Pakistan pharmaceutical industry and Fake Medicines Crises


By Shoaib Habib Memon

Pakistan has a growing pharmaceutical industry. As of 2012, the total export value of Pakistani-manufactured medicines around the world stood at $400 million.Many different companies sell a diverse range of drugs and pharmaceutical products, the biggest household names of which include:

Ferozsons Laboratories

Getz Pharma

Herbion

Remington Pharmaceuticals

Barrett Hodgson Pakistan

Zahoor Pharmaceutical Industry PVT LTD

Bosch Pharmaceuticals

Nucleus Pharmaceuticals (Pvt) Limited

Shaf Pharma

Macter International Limited

Today, the pharmaceutical sector is one of the most developed hi-tech sectors within the country’s economy. New pharmacy schools have been set up nationwide in the past few years which provide and cater to quality pharmacy education to students of pharmacy. Within the province of Punjab,the Punjab Pharmacy Council (based in Lahore) is a government department responsible for conducting examination and tests.

The Pakistan Pharmacists Society is the national professional organisation of pharmacists country-wide and also acts as a regulatory authority controlling pharmacy practice in Pakistan. Pharmaceutical authorities in Pakistan are part of the International Pharmaceutical Federation.The Pakistan Pharmacists Society (PPS) is the national organization of pharmacists and student pharmacists, committed to providing leadership for the pharmacists. PPS has a mission to promote and expand the profession of pharmacy and the role of pharmacists in Pakistan. PPS is dedicated to improve public health and patient care by enhancing professional development of the pharmacists and the Pakistan pharmacy council.

PPS Objectives are,To promote pharmacy as an essential component of the healthcare team and to serve as primary catalyst for this change.

To contribute to continuing education programmes for pharmacists already engaged in practice to improve the medication use and health outcomes of patients.To promote high standards of professional conduct amongst pharmacists in order to improve medication use.To provide leadership in the identification, development and implementation of health policies of concern to pharmacy.To hold seminars, symposia, exhibitions and conferences in order to foster national and international collaborations. To liaise with health professional organizations and others in order to achieve aforementioned objectives.

In most jurisdictions (such as the United States), pharmacists are regulated separately from  physicians. These jurisdictions also usually specify that only pharmacists may supply scheduled pharmaceuticals to the public, and that pharmacists cannot form business partnerships with physicians or give them “kickback” payments. However, the American Medical Association (AMA) Code of Ethics provides that physicians may dispense drugs within their office practices as long as there is no patient exploitation and patients have the right to a written prescription that can be filled elsewhere. 7 to 10 percent of American physicians practices reportedly dispense drugs on their own.

In some rural areas in the United Kingdom, there are dispensing doctors who are allowed to both prescribe and dispense prescription-only medicines to their patients from within their practices. The law requires that the GP practice be located in a designated rural area and that there is also a specified, minimum distance (currently 1.6 kilometres) between a patient’s home and the nearest retail pharmacy.

In other jurisdictions (particularly in Asian countries such as China, Malaysia, and Singapore), doctors are allowed to dispense drugs themselves and the practice of pharmacy is sometimes integrated with that of the physician, particularly in traditional Chinese medicine.

In Canada it is common for a medical clinic and a pharmacy to be located together and for the ownership in both enterprises to be common, but licensed separately.

The reason for the majority rule is the high risk of a conflict of interest and/or the avoidance of absolute powers. Otherwise, the physician has a financial self-interest in “diagnosing” as many conditions as possible, and in exaggerating their seriousness, because he or she can then sell more medications to the patient. Such self-interest directly conflicts with the patient’s interest in obtaining cost-effective medication and avoiding the unnecessary use of medication that may have side-effects. This system reflects much similarity to the checks and balances system of the U.S. and many other governments.

A campaign for separation has begun in many countries and has already been successful (like in Korea). As many of the remaining nations move towards separation, resistance and lobbying from dispensing doctors who have pecuniary interests may prove a major stumbling block (e.g. in Malaysia).But Still Pakistan pharmaceutical Companies not pursuing the rules. Several Patients die due to usage of Fake  Drugs.

During late January 2012, a fake medicine crisis at the Punjab Institute of Cardiology (PIC) hospital in the Lahore region of Punjab, Pakistan, claimed the lives of over 100 heart patients. According to various reports, the incident involved patients who had been receiving treatment at the hospital and had been prescribed with substandard medicine.The medicine triggered an unknown disease which deposited itself in the bone marrow and ended the body’s resistance. The generation of white blood cells stopped in the body. Among the symptoms of the disease were a severe chest infection, change in complexion, low platelet count and blood vomiting.

The medicines were free of cost and distributed mainly to poor people. The total number of people who may be at risk after taking medicine from the hospital may be as high as 46,000 according to one report.

Almost all victims were from the Lahore area. One fatality was also recorded in Multan.The Chief Minister of Punjab Shahbaz Sharif vowed “stern action” against those responsible and announced a compensation of Rs. 500,000 each for the victims’ families. The Federal Investigation Agency (FIA) formed an investigation team to probe the incident on the orders of Minister for Interior Rehman Malik.The team arrested some people reportedly involved in the distribution of the medicine. Cases were also registered against three pharmaceutical companies who made the medicine.

Investigations revealed that the licence in one of the three pharmaceutical laboratories which supplied the contaminated drugs to the PIC had long expired in April 2011. Despite this, the company continued to manufacture the drugs in bulk and supplied them to government hospitals and open markets. As the death toll exceeded one hundred, the Lahore High Court ordered respondents involved in the case to file their replies by the 30th of January.

Tests performed by the British Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom indicated that one of the five suspected drugs – Isotab – was contaminated. A report also showed that the medicines contained Pyrimethamine which is in fact used for the treatment of malaria. The presence of pyrimethamine proved to be toxic.

The writer can be contacted at -shoaibhmemon@yahoo.com