E-drug: Re: MSF letters Lancet, Generic medicines & Global Fund
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A few comments on MSF' letter in The Lancet: Generic medicines
are not substandard:
Sir--"The most probable cause of the poor quality of drugs is
absence of adequate quality assurance during manufacture.
Substandard drugs sold in the pharmacies of less-developed
countries could contribute to global microbial resistance and
therapeutic failure of infectious diseases."
Some clinicians HERE even ask their patients to buy specific brands
because, according to them, drugs from certain countries in Asia
don't work. There is now a general myth in population that drugs
from Asia are always inferior. Let us face the facts. Though some
very cheap generics may be inferior -- from a practical perspective
in this setting, it isn't enough to prove this by chemical tests.
Chemicals can be altered at atomic and molecular level by the
different methods of synthesis, manufacture. The differences can
reflect in the way the products work. Chemical tests in laboratories,
which may be prohibitively expensive, should be 2nd lines of
defence. Such tests can even suggest that the products are good
for use, even when they are not. (I am not suggesting to give up
chemical tests).
We need not only cheap, but also GOOD generics. Why should we
buy bad generics at the price of good ones. Having been in the
system for a significant period, I proposed:
- Regulatory Authorities to set up systems for investigating
complaints concerning generics which fail to work. Wrong
prescribing (which is rampant here); interactions; inadequate
information to patients concerning treatment (which is exceedingly
common here) or refusal of the patients to take drugs; poor storage
can cause treatment failure. Investigations are therefore mandatory.
To be practical, a drug information unit can rule out the possibility
of other factors that cause treatment failure in the developing
world.
- Sensitize health professionals to make use of the service. Health
professionals handling medicines will need training on the relevancy
of wholesaling, dispensing records. Health professionals includes
health workers in both public and private facilities. Failure to make
useful records, which is common here, especially at the level of use
will hinder any progress. Health workers can then file in complaints
concerning suspected products to a drug information unit against a
prescribed manner.
- All complaints which pass tests of wrong prescribing, inadequate
information to patients, interactions and bad storage, qualify for
further investigations. It is unreasonable to start from the top and
condemn products which may actually BE of good quality.
- The general public needs sensitisation too.
Without these interventions, we risk making arguments with
minimum progress.
Gathering from the open letter the Director of MSF wrote to the
global fund board meeting, the idea of increased access can't be
overemphasized. Nevertheless, I thought we can step up efforts to
prevent malaria, through operational research. Giving up on this
aspect of control is to hide away from challenge or perhaps
responsibility.
Finally I would like to submit that the way drugs are used in
developing countries should also raise global concern. Stressing
access alone will yield results for a few years. What shall we use to
treat malaria, tuberculosis 10 years from now? Stress access now,
have the products in place, and five years down the road, they will
no longer be valuable. Why? Because we hardly talk about the
wrong prescriptions, poor dispensing, storage (we are in the
tropics, and the stores are at times hotter than the outside,
imagine!).
Regards,
George Kibumba, MPS
Teaching Assistant
Clinical Pharmacy, Makerere University, Kampala,
P.O.Box 7072, Kampala, UGANDA
e-mail:kibumba@yahoo.com
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