Much more than self-esteem damaged by fake drugs

Thierry Powis, Chairman, International Pharmaceutical Manufacturers Group in Indonesia, Jakarta

Why should we trust drugs or medicinal products? Especially since not so long ago President Megawati Soekarnoputri confessed openly that she had a personal experience with counterfeit medicines. Many of us would have thought that this would have not been possible. A President, with so many rings and layers of security systems protecting her, had swallowed substandard medicines? Certainly the staff did not fill the prescription from unauthorized street-side vendors?

We must praise the President for bringing the issue forward. She has the courage to talk about this very important subject, because she realizes that if she is affected, so does the whole population.

On one hand, President Megawati's statement did not come to us as a surprise. Our association has since a few years back been monitoring the incidence of substandard medicines, and have been actively trying to curb the occurrence on industry-level. We are currently in the driver's seat incorporating a cross-sectoral multi-industry anti-counterfeit coalition.

But, on the other hand, we feel deeply sorry every time we hear about someone being exposed to substandard medicines -- be it President or ordinary folk -- since quality of life is always at stake.

Last year, during a raid in Shanghai, it was found that fake Viagra outnumbers its genuine product. Imagine, a good numbers of Shanghai men must have been embarrassed to death for failing to prove their virilities.

But, that only show a marginal impact of counterfeit medicines to patients. Embarrassment never kills. It was just like someone who bought a Louis Vuitton bag, and later realized that it was a fake product. Only his/her self-esteem was hurt. Nothing more!

Fake medicine is a far more serious matter compared to fake fashion items, pirated VCDs, or even counterfeit money. How can a cardiac patient survive if his heart stimulant product does not contain the active medicines? How can a severe infection regress if the antibiotic is not present? And what about diabetic medicines, transplantation drugs, or drugs to treat cancers?

Ironically, in Indonesia, fake drug once killed the father of a staff of a pharmaceutical company. Because of post-surgery complication, the father suffered gangrene infection. The cost of medicine prescribed for him was expensive. The prescription was then showed to a drug vendor at Pasar (market) Pramuka -- known to be the center of illicit drugs in Jakarta -- where it could be made available at knockdown price.

This act of economizing, however, turned out ugly. The father condition worsened and did not get cured. He was evacuated to Malaysia for further care. There, the leg was amputated. A few weeks later, he died. It turned out, the medicine bought at Pasar Pramuka was a fake one and very likely the cause of his deterioration of health leading to his death.

Many more Indonesians must have fallen victims to fake drugs, without us knowing. Death caused by fake drugs is not easy to prove. Unfortunately, not many of us care either. This must change! President Megawati has spoken. We can not stay silent.

Indonesia should not feel ashamed for the prevalence of counterfeit drugs. The International Federation of Pharmaceutical Manufacturers Association estimates that the world's counterfeit drugs market amount to five percentile, or about US$20 billion a year. There was an attempt to correct the figure down to two percentile, simply to prevent the customers from panicking.

But, does it pay to cover up the real fact on counterfeit medicines? In Myanmar, Cambodia, Laos, Vietnam, and Thailand, it was evidenced that 33 percent of anti-malaria tablet in the market were found to be without active ingredient. In Nigeria, 50 percent of drugs found in the market were already expired nor damaged.

The prevalence of counterfeit medicine does not happen only in developing countries. Not long ago, embarrassingly, cases of fake drugs were also found in the United States and the United Kingdom.

In Indonesia, unfortunately, no one dares to state the precise nature of counterfeit medicines.

By definition, counterfeit drugs should include illicit drugs. Smuggled drugs, therefore, fall under illicit drugs. We view smuggled drugs to be dangerous for at least four reasons.

Firstly, because they usually are made using porcine capsules, rendering them to be "haram" for Muslims.

Secondly, many smuggled drugs originate from stolen consignments. Probability of expired drugs, therefore, is high.

Thirdly, most smuggled drugs are not handled properly and packaged in a way that is appropriate for high humidity and hot climate. We know that many pharmaceutical products loose their stability if not packaged properly for countries like Indonesia. Illegal products are most often not packaged properly and the expire date is not valid for Indonesia. And lastly, most counterfeit drugs are disguised as if they were imported products.

Some "habits" of people here also make ways for counterfeiting. Indonesians like to keep used containers for resale and recycle. No wonder, last year it was discovered the incidence of fake infuse-solution at many Jakarta hospitals. Surprisingly, it was also found out that many injection solutions were also faked. We feel that a regulation to discard used medicine containers must be destroyed is needed.

We certainly understand that health-care officials in Indonesia are reluctant to disclose figures in relation with fake medicines. There is, in fact, a danger to inform the public about the prevalence before the market is ready with a solution. Otherwise, the pharma industry could be threatened to collapse. Rich patients could easily go abroad to have their prescription filled. But, what about mainstream Indonesians who could not afford the luxury?

We understand that the abatement of counterfeit drugs can not solely be undertaken by the pharma industry. This takes the full commitment of Drug and Food Control Agency (BPOM), police, customs, and other related institutions. We acknowledge that BPOM has lately increased its enforcement measures to combat fake drugs. But, the consumers need also to be educated on the phenomenon of counterfeit medicines.

Yasuhiro Suzuki, Executive Director of the World Health Organization once stated: "No country is immune from the threat of counterfeit drugs. But, those with weakly regulated pharmaceutical suffer most." How very true! The business of counterfeiters is made easier because the penalties are positively not a deterrent. Even when caught, they have become so rich that they can bend the law somehow. Medicine is one area where zero-tolerance should be the norm. Selling inferior medicines should be considered as homicide, and the perpetrators must be punished accordingly.

In summary, quality medicine is largely worth the effort. For our lives, our economy, and our wellbeing. The most expensive and dangerous medicine is in reality the one that does not work. It does not only cost us money, but also our lives!