Cutting corners on medicine

Consumption of poor quality medicines could be accelerating drug resistance. India has to share some of the blame It is common for patients to stop taking medicines as soon as they start feeling better. Doctors have blamed this particular habit — of not completing the entire dose of antibiotics — to the emergence of drug resistant strains in diseases such as malaria and tuberculosis (TB). However, experts say that under-dosing, or the use of poor quality medicines, could be accelerating this drug resistance. Seen this way, India — which is one of the world’s largest manufacturers and exporters of generic medicine — could be contributing to the rise in drug resistant strains of diseases. “India’s proud to call itself the ‘world’s pharmacy’, and it should be. But it comes with a huge responsibility,” says Dr. Elizabeth Pisani, epidemiologist at the London School of Hygiene and Tropical Medicine. “If the world’s pharmacy is selling poorly-made products — if they’re selling crap, to put it bluntly — then sick people don’t get cured; they may even die.” India could take a lot of credit for supplying affordable medicines to treat TB and malaria around the world. But this progress is being “reversed” because of growing resistance, and India “has to take some of the blame” due to medicines that “don’t work very well, medicines that cut corners on active ingredients or don’t dissolve correctly… superbugs are spreading,” says Dr. Pisani. Results of JAMA study The World Health Organisation (WHO) estimates that one in 10 medical products sold in low- and middle-income countries such as India are either substandard or falsifiedSF. A recent study in the Journal of the American Medical Association found that 12.4% of antibiotics and 19.1% of antimalarials in such countries were SF. WHO defines “substandard” medicines as products that are “out of specification” — products that have degraded since they left the factory during transportation or storage and fail to meet quality standards. Falsified drugs are medical products that deliberately/fraudulently misrepresent their identity, composition or source. SF medicines can cause serious (sometimes fatal) injuries to patients; they can prolong an illness due to wrong dosage or the lack of an active ingredient, which could result in emergence of drug resistance. In the November 2015 edition of the Review on Antimicrobial Medicine , Dr. Pisani noted that “every shred” of available evidence suggested that poor quality medicines were contributing to the development of drug resistant pathogens in lower income countries.

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