ADULTERATION 101

139 Dead hitherto, 270 under care and countless others with this bomb inside them ticking to death, the Lahore Incident is rapidly proving to be Pandoras Box. Five adulterated drugs which include Cardiovestin (Simvastatin), Alfagril (Clopridogril), Concort (Amlodipine), Soloprin (Asprin) and Isotab have the entire health sector on its toes and the nation watches in shock as the tragedy unfolds before their eyes in the Metropolis city of Punjab and the death toll mounts. The cause of death by using these is reported to be a deadly drop in WBC count thereby leaving the body defence mechanism off guard. Other symptoms include low Platelet Count, Chest infection, change of complexion and bloody vomiting. To top it off, this reaction looked exactly like Dengue and thus it remained a mystery even longer. With this problem spiralling out of control and everyone remotely associated scanning to blame someone else, Stanislaw Jerzy Lec has it right; No flake in an avalanche ever feels responsible! Someone has to lie in the bed they made but who? The countless people who work for these pharmaceutical industries? But how come only now in all the years they have been working did this problem crop up and in Punjab Institute of Cardiology alone? If the doctors are not to be blamed how do you explain this mass sacking of doctors in Punjab including the big names like Dr Saleem Jaffar, MS of PIC, the closed wards in Punjab and the strike by Young Doctor Association? It couldnt possibly be The Drug Act 1975 that governs all the pharmacy practices because its water tight, fool proof and you shall see it for yourself in Course 703 Forensic Pharmacy. While this incident has played on like a recurring nightmare, its laid bare our institution for heavy criticism and even more so when the Central Drug Lab couldnt find anything wrong with these medicines following the monograph analysis procedure and the labs in London showed traces of Pyrimethamine among others in Isotab. The Chief Justice, Iftikhar Mohammad Chaudhry, in trying to reign in this charging horse, took suo moto action and sent notice to secretaries of Federal and Provincial Heath set up and the trial yet to come is going to be messier. The Class 1 recall of adulterated drugs following FDA protocol, albeit slow, is nevertheless underway. The Punjab government as usual promised compensation to victims, something that has come too little too late. Lessons are to be learned here, the likes of which gave birth to Pharmacovigilance (activities relating to detection, assessment and prevention of drug related problems) after the Thalidomide Disaster, 1961. Serious thoughts are being given to setting up first Adverse Drug Reporting Database. While angry protesters of deceased demand pinning of murder charges on those involved, drug inspectors raid the retail stores and fine the owners who hold drugs falling short of useable; this has come as a much needed lesson to a million others! The other day I was watching some lady on a news channel grill a retail drug store owner about the medicines he was selling, I found myself smirking but then I thought if this step is not taken at this point, who is to say it couldnt be Karachi next with a massacre of biblical proportion around the bend and no Punjab Government to blame!