Recently, BBC reported deaths of children in Gambia after having a cough syrup manufactured by an Indian company. WHO published a warning against these medicines. A whole of host other publishing houses questioned the Indian pharmaceutical industry. Here are some stats that Deutsche Welle published with this tragedy in the backdrop:
- 20% of all drugs sold in India are counterfeit
- About 7,500 samples failed the drug test in just over a decade
- Only about 25% of facilities producing drugs are GMP (Good Manufacturing Practice) certified
- 4.5% of all generic drugs sold in India are substandard
Forbes India quoted a study saying that the Indian manufactured drugs that are sold in Africa are poorer quality than those sold anywhere else.
What are the reasons for such practices to survive?
There are many reasons why such life threatening practices exist over the years. The top two which cover most of the other reasons are:
Surely one cannot put a price on someone's life but having a medicine is better than not having anything at all.
With countries ridden by poverty, patients typically choose the cheapest drug or medicines available for free at public hospitals or as a part of government run schemes. The recent case in Gambia is probably similar. Even the government of Gambia does not have a testing lab to see if the medicines are of poor quality. They have to rely on WHO labs to get the test reports to confirm anything.
Profit hungry corporations, in order to meet the low-cost-low-price mandates, use cheaper / illegitimate ingredients. These are then sold through the local distribution channels or in government contracts (whether within the country or exports).
Lack of knowledge:
Most of us who do not have medical background will not understand the ingredients or the effect they have on the body. In the Gambia case for example, the WHO lab "confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants". We would never know if these molecules are accepted by the body and if so, what is the permissible limit. And unfortunately, either owing to money or otherwise, one would hardly consult a practitioner to get a prescription and get the right drug.
Aren't these medicines tested before being allowed to be sold in the market?
In India, the Central Drugs Standard Control Organisation (CDSCO) certifies all medicines that are produced under the Drugs and Cosmetics act. Also, the facility is certified as following GMP for it to be allowed to produce medicines. Then how can such fiascos happen? Here are a few possible answers:
The CDSCO is under staffed
With many manufacturers wanting to be part of the multi-billion dollar, ever growing pharma export market in India, there are not enough people to thoroughly do the job and the certificates are granted without following much of the process
Even if there are enough people at the government offices, they are OK certifying medicines without much of testing by accepting bribes. Even they are probably not aware of the harm the medicine could do. Going back to the Gambia example, the pharmaceutical company had been in business for a long time (32 years is what their website claims). The officials wouldn't have expected them to be so wrong and hence approved the products for sale without going through the complete cycle of testing (for the product and the facility).
Lack of knowledge
With the ever evolving ailments (COVID just strengthening this belief that viruses also evolves along with our medicines), possibly the government authorities are not able to assess the efficacy of the medicines. Clearly, in the case of Gambia, this was not the case. It is not the first time that these compounds have proved to be fatal. In India itself, just a couple of years, 17 deaths were reported in the hill states because of the same compounds as Gambia.
What is certified isn't sold
The samples that are sent to the inspecting agency are of high quality. But when it comes to actually supplying the medicines, owing to cost pressures, the ingredients are compromised and hence, what is actually sold, is of sub-standard quantity. This can only be caught by checking random samples of every batch. This would be highly labour intensive and a costly affair considering the number of samples that would need to be examined.
This is rampant even within the food industry wherein most manufacturers claim to have their product tested through the most stringent of tests but the quality is no where comparable to what one would expect.
How can one protect against such things?
Consult a doctor
Rather than popping a pill or taking a syrup without having any knowledge of it, there are enough online consultations available, even for free. If you would like to have a consult from our panel of experts, you can just fill in the details here. It is always better to have a consultation or prescription before taking a medicine, even if it is for common cold.
Consider alternate medicines
Most alternate medicines have little to no side effects since they are naturally made. But again, be sure to check the credentials of the organisations. While it is good to have certifications like GMP or from the Ministry of Ayush, it is not mandatory to have them to sell ayurvedic products in India. We have an FSSAI license as a proof to our products being safe for consumption.
Read the descriptions and ingredients carefully before choosing a product
While we may not know most of the ingredients, a quick search about the key ingredients could help us decide on whether the product is right for us. At times, it is common sense that can help. For example, the cough syrup from one of the largest ayurvedic companies in India contains 70% sugar water as per their own label.
One might still choose to have it but being aware of such little things can help us go a long away. We write both botanical and common names for all our ingredients and also try to give some research done on some of the key ingredients. You can look for it in the FAQs for every product. Also, a live chat can help you with any doubt that you might have.
Cheaper the better is not always true
Like for most other products, trying to save some money might hamper our wellness in the long run. Especially for products that one consumes daily, it is critical to be sure of the quality and hence cheaper need not necessarily be the best. One product that people in India have every morning is honey. Again, one of the leading brands in the country sells the cheapest honey and claims for it to be certified by the best authorities. But keep the honey in the fridge and you can see sugar crystals forming. Similarly, having a product which is 65% sugar water vs our product for cough (seasonal or otherwise), Good 4 Throat, there will be a difference in both the efficacy and the price.
In essence, see a doctor if you are ill. If you are still stubborn on doing it, research what you are ingesting into your body, chat with experts and then decide on your course of treatment.