Much more than self-esteem damaged by fake drugs

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!