#India lags in transparency laws on drug firm-doctor dealings #healthcare



Rema Nagarajan,TNN | Jun 10, 2013,=
The trend towards greater transparency in interactions between the healthcare industry and healthcare providers, including doctors, is catching on globally with France being the latest in enacting a law to make disclosures of relations between healthcare professionals and industry.

The French law, dubbed Strengthening of Health Protection for Medicinal and Health Products, was brought into force in the last week of May laying down disclosure obligations, which affect all agreements concluded between healthcare professionals (HCPs) and companies, as well as every benefit in kind or in cash exceeding 10 euros. According to the decree implementing the law, a free public website with all the disclosures will be maintained by a public authority. This law is similar in intent to the US Physician Payment Sunshine Act, which came into force earlier this year.

Several other countries are ramping up their transparency laws regarding payments between healthcare companies and physicians even as India continues to have no laws to regulate companies that give doctors freebies. If caught, only doctors are penalized, not companies.

Disclosure under the French law will include all contracts such as R&D contracts, contracts for clinical trials or observational studies, consultancy agreements for being speakers or on advisory boards and invitations to scientific or medical events for which the costs such as registration fees, travel costs, meals and accommodation expenses are paid by the company. This disclosure obligation applies to every payment and contract issued from January 2012 onward.

The US law requires the healthcare industry to report annually to the secretary of health and human services certain payments or other transfers of value to physicians and teaching hospitals. All the information is to be posted on a public website expected to be ready by next year.

Slovakia, too, is reported to have enacted a similar law. Belgium is looking into the possibility of introducing a similar law. Already, in Belgium, companies that have marketing authorisation for medicines have to keep a record of all gifts or benefits offered to doctors.

In Germany, there are no similar transparency laws but insurers are demanding prison sentences of up to three years for doctors who accept bribes or other favours. This demand followed cases of doctors being allegedly paid to prescribe a company’s drugs and the publicizing of many doctors earning huge amounts of money for supposedly conducting observational studies, where pharmaceutical companies pay doctors to observe the side effects of new drugs, often a cover-up for paying them to prescribe certain drugs.

In the midst of this clamour internationally for greater transparency in drug industry ties with healthcare providers, the Indian government continues to ignore recommendations of the parliamentary committee on health, the Medical Council of India and several doctors

“To those who believe in resistance , who live between hope and impatience and have learned the perils of being unreasonable. To those who understand enough to be afraid, and yet retain their fury”

 

Drug Patent Rights India Wins First Round Novartis Full Text of Judgement


 

The instances of Multinationals stealing indigenous medicines is well-known.

So are the capricious overpricing of life saving Drugs, like Cancer Drugs.

The Intellectual Property Appellate Board rejected the German drug maker’s appeal of the 2012 ruling on Monday. It also ruled that under the license Natco must pay 7 per cent in royalties on net sales to Bayer.

Bayer sells a one month supply of the drug for about $5,600. Natco’s version would cost Indian patients $175 a month, less than 1/30th as much.

Western pharmaceutical companies have been pushing for stronger patent protections inIndia to regulate the country’s $26 billion US generics industry, which they say frequently flouts intellectual property rights. However, health activists and aid groups counter that Indian generics are a lifesaver for patients in poor countries who cannot afford Western prices to treat diseases such as cancer, malaria and HIV.’

Big Court Ruling Favors Generic Drugs: The Times’s Katie Thomas explains why a ruling in India favoring generic drugs has rippling effects around the world.

Big Court Ruling Favors Generic Drugs: The Times’s Katie Thomas explains why a ruling in India favoring generic drugs has rippling effects around the world.

India drew first blood in a Patent case in The Supreme Court .

DOWNLOAD FULL JUDGEMENT

‘People in developing countries worldwide will continue to have access to low-cost copycat versions of drugs for diseases like H.I.V. and cancer, at least for a while…

Production of the generic drugs in India, the world’s biggest provider of cheap medicines, was ensured on Monday in a ruling by the Indian Supreme Court.

Cost of Glivec used for targeted therapy in CML patients: 1 lakh per month (approx)

Cost of its generic versions : 8,000 -10 ,000 per month

No. of cancer centres in India: 450 approx (half are in the private sector)


The debate over global drug pricing is one of the most contentious issues between developed countries and the developing world. While poorer nations maintain they have a moral obligation to make cheaper, generic drugs available to their populations — by limiting patents in some cases — the brand name pharmaceutical companies contend the profits they reap are essential to their ability to develop and manufacture innovative medicines.

Specifically, the decision allows Indian makers of generic drugs to continue making copycat versions of the drug Gleevec, which is made by Novartis. It is spelled Glivec in Europe and elsewhere. The drug provides such effective treatment for some forms of leukemia that the Food and Drug Administration approved the medicine in the United States in 2001 in record time. The ruling will also help India maintain its role as the world’s most important provider of inexpensive medicines, which is critical in the global fight against deadly diseases. Gleevec, for example, can cost as much as $70,000 a year, while Indian generic versions cost about $2,500 a year.

The ruling comes at a challenging time for the pharmaceutical industry, which is increasingly looking to emerging markets to compensate for lackluster drug sales in the United States and Europe. At the same time, it is facing other challenges to its patent protections in countries like Argentina, the Philippines, Thailand and Brazil.

“I think other countries will now be looking at India and saying, ‘Well, hold on a minute — India stuck to its guns,’ ” said Tahir Amin, a director of the Initiative for Medicines, Access and Knowledge, a group based in New York that works on patent cases to foster access to drugs.

In trade agreements — including one being negotiated between the United States and countries in the Pacific Rim — the drug industry has lobbied for stricter patent restrictions that would more closely resemble protections in the United States.

 

 

#India-Will you really get cheaper medicines?


RAJ PRADHAN | 23/11/2012 06:26 PM |   Moneylife.com

The government’s decision for simple average of market-based pricing for 348 drugs is simply a whitewash, according to many activists who were hoping for cost-based pricing. There may be marginal reduction in some medicine prices, but it legitimises overpricing of life saving drugs
After a delay of seven long years to decide on a comprehensive drug pricing policy, the Group of Ministers (GoM) has decided in favour of simple average Market Based Pricing (MBP) policy for price fixation of 348 essential drugs ostensibly to reduce drug prices. While drug companies may declare that it will impact their profit margins for some drugs, they must have sighed a relief that cost-based model is scrapped. MBP will legitimise overpricing of life-saving drugs.
At present, the government through the National Pharmaceutical Pricing Authority (NPPA) controls prices of 74 bulk drugs and their formulations through cost-based pricing. What happens to it? Dr Chandra M Gulhati, editor, Monthly Index of Medical Specialities (MIMS) says, “74 drugs under cost-based DPCO (Drug Price Control Order) will shift to the new policy (MBP) with substantial increase in prices.”
This new formula will fix the ceiling prices of medicines by calculating simple average of prices of brands of medicine having more than 1% share. This is a clear ploy to minimize the reduction in drug prices, to allow pharmaceutical companies to continue to charge inordinately high prices for their products. The complete divergence between the manufacturing costs of medicines and their present market prices (in case of those not presently under price control) has been widely documented.
The table below also shows that using simple average instead of weighted average (which was proposed) is hardly beneficial to patient.

Drug    Disease Market Based Pricing   (Weighted Average) Market Based Pricing  (Simple Average) Cost Based  Pricing
Metformin Diabetes Rs33 Rs35 Rs14
Atorvastatin High blood cholesterol Rs142 Rs127 Rs17
Atenolol High Blood pressure Rs51 Rs38.5 Rs8

Source: Jan Swasthya Abhiyan
The new policy allows a leeway for 10% p.a. increase in the prices of 348 drugs. According to Dr Gulhati, “There are about 900 total medicines. The price regulation will cover 348 drugs. There will be lots of opportunity to shift from regulated to unregulated drugs. 10% increase annual increase can mean adding Rs630 crore every year to total sales.”
According to S Srinivasan, managing trustee, LOCOST (Low Cost Standard Therapeutics), “The new drug policy is simplistic, still legitimates overpricing and full of loopholes.”
It may be recalled that responding to a petition by the All India Drug Action Network (AIDAN), the Supreme Court in 2003, had directed the government to devise a policy which would ensure that essential medicines are available at costs that ordinary people can afford. Further, the Supreme Court—while hearing arguments on this writ petition—had recently opined that the government should continue to use the cost-based formula for price fixation of 348 essential drugs.
JSA (Jan Swasthya Abhiyan—Peoples Health Movement—India) contends that though policymaking is the prerogative of the executive, the Supreme Court has acted well within its constitutional mandate in directing the government to take a policy which would stop the denial of the human rights of millions of Indian people. According to JSA, “As reported in the press, the Additional Solicitor General has reportedly advised the government that it need not follow the Supreme Court’s   suggestion to follow cost-based pricing under the pretext that policy making is the executive’s prerogative.”
JSA contends that Supreme Court’s suggestion is to protect human rights of citizens and ignoring it shows the disrespect for the Supreme Court’s attempt to protect right to life enshrined in the constitution; it’s tantamount to contempt of the SC.
According to Dr Anant Phadke of JSA, “We are hoping that at the next SC hearing on 27 Nov 2012, there may be something positive that will force the Government to rethink.”
The Jan Swasthya Abhiyan demands that

1)  The government should heed the Supreme Court’s opinion and impose price control on all 348 essential drugs and their derivatives, using the existing cost-based formula for price fixation.
2)  All escape routes used to wriggle out of the price regulation must be plugged. Thus all dosage forms of all 348 essential medicines and all fixed dose combinations of these medicines must be brought under price-control; (all irrational fixed dose combinations should be banned.) Otherwise in practice, the price regulation would be largely nullified.
3)  The government should immediately set up a committee of experts to list crucial medicines that—a) have been left out of the current list of essential medicines and   b) have been included in the essential drug lists of states but which are not currently included in the NLEM (National List of Essential Medicines).

 

German doctors free to take cash from drug firms #Badnews


 
A recent ruling by Germany‘s Supreme Court has caused a public storm over the ethical conduct of doctors and drug companies in the country. Rob Hyde reports from Hamburg.
Self-employed physicians in Germany accepting up to €10 000 from drug companies in cash, or gifts such as computers, equipment, or holidays, will not face corruption charges.
The Federal Court of Justice, in Karlsruhe, Germany‘s Supreme Court, ruled that drug companies cannot be penalised under current legislation, even when paying German freelance physicians to prescribe their drugs. Similarly these doctors can now officially accept this money without either party facing criminal charges of bribery. The ruling could apply to around 124 000 of 342 000 doctors working in the country, which includes around 121 700 independent physicians working under freelance contracts in Germany’s national health system.
The most recent case in question involved a sales representative of a major German drug firm who, via its benefits programmme, paid cash to a group of national health service doctors. Here each doctor received a 5% commission on each product they prescribed. Though the firm officially said the money was remuneration for delivering academic presentations, these seminars never took place. The sales agent was then charged with commercial bribery by a lower court, and fined.
When the sales representative appealed, the case was referred to the Federal Court of Justice. Here the Grand Criminal Panel reversed the lower court’s ruling and acquitted the accused. It then also ruled that the physicians were neither civil servants, nor representatives of a state institution, and so could not be charged with “bribery of public officials”, as defined in paragraph 332 of the German Penal Code, or under criminal law. The court further decided that the physicians were also neither employees nor representatives of a business operation, and so could not be charged with commercial bribery under paragraph 299.
The court’s decision has been welcomed by a wide range of leading German health organisations. Though declining to comment directly, in a written press statement Birgit Fischer, managing director of the Association of Research-based Pharmaceutical Companies, said the decision meant doctors “…can now continue to see themselves as members of a free profession and are not just categorised as the extended arm of the statutory health insurance funds”.
Speaking to The Lancet, head of the German Medical Association, Frank Ulrich Montgomery, shared the view, saying the court ruling protects the rights of doctors to operate in an independent professional capacity. “Such physicians are not public servants or employed by anyone, so they should be free to perform freelance work for clients in the same way that an architect or lawyer can.”
“Self-employed entrepreneurs are not an organ of health insurance funds and this is a good thing. If they were either civil servants or had been commissioned by the health fund then they would be working for the health fund and so would be subordinate to it. This means they would have to consider the economic interest of this insurance fund before the needs of the patient. A freelancer is free of this economic agenda.”
Much of the German press, however, has reported the recent court verdict in terms of it now officially giving drug companies and doctors the legal right to bribe and be bribed, respectively. Coverage has included headlines such as “Bribery of doctors is completely legal” from the television news channel n-tv. According to Montgomery, the media coverage of the case is part of wider behind-the-scenes agenda to tarnish the reputation of doctors. “We now have a campaign orchestrated by the health insurance funds to make doctors out to be completely corrupt…The Supreme Court did indeed rule that the doctor had not broken criminal law, but that definitely does not give doctors now the right to be bribed by the pharmaceutical industry. Doing this breaches the professional code of the German Medical Association.”
For Ann Marini, spokesperson for the Central Association of Health Insurance Funds, it is not enough for a professional code of conduct to be left to apply the penalties which the legal system is not able to. She said that the Supreme Court has not taken a clear stance on the real issue. “It cannot be that behaviour for one type of doctor is considered by the German Penal Code, to be a crime of bribery, and yet the very same behaviour from a freelance physician is perfectly legal. We would have wished that the court had openly and clearly said that all doctors, of all sorts, can be prosecuted for corruption.”

WARNING -Pharmaceutical companies and drug controllers- First time MP, Jyoti Mirdha #goodnews


 

10 AUG, 2012, 02.10AM IST, KHOMBA SINGH,ET BUREAU

Jyoti Mirdha is one of the 31 members in a parliamentary committee that voluntarily examines healthcare issues.

Jyoti Mirdha is one of the 31 members in a parliamentary committee that voluntarily examines healthcare issues.

NEW DELHI: If pharmaceutical companies and drug regulators in India have been lately facing scrutiny in greater and vicious doses, some of it can be traced to the dogged inquisitions of a young, first-time parliamentarian: Jyoti Mirdha. This Congress MP is one of the 31 members in a parliamentary committee that voluntarily examines healthcare issues, but she is making her presence felt with her proactive work and, some say, her anti-industry policy positions.

Sample this. In July, about a month after Mirdha wrote to the prime minister, the government pulled out of cold storage a code of conduct for companies on dealings with doctors and promised to notify it in August.

Earlier, in May, she made a presentation to the group of ministers (GoM) on the new drug pricing policy, making a case to bring all drugs under price regulation. That same month, the parliamentary committee, based on a report by a sub-committee of which she was the convenor, alleged lapses and corruption in the process of drug approvals, shaming several frontline companies and hauling up the lead drug regulator. “She is the driving force behind the report,” says Ramesh Adige, the former head of regulatory affairs at Ranbaxy Laboratories.

For all the attention her work is drawing, the Lok Sabha MP from Nagaur in Rajasthan is reluctant to talk about it, or herself. “…if you dig slightly deeper, you’ll know I don’t interview!” she initially emailed ET in response to a request for an interview. She later relented, but only to clarify her stand on issues raised by her.

What is known about Mirdha is that she is the grand-daughter of late Nathuram Mirdha, a veteran politician. Her profile page on the Lok Sabha website shows that Mirdha graduated as a doctor from SMS Medical College, Jaipur, and lists her ‘special interests’ as “water resources, alternative medicine (especially nutrition) & renewable energy”.

The medical education appears to be holding her in good stead today as she is voicing her opinion on a range of issues relating to the pharma industry, including drug pricing, clinical trials, acquisitions by foreign companies and marketing practices.

Describing her as “passionate and sincere”, Dr Sanjay Jaiswal, another committee member and BJP MP, says: “She is well-prepared, with loads of information.” Adds Lalit Kumar Jain, a lobbyist for small drug manufacturers: “She is also close to some NGOs and drug regulatory experts who are working in public interest. They provide her all the requisite information.”

Keeping Distance from Drug Companies

Mirdha is also seen to keep a distance from pharma companies. “She has no conflict of interest,” says Jaiswal, adding that she has, at times, even asked committee members to abstain from discussion on issues where they had a business interest.

At least three of Mirdha’s policy positions have riled industry players: controls on pricing of all drugs; mandatory rules and penalties to govern the company-doctor relationship; and controls over foreign investment in Indian companies. “When policies are made, you should look at the welfare of 120 crore people, and not that of a few individuals or companies to further their limited interest,” she says. “I’m all for industry if it means productivity, enterprise and innovation. But if it means exploitation or extortion, then you could label me anti-industry.”

Mirdha feels prices of all drugs should be regulated, not just those based on 74 ingredients (out of 900-odd), as is the case now. “A cost-based mechanism is the only effective way to regulate prices of drugs,” she told ET in May. “Companies have been found to be selling at multiple times the cost price and market-based pricing would further support it.”

When the department of pharmaceuticals put out a draft of the drug pricing policy and invited public comments, she was the sole MP to respond, resulting in the GoM on drug pricing inviting her to make a representation. Mirdha made a 29-slide presentation to the GoM, the central idea of which was to bring all drugs under price regulation, something the industry is strongly opposed to.

 

‘Sponsored’ doctors under scanner’ #Goodnews :-)


 

English: Shivraj Singh Chauhan, Chief Minister...

English: Shivraj Singh Chauhan, Chief Minister of Madhya Pradesh, India. Français : Shivraj Singh Chauhan, chef de l’exécutif (Chief Minister) du Madhya Pradesh, Inde. (Photo credit: Wikipedia)

 

 

By Express News Service – NEW DELHI

11th July 2012 10:18 AM

Eleven doctors from Madhya Pradesh, who allegedly went with their families to England and Scotland, are facing a probe, with the Ministry of Health and Family Welfare suspecting that a pharmaceutical company could have sponsored their trip.

Speaking to Express, Medical Council of India (MCI) Secretary, Dr Sanjay

Shrivastava, said he is yet to receive a formal order from the Health Ministry for a probe against the doctors.

“Our ethics committee, which has eminent members on the board, will examine the matter after receiving the complaint and only after getting the report we will decide the next course of action,” Shrivastava said.

However, the doctors who figured in the list sent to the PMO denied taking a sponsored trip and said the group of doctors paid for the entire travel. One of the doctors, Srikant Rege of Indore told Express that he never accepted any free tickets from any drug  company and that the allegation was a farce. Another medical practitioner from Jabalpur, Dr Harsh Saxena, said somebody with ulterior motives had complained to Member of Parliament Dr Jyoti Mirdha about the group travel and there seemed to be some misunderstanding as it was a self-financed tour. He also refuted the genuineness of evidence submitted to the Prime Minister’s Office by the Mirdha.

MP Jyoti Mirdha, along with her letter, had enclosed the ticket and PNR numbers, as well as the itinerary prepared by drug manufacturing company for the travel to England and Scotland.

“As I’m writing this letter a total of 11 doctors along with their families are holidaying in England and Scotland on a trip financed by Intas Pharmaceuticals Ltd. Details including names of passengers along with their addresses, ticket numbers, hotels and itinerary are attached for your perusal. Needless to say, acceptance of such trips is in violation of MCI rules,” Mirdha’s communiqué to PM stated.

She has also raised the issue of dichotomy in rules set up to govern the sponsorship issues. “While the MCI rules bar doctors from accepting gifts, tickets, hospitality from healthcare industry, there are no corresponding obligations on the part of the drug industry not to offer such freebies and face penal action in case of violations,” the letter dated June 1, 2012, said.

After some multinational companies were fined by regulating authorities for inducing doctors through unethical means, the MCI notified a mandatory code of ethics to be followed by all medical practitioners. The gazette notification dated December 10, 2009, prohibits the acceptance of gifts, hospitality, travel grants, funds and endorsement of commercial products by doctors.

CHECK THE HOLIDAY TICKET BELOW

Intas.Doctors on holiday

 

 

 

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

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