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!