The Drug Industry’s Poison Pills
Mareeg.com-BOSTON – One does not need to spend a lifetime in the global health-care sector to
appreciate that substandard or counterfeit drugs are a major public-health hazard.
These bogus products have infiltrated pharmaceutical supply chains from Azerbaijan
to Zambia, wrecking the most promising programs to control, manage, and eradicate
deadly diseases. Yet little is being done to stop this criminal activity.
Growing up in Pakistan, I realized how vital it was for my mother, like any educated
parent, to know which drugs and pharmacies could be trusted. Little has changed
since then. Local pharmacists from Lahore to Lusaka continue to sell a variety of
brands of the same drug at different prices; and shopkeepers are called upon to give
a candid opinion of their benefits and shortcomings.
Unfortunately, the problem runs a lot deeper than a few bad drugs sold at the corner
pharmacy. Around $75 billion of substandard drugs are sold annually, causing an
estimated 100,000 deaths worldwide, and making many more people seriously ill. The
trade in inferior drugs also undermines fragile public-health systems in poor
countries. As well as killing consumers, the effects of bad drugs can be passed from
parent to child, and even create new drug-resistant strains of diseases that
threaten us all.
Yet the fight against substandard drugs has never been taken as seriously as other
global health crises such as malaria, HIV, or maternal and infant mortality. This
may be because there is no obvious solution.
But, in seeking answers, we must first acknowledge that the issue is larger than
just counterfeit medicines. Many legitimate manufacturers worldwide, whether through
complacency or incompetence, lack adequate quality controls. In some cases,
deficient storage and refrigeration systems turn safe medicines into dangerous
Unfortunately, those drug makers then take advantage of developing countries’ weak
or poorly implemented legislation and corrupt officials to pass their products
through local supply chains and into shops. Public ignorance or apathy means that
those responsible are able to avoid prosecution.
The technical expertise and equipment needed to detect inferior products is usually
beyond the financial reach of many developing countries. But there are low-cost
alternatives. One approach, for example, would be to include on packaging a “scratch
code” that includes a phone number for consumers to call in order to check that the
batch number matches an authentic product. But, while this approach would certainly
help to catch counterfeits, it would miss the substandard or degraded products made
by legitimate firms, which are tested only by the consumer – and often at great cost
in terms of health risks.
It is therefore imperative to develop new detection technologies that will work in
poorer countries, and that complement existing systems such as bar codes. Detection
technology must be capable of analyzing all forms of a drug – whether powder, pill,
capsule, or syrup – and of detecting several different grades of quality, not just
the junk. It must be simple, affordable, adaptable, and scalable; and it must work
at all stages of distribution, whether at customs, in hospitals, or in remote
But technology alone will not be enough. Regulators, hospitals, and drug-safety
authorities must take the lead, rather than placing the burden on often poor and
uneducated citizens who are struggling to care for loved ones.
The search for new, sustainable solutions, requires at least three initiatives.
First, we must encourage innovation by offering research grants to support small
initiatives or large-scale projects (like campaigns to fight HIV, malaria, and
maternal mortality). Ideally, an international group would coordinate and develop
all of the ideas and products, and take them from the laboratory to the field.
Second, we need to harness the creativity and commitment of young students, so that
they understand the devastating impact of bad pharmaceuticals and become motivated
to make a difference in people’s lives.
Third, we must make use of the media. Just as the world cries foul when an illegal
shipment of ivory is uncovered, we must launch campaigns in the press, on
television, and online to bring to account any trader, state official, or company
caught selling or promoting low-quality drugs.
In this way, we will remind those in the industry of a fundamental premise: their
most precious commodity is not a blockbuster drug, but the public’s trust. If drug
makers and pharmacists cannot protect their customers’ health, they cannot protect
Muhammad H. Zaman is Director of the Laboratory for Molecular and Cellular
Dynamics at Boston University.
Copyright: Project Syndicate,