counterfeit drugs may look strange or be in poor-quality packaging, but they often seem identical to the real thing. The only way to make sure you have the real thing is to bring all the drugs you will need during your trip with you from the United States, rather than buying them while you are traveling.
If an emergency occurs and you must buy drugs during your trip, you can reduce your chances of buying drugs that are counterfeit:
- Buy medicines only from licensed pharmacies and get a receipt. Do not buy medicines from open markets.
- Ask the pharmacist whether the drug has the same active ingredient as the one that you were taking.
- Make sure that the medicine is in its original packaging.
- Look closely at the packaging. Sometimes poor-quality printing or otherwise strange-looking packaging will indicate a counterfeit product.
- If you buy drugs online, visit Buying Prescription Medicines Online: A Consumer Safety Guide to learn how to buy safely.