Dear Richard,
I've been following the discussion on "fake or counterfeit drugs" with a lot
of interest. I agree with you regarding the proportions of
counterfeit drugs quoted glibly in the literature.However it does not preclude
the existence of counterfeit drugs, nor does it diminsh the impact it must be
having in developing countries where "prescription only medicines" are sold
across the counter. A good definition of counterfeit drugs can be found in Susan
Fosters' paper on " Supply and use of essential drugs in sub-saharan Africa:
Some issues and possible solutions" Published in Soc. sci. Med. 1991;32,
1201-1218.
Further I think that the " misqouted" paper from Nigeria referred to by the
E-drug moderator may be the one by Ityavyar DA " Health services inequalities
in Nigeria" published in Soc. Sci. Med. 1988; 27: 1223-1225.
A frightening addition to this discussion is the fact that in Kano, Northern
Nigeria, (1991-1992), 40% of TB-related mortality was documented in
TB patients who had purchased recommended 6-month anti-TB regimens
(2SHRZ/4HR) and received Directly observed Therapy for at least 2 months.
The recorded mortality was within 14 months and, though uncontrolled for HIV/
AIDS, is still alarming. (Onyebujoh PC et al," Immunotherapy with
Mycobacterium vaccae as an addition to chemotherapy for the treatment of
pulmonary tuberculosis under difficult conditions in Africa"
Resp. Med. 1995; 89: 199-207)
There is no doubt that as suggested by you, we should have properly conducted
surveys with requisite lab confirmatory tests. Unfortunately countries with
such problems are usually developing and may not have the facilities nor the
political willingness to investigate the size of counterfeit drug problems in
their countries. I think that this is not just stimulating but a
highly relevant area for research, especially in developing countries where
the
scourge of Multi-drug resistant bacilli, especially TB, is rearing
its ugly head. I would like to keep in touch with anyone who would be
interested in investigating the size of this problem in developing
countries, or who have access to appropriate data.
Thanks.
Philip Onyebujoh
Senior Specialist
National TB Research Programme
Medical Research Council,
King George V Hospital,
PO Box 19494, Dormerton 4015
Durban, South Africa.
Tel : + 27 31 2071675
Fax : + 27 31 286053
Email: labusch@eagle.mrc.ac.za