Lethal malpractice in Asia
There is disturbing evidence, reviewed in Nature for 10 March, that a great deal of malpractice in developing countries in Asia is putting people at risk when the medicines they rely upon turn out to be counterfeits that fail to have any effect. As an editorial puts it: “The continent’s pharmacies are awash with fake drugs that contain little or none of the labelled active ingredients.”
These bogus products are produced mostly in China or India but are also exported
to Africa and the rest of the developing world. The trade is run by ruthless
individuals who show scant regard for human life, and depends upon the willingness
of corrupt officials to turn a blind eye — for a consideration, of course.
According to Peter Aldhouse, chief news and feature editor of the journal, evidence
began to accumulate from 1999, when Sam Veasna, a field biologist and conservationist,
died in Cambodia, aged 33, from malaria brought on by mosquito bites. He had
been treated with a product that was labelled mefloquine but failed to control
his fever. The use of a counterfeit product was suspected but, because his remaining
tablets had been thrown away, no close investigation could be performed.
It is not known how many malaria deaths in the developing world can be attributed
to fake pharmaceuticals, but the trade in counterfeit antimalarials is reputed
to be rife across south-east Asia. Artesunate has been implicated in Cambodia.
Half the blister packs of the antimalarial were found to contain tablets with
no active ingredients. Between 2000 and 2003 the situation deteriorated, to judge
from samples obtained in Cambodia, Laos, Myanmar, Thailand and Vietnam. Tetracycline
also was involved in the scandal.
Some of these instances, it is conceded, might represent shoddy manufacturing
and not deliberate deception. A lack of analysts makes quality control difficult
to achieve. Officials in Cambodia are not in a position to enforce controls and
corruption is endemic.
There is a need to crack down in the factories producing the fakes, but the mildness
of the fines imposed encourages criminals to turn their attention to such products
in place of narcotics, for which drastic penalties apply.
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It surprises me to come across references to our extinct Neanderthal cousins almost every month in the scientific journals. They disappeared from the face of the earth some 28,000 years ago, but we are still discovering fascinating facts about them.