Thursday, March 29, 2012

Response to 26 March 2012 Daily Nation article titled 'Policing the drugs business'


This post is a reply to an article on Daily Nation of 26th of March 2012.

The original article can be accessed via this link: http://www.nation.co.ke/Features/DN2/Policing+the+drugs+business+/-/957860/1373432/-/item/0/-/137y6o7/-/index.html

I have not read the print version of this article, but the author had not declared any potential conflict of interest that we the readers should consider when reading this article. Other than that I think the writer has a valid point, and Pharmacy and Poisons Board (PPB), the beneficiary of the TruScan technology needs to consider this as they go ahead and use this 'donation'. The Board members, who generally represent larger pharmaceutical sector, with heavy representation from the Pharmaceutical Society of Kenya (PSK), should be clear on what this scan technology can do and what it can't. That is why the PPB employs experienced pharmacists who should be able to use intuition, common sense, practice knowledge, well thought out drug policing strategies with a wide reach and finally the TruScan to identify the true counterfeits. I'm a pharmacist, and naturally I'm interested in knowing what technology the TruScan machine uses. Does it use infra red, MRI, UV or rapid chemical tests to identify active ingredients in a drug? If it does that, and that can be validated, then it is able to scan for the presence of the active medicine in any drug, brand or 'generic'. Is the 'analysis' that it does quantitative or qualitative? You need to know both attributes to declare a medicine a 'counterfeit'. In pharmaceutical science, too little of the right medicine is a bad thing and too much of it is still a bad thing.


 If the TruScan is not looking for an active ingredient, then is it scanning the primary and the secondary packages of the medicines to identify 'genuine packs'? And is knowing that just the pack is genuine good enough?


 Does TruScan just 'scan' Pfizer products, all the branded products, or it 'scans' all licenced for use and registered for trading pharmaceutical products? Who is the inventor of this technology? This is the kind of information that I was looking for when I chanced on this article, but did not find.


Remember, there is also competition between branded product manufacturers, and Pfizer here does seem to take up the burden of 'funding' an initiative that benefits all the multinationals whose products get faked. Why is it that it is only Pfizer which is purchasing this TruScan? Why would Pfizer fear generic products more than other manufacturers of branded pharmaceutical products, yet it has a wider range of medicines and still a respectable market share of each, and absolute market share for some? The article should either address Pfizer directly or generalize only when there is involvement of other multinational companies, otherwise the message will be construed to be views that are not necessarily objective.



It is my considered opinion that a counterfeit is that which claims to be what it is not. As a pharmacist, I do not perceive generics as counterfeits. I almost daily have to reassure a nervous client who has a mistaken idea of what generic drugs are, and educate them on the concept at the same time. I also know that it is the branded drugs, that many of us tend to rush to, that are the targets of the counterfeiters and not the generic brands.



I would then understand if the big pharmaceutical companies come together to address the problem that is unique to them. They lose the most to counterfeits, and gain the most if counterfeits are wiped off the pharmacy shelves. If people were to shift en masse and buy generic brands, the counterfeiters will go there. In Kenya now, generic brands, suffer the least when it comes to counterfeiting, and when it comes to fighting these counterfeits, it will make sense to focus on the branded products and get the companies affected on the board because they have everything to gain from such an initiative and so do the public.
A good every day example of counterfeiting are the paper currency notes counterfeiters and their motivation. They do not bother with a fifty shillings note: but they do fake the one thousand note where they are assured of higher returns if not, or before they are detected.



A survey preferably funded with public funds or by companies without their direct involvement in the processes, is welcome as the writer has suggested, identifying the true extent of the influence of counterfeit products in the market, its supply channels and its effect on public health. The survey should not just end there, but also suggest actions required to address the menace once and for all.



Pharmacists also know that just having a genuine product is not good enough. Before it gets to the right patient at the right dose and for the right medical condition, it must also be stored right. If a pharmacy does not store products in a way to preserve chemical integrity, buys from suppliers who don't do so, or worse still, buys from suppliers who they have no idea how they handle and store medicines, then the patients will still suffer, even when presented with a 'genuine product'.



Finally, I feel very uncomfortable with conversations that happen in virtually almost every pharmacy that this one medicine is 'original' that one 'is not'. Who will take up a product that is 'not original' even if the intention was to say this one is 'branded' and the other is a 'generic brand'? It is very unprofessional and not a priority conversation, when there are so many things to talk about that will benefit the patient the more: like the patient's medical condition; how to use the medicine and what to expect from the medicine. The patient is also supposed to be equipped with the knowledge on what to do if an expected positive outcome of the medicine does not occur or an expected negative outcome does occur!


4 comments:

Unknown said...

Just in case the article is ever moved from the current website and link is lost in the future, here is the article in full below:

Unknown said...

By WAGA ODONGO

Part I

American pharmaceutical giant Pfizer recently donated a machine called TruScan (it is rather disquieting that such an advanced chemical contraption would eschew basic spelling) to the Pharmacy and Poisons Board (PPB). The machine employs technological wizardry to sniff out fake drugs.

Well, it bothers me when regulators receive training or equipment from those they ought to be regulating. While noble, the gesture is not exactly selfless.

I have written before about the positively incestuous relationship that the Kenya Anti-Corruption Authority has had in the past with mobile manufacturers.

The KACA has been the beneficiary of workshops organised by phone makers and, in their campaign against counterfeit mobile phones, they quoted figures that were — coincidentally — the same as those supplied by mobile phone manufacturers.

Perhaps it was a case of great minds thinking alike, but the figures were inflated beyond comprehension.

Pharmaceutical companies have differed with the Pharmaceutical Society of Kenya (PSK) as to the extent of the drug counterfeiting problem.

They claim that 33 per cent of all drugs in Kenya are fake. The Pharmaceutical Society of Kenya says that figure is between two and five per cent.

It is obvious that Big Pharmas are interested in inflating the figure into epidemic proportions so as to advance their bottom line and pretend the problem is worse than it actually is.

If it was actually true that one out of three drugs sold in Kenya was fake, how many mothers would feel safe buying their sick children medicine?

People would be dying in the thousands from ingesting fake drugs. One out of three? You have better chances playing Russian roulette. At least there the chances of killing yourself by your own hand are one in six.

Or perhaps the numbers are bundled up to include generic drugs. Generic medicines are drugs that are cheaper but contain the same active ingredient as their brand name equivalents and are just as effective.

Kenyans have been taking more and more generic medicines to save on both costs and lives.

Pharmaceutical companies may consider generic drugs as “fake” in arriving at this rather alarming figure. In which case we should treat their findings with the contempt they deserve.

Further reason to disregard this 33 per cent claim is the fact that the PSK says no independent study concerning counterfeit drugs has been done in the country.

So, such inflated figures are the work of apocalypse-scenario statisticians and are derived from models heavy on assumptions and generalisations and low on groundwork.

Regulators should steer clear of those they are meant to regulate as this might lead to a perception that the regulator is in the deep pockets of the companies they are meant to police.

While the gesture to donate these machines to board is commendable, one wonders whether these electronic sniffer dogs will be partial to generics.

The machine is said to have a programmed memory of the chemical composition of every available genuine drug and can, therefore, tell you whether or not a drug is real.

Unknown said...


Part II

By WAGA ODONGO

Are generic drugs considered “real” by the donators of these gadgets?

It is no secret that Big Pharmas are not particularly thrilled with generics, which have eaten into their market share.

The anti-counterfeiting law is so pliant that it could be used to attack generics. So we should find out whether the machine does indeed classify generics as fake before allowing it to be our first line of defence (or pharmacovigilance, as they would have us call it) against illegal drugs.

Furthermore, the donation of these machines to address a problem that is clearly inflated by pharmaceutical companies seems to be attacking the wrong end of the counterfeit drug issue.

Let us first ask PSK and PPB what would be the right way to tackle the drug counterfeiting problem in Kenya. We should not accept silver bullets from parties who are interested in killing more than just vampires who counterfeit their products.

Would the company’s efforts not pay off better if it donated money for a proper study into the drug situation in the country? Or use the Sh4.8 million to set up dispensaries that will dish out brand name medicines to those in need?

(The TruScan machine costs 4.8 million shillings, a price tag that the PPB claims is prohibitive. It makes you wonder what they do with the 200 million shilling budget that Chinese press agency Xinhua claims they receive annually).

Or, better yet, give the money to PPB to buy generic drugs since you get more pills that way?

Whether as lunches, air tickets, or accommodation during workshops, regulators should not receive any assistance from those they are meant to regulate.

Prison wardens should not receive locks or ideas about locks from prisoners. There might be a conflict of interest in play.

dn2@ke.nationmedia.com

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