February 03, 2012
Spurious drugs killed 112 people in Punjab till January 29. However, people believe the number of deaths is much higher. In a country where large-scale illiteracy prevails, one cannot expect that the total number of fatalities in the case of outdoor patients would have been reported to authorities by the relatives of the dead. The deceased were under treatment at the Punjab Institute of Cardiology (PIC), Lahore and benefitted from the facility of free medicines, which were provided to the not so-well-to-do people by the institute.
Reportedly, the provincial government has started a door-to-door campaign to collect harmful drugs supplied by PIC to its patients. The quarters concerned have also appealed to patients not to consume the PIC-supplied fatal drugs. But, there is every possibility that the authorities’ appeal may not come to the notice of all patients, particularly the poor and illiterate people, who live in faraway corners of the country. As nobody is ready to accept responsibility for the criminal lapse, the Punjab government has decided to request Lahore High Court to form a judicial commission to investigate and establish the causes of deaths
According to knowledgeable sources, PIC administers medicines valuing about Rs600 million per month, on an average, to poor patients under treatment at this Punjab government-managed facility. Some five drugs being provided by PIC to its patients were reportedly substandard, leading to the death of persons. Cardiovestin, Soloprin, Isotap, Atenololo and Concort were suspected as fake drugs and their samples have been sent to laboratories, both local and foreign, for examination.
The platelet count in the blood of patients, who used spurious drugs, drastically decreased, causing their death. The human blood consists of three types of basic cells – red blood cells, white blood cells and platelets. In case of wounds, platelets help in stopping the outflow of blood, contributing to the healing of injuries. Before a drug is allowed to be marketed, it has to pass through a lengthy and tedious process of research, tests, investigations and registration by the appropriate authorities.
When someone succeeds, after years of research, in finding a sure remedy for treatment of a disease, then initially the drug is tested on guinea pigs or mice for its efficacy, results and side-effects, if any, over a period of time. If no major complications or adverse reaction comes to notice, then the medicine is allowed to be administered to volunteers under strict vigilance and control of doctors. If doctors are satisfied with results, only then the medicine is presented for registration, supported by complete research data, tests and investigations carried out as well as the results obtained.
In developed countries, the whole process may take 10 to 20 years. When an application is received for the registration of a drug, the authorities also conduct a number of tests and satisfy themselves fully before registering it. In US, the total number of registered drugs is about 6,000, but in Pakistan their number exceeds 55,000. Four years ago, their number was around 25,000, but some 30,000 drugs have been registered during the last four years. The state minions performed this feat through corrupt practices. These horrifying statistics indicate the importance that authorities attach to the health of the nation.
Reportedly, the provincial government has started a door-to-door campaign to collect harmful drugs supplied by PIC to its patients. The quarters concerned have also appealed to patients not to consume the PIC-supplied fatal drugs. But, there is every possibility that the authorities’ appeal may not come to the notice of all patients, particularly the poor and illiterate people, who live in faraway corners of the country. As nobody is ready to accept responsibility for the criminal lapse, the Punjab government has decided to request Lahore High Court to form a judicial commission to investigate and establish the causes of deaths.
Chief Minister, Shahbaz Sharif has directed all administrative departments to assist the high court in the judicial inquiry. He has also advised that the judicial commission should also be informed about the results of investigations conducted by Major Mubashar and the Chief Minister’s Inspection Team. One is sure that the judicial commission would conduct thorough investigations, identify the culprits and fix responsibility. However, according to some persons who have served at top positions in the Health Ministry, three aspects in particular need to be probed.
When, how and under which circumstances were these drugs registered by the authorities? When, how and by whose authority were these drugs purchased in Punjab? When was the last time that the pharmaceutical companies, now under scrutiny, were last inspected for good manufacturing practices by the official drug inspectors? Targeting a few doctors and proprietors of pharmaceutical companies will not serve the purpose. Obviously, the prime responsibility for the purchase of spurious drugs lies with the officials who authorized their purchase. However, the catastrophe brings to the fore the need for devising foolproof systems and procedures for registration, purchase and storage of medicines.
Meanwhile, Punjab Health Secretary Jahanzeb Khan and PIC’s head Prof Muhammad Azhar have been made OSD; while MS PIC Dr Jaffer Saleem has been arrested, and DMS (Stores) Dr Ali Hasan, Director Drug Testing Laboratory Mufti Abdul Salam, Pharmacist Yousaf and Storekeeper Zulfiqar have also been suspended. DG Health Punjab Dr Muhammad Aslam Chaudhry, who was relieved of charge on January 16, has now been suspended for allowing acquisition by different hospitals of donation of medicines by WHO and other international donor organizations without following the due procedure of registration and approval by the Drug Testing Laboratory. But, according to knowledgeable sources, the donated drugs had nothing to do with the real issue.
The move of making the high quality donated medicines ‘controversial’ was made to divert the chief minister’s attention from the real issue, fearing that the ‘actual culprits’ behind the drug reaction scandal might expose the names of buddies of some PML-N parliamentarians, who have now fielded bureaucrats of their choice to accomplish this task. The move was launched even when investigations carried out by consultants/health experts at the departmental level categorically mentioned in their findings that no donated medicine was involved in the scandal.
Pakistan Medical Association (PMA) has condemned suspensions and arrests of PIC’s senior doctors and demanded their immediate release given that detailed inquiry to fix responsibility for the cardiac deaths’ fiasco is not yet over. A section of the doctors has termed the arrest of senior doctors the height of injustice, adding that doctors were once again being victimised while those involved in the purchase of medicines and in their clearance from the Drug Testing Laboratory were free. On the other hand, Pakistan Pharma Manufacturers Association has claimed that PIC patients did not die due to the use of sub-standard drugs but because of wrong prescription of ‘Blood thinning’ and Lipid lowering medicines to them without taking their past medical history into consideration. The medical community, however, believes that it is the moral responsibility of Chief Minister Shahbaz Sharif, who also acts as health minister, to accept full responsibility for the health crisis as the shake-up of his entire team also casts aspersions on his own performance.
The portfolio of health, like some 20 other more important ministries, is with the Chief Minister himself. It seems there is no one capable or trustworthy in the entire Punjab province that should have been given the responsibility of leading the health department. This also applies to other 20 departments that the Khadim-e-Aala has retained with himself! Here a question arises, is it humanly possible for one man to run over two dozen departments and deliver on all fronts? No, certainly not. Instead of the chief minister, if the portfolio of health had been with a professional, perhaps the Health Department’s matters would not have deteriorated to such an extent.