A Signal Catastrophe
Rasheed Hasan Khan
Since the advent of the New Year, the various T.V. channels have been airing dismal visual coverage of fatalities at the P.I.C. This was presumed to be due to the reaction to one or more medications dispensed at the Punjab Institute of Cardiology. The recipients of the free medication at the P.I.C. were largely from the under-privileged section of the society. This gave an added poignancy to the tragedy, because it raised the vision of indigent patients receiving death instead of a cure because of their inability to purchase expensive medicines from the open market.
Now, after nearly a month of speculation, mutual accusation and acrimony and more than a hundred fatalities, some concrete facts are beginning to emerge. The results of the analyses carried out on the samples sent to the Laboratories in the U.K. show that the samples of the tablet Isotab-20 ( isosorbide mononitrate) were heavily contaminated with an anti-malarial drug, pyrimethamine. It was the cumulative over dosage of pyrimethamine that lead to bone marrow depression and other lethal sequelae in the patients. So far so good, but that does not answer all the questions. The first question that comes to mind and which is directly related to the question of culpability is the procedure of drug purchase and procurement by the Government, Autonomous and Private hospitals. On paper, the manufacturers are supposed to obtain registration of any drug with the central Drug Regulatory Authority, so that the drug may be eligible for purchase by a hospital. The Drug Regulatory Authority in turn is mandated to register the drug after necessary tests to determine its chemical composition, purity, dates of manufacture and expiry etc. Here lies the crux of the problem. There is no drug testing laboratory of International Standard either with the Regulatory Authority or anywhere else in Pakistan. The registration of drugs by the Regulatory Authority is thus, a mere formality, with no scientific significance!! According to reports in the press, in a 2010 meeting of the ministry’s Drug Registration Board, the approval was given to 4,000 drugs in a single go!!. This speaks volumes about the lax procedure used by regulatory authorities.
It is a very deplorable situation. While those at the helm of affairs do not tire of flaunting the Nuclear Weapon capability of Pakistan, they conveniently ignore the primitive and rudimentary situation of our social sector, be it health, education, mass transit or any other department .It is estimated that a large proportion of the drugs sold in the market are counterfeit, with some putting this category as amounting to nearly 45 per cent of the total produced.
According to the Pakistan Pharmaceutical Manufacturers Association, there are about 400 manufacturing units in the country and the industry meets around 70 per cent of the country’s demand for medicine. The value of pharmaceuticals sold in 2007 exceeded $1.4bn, and it is expected to exceed $2.3bn this year. These figures help provide a clue to how lucrative this industry is, and how profits can be multiplied through un-ethical and illegal means.
Human Development Report 2010 states that the total expenditure on health in Pakistan, as a percentage of the GDP was 0.8 — not even one per cent. With a mere eight physicians per 10,000 people, and with the major section of the population living in rural areas, the setting is conducive to all sorts of unethical practices.
Marketing incentives and strategies used by both multinational and national pharmaceutical companies often induce doctors to prescribe non-generic and over-priced drugs. This helps the unscrupulous elements producing these drugs in further increasing their profit margins. Healthcare professionals must be alive to their responsibility to their patients and the people at large and remain faithful to their commitment to keep the interests of the people above all other considerations.
The Signal Catastrophe of the P.I.C. painfully illustrates the alienation of the ruling classes from the masses they rule. While they are engaged in a struggle among themselves for a re-definition of parameters of power, the issues close to the life and well being of the people of Pakistan, are studiously ignored. Thus it would not be wrong if the masses considered this to be a sterile exercise. The crisis in the health delivery system is itself an indicator of the malaise affecting the system as a whole. Lack of commitment to social goals and single minded pursuit of self interest is a moral degeneration and corruption beyond any financial wrongdoing. But sadly, this is the all pervasive illness affecting the ruling classes today. Let no section of the ruling classes strike any self-righteous pose, the masses have had more than enough opportunity to see through these bogus sanctimonious postures. This is high time the ruling classes and its institutions woke up to ground realities and corrected its criminal behavior. History shows that no society can continue to exist without resolving its internal and external contradictions. No superpower and no accident of history can prevent the extinction of an unjust and oppressive society.