The World Health Organisation(WHO) recently flagged a serious problem threatening the world’s health in a report on falsified and substandard medications, a report it published nearly after a decade.Read it here.

The WHO report said : An estimated one in 10 medical products circulating in low- and middle-income countries like India is either "substandard or falsified".

The problem of fake medicines

The report noted that a lot of developing countries had a problem of fake medicines circulating in their healthcare systems. According to the WHO, the proportion of fake drugs was as large as 10% or nearly one in ten drugs. According to WHO, these medicines not only fail to treat or prevent diseases but can also cause serious illness or even death. Spurious drugs are a major problem for the global healthcare fraternity. In many cases, it can not only endanger the lives of patients, but if they contain low doses of the drugs, can also trigger a chain of resistant organisms, which already is a serious problem across the world, now threatening to turn into a large cause of death with nearly 10 million deaths a year projected due to it by 2050.

"Substandard and falsified medicines particularly affect the most vulnerable communities," said Tedros Adhanom Ghebreyesus, the WHO Director-General while releasing the report to the public. The WHO has received nearly 1,500 cases of substandard or fake medications.

The most commonly faked products are either anti-malarials or antibiotics, easily the most necessary medications due to the global prevalence of bacterial diseases and malaria.
 

The region-wise distribution shows that nearly 21% of the complaints come from the WHO Americas region, 21% from the WHO European Region, 8% from the WHO Western Pacific Region, 6% from the WHO Eastern Mediterranean Region, and just 2% from the WHO South-East Asia Region. Considering these statistics, the WHO team of researchers are certain that these cases are definitely only the tip of the iceberg, and that a large proportion of these cases were going unreported. The WHO noted that the medications were sometimes manufactured out of smaller operations wherein the producers used fake packaging to disguise their products and then get them into the supply chain surreptitiously, while other larger operations were more sophisticated, and could mimic real drugs more effectively.

The WHO voiced concern regarding this issue, "The organisms that survive after being treated by fake drugs will be the ones that have mutated enough to survive low doses of the medicine. Usually, they do not reproduce very quickly. But with all the more susceptible strains killed by the weak medicines, they have room to multiply and spread to more people," said the report.

According to the report, there is clear evidence that resistance to the most important antimalarial medicine, artemisinin, first appeared in a part of the world where at one point between 38 and 90 per cent of the artemisinin medicines on the market were substandard or falsified.The findings are part of WHO Global Surveillance and Monitoring System for substandard and falsified medical products. It is first time in 10 years that the WHO is publishing estimates on substandard and falsified medical products in low- and middle-income countries.

Doctors and other health workers waste precious time trying out alternative treatments when all that is really needed is a quality version of the same treatment. In the worst cases, several of which are described in this report, people die, either from untreated disease or because the product itself kills them.

The WHO noted that this was a global problem. The easy mobility of people due to cheaper air travel, people resistant to infections because of substandard or falsified medicines could pass on their mutant strain to others in that country, making the real drugs in that country ineffective to treat that disease, and essentially, trigger an epidemic.

What can doctors do about it?

The WHO noted that in case of fake drugs produced in sophisticated settings, it would be virtually impossible for doctors or even patients to identify if they were fake since they would most likely pass as genuine due to the quality of their packaging and the wide reach of their distribution networks. However, some pointers are useful for consumers and doctors to check if their medicines are fake:

Examining the packaging for condition, spelling mistakes or grammatical errors;

• Checking the manufacture and expiry dates and ensuring any details on the outer packaging match the dates shown on the inner packaging;
• Ensuring the medicine looks correct, is not discoloured, degraded or has an unusual smell.
• Discussing with your doctor or other healthcare professional as soon as possible if you suspect the product is not working properly or you have suffered an adverse reaction.
• Reporting suspicious medical products to your National Medicines Regulatory Authority. In India, it would be the Central Drug standards control organization.

Moreover, in an age where medicines can be obtained online, it would be prudent for doctors and patients to remember the following tips to avoid being scammed by fake medicine sellers:

• Ignore emails from spam email advertising
• Ignore and flag emails which are not authentic and have no verification logo or certificate
• For websites, be suspicious if it does not display a physical address or landline
• Flag and report websites offering prescription-only medicines without a prescription
• If the product price is suspiciously low, it should be alarming for both doctor and patient.

Medical practitioners should always advise patients to check dispensed medications, especially the brand, drug, dose, packaging, appearance and visual quality, signs of tampering on some medication packaging, batch number and expiry dates. Even such simple steps can ensure that the problem is reduced, if not eliminated.