It was in 2009 that a Chemistry gold medallist, who was in a team collecting data about the sale of spurious and substandard drugs in Karachi, told me the shocking tale of pills and capsules being sold by weight on pushcarts in Boulton Market.
The sale of such drugs is not a laughing matter, however neither of us could help picturing a scenario featuring a neurotic customer purchasing bags of pills. "I'll take 500 grams of those while pills, and 200 grams of those pretty pink ones, and those lovely green capsules which you say are vitamin E can I have a dozen blister strips..." and so forth.
The scenario was ridiculous but not incredible. In a county with a largely illiterate and ill-informed working class in cities, towns and villages, who also have numerous real and imagined health problems, pills and capsules are identified by colour. White pill means a pain killer, an aspirin, an analgesic drug that is widely used to relieve pain, inflammation and fever. Pink means a drug for blood pressure, wither high or low is irrelevant. It is one of the favourite afflictions of the poor who term it "blood press" or "bippi". As for capsules, they simply love them as it gives them kind of higher status among patients who are merely prescribed pills. "Kafsool" is very popular, and quacks often prescribe capsules on patient's demand.
It was last week that we got some idea of how drugs land in the open market to be sold on pushcarts. Last Saturday a drug court issued notices to the federal health secretary and other senior officials on two applications about the sale of substandard and spurious drugs. The case will be heard on June 16. Notices have been issued to the respondents including the federal health secretary the central licensing board, the registration board, the federal chief drug inspector.
The two advocates, Mohammad Shakir and Nadeem Sheikh who filed identical applications (being treated is one case) before the three-member drug court in Karachi produced sufficient evidence of the involvement of senior drug officials. Their data corroborated what I was told by the gold medallist chemist two years ago except that she and other chemists in that study team had no suspicion that government officials were involved.
Nearly every one who has heard about the sale of spurious and substandard drugs has imagined the real source of these drugs were illegitimate private manufacturers. It turns out now that substandard drugs on sale in the pushcart originated in licensed drug factories. The drug companies may (or may not) know that it was their drugs. According to my informant the drugs appeared to be standard products but the exposure to open air, sun and pollution in Boulton Market rendered them inefficacious, destroying their fragile chemical quality.
The two applicants in the drug case submitted that half of these substandard drugs were purchased by government for their primary health-care units and the remaining stock was put on sale in the market. They have thus alleged that the drugs were substandard in manufacture and not that they deteriorated when put on sale in the open market. This is a much more serious allegation and the applicants have asked the court to immediately ban open sale of drugs.
Up till now one had imagined the source of spurious medicines was the number of dubious factories that exist in the city. In my trainee days I had an opportunity to accompany the crime reporters who had gone to see one of these factories. It was a dirty shed in a refugee hut, a juggi, where a spurious version of a very popular tonic Waterbury's Compound was being made. The culprit had absconded but the place clearly bore evidence of spurious manufacture. There were empty old bottles of the tonic in piles and freshly printed labels. The machine that made sealed metal caps for the tonic bottles was missing. It must have been the only expensive machine and must have been taken away and hidden by the factory owner. Chemical examination of the tonic proved it was just a concoction of alcohol, sugar syrup, red food colour and a tincture that gave the spurious tonic its medicinal flavour.
A few years later PTV had a drama in which a maker of spurious drugs tragically looses his little son who has been administered the fake medicine by the ignorant wife. The play made an impact at that time as it was widely discussed by all types of televiewers. Through the 1960s and 70s the hunt for spurious medicine manufactories remained high on the crime-fighting agenda of the city police. But little was done to create public awareness and warn people about the use of spurious medication.
The focus changed drastically in later decades especially after the start of the Russian invasion of Afghanistan. Opium smuggling became Karachi underworld's great criminal activity. Opium, heroin and other types of drug abuse became the greatest menace of the city, leading to increase in petty crimes such as the theft of metal manhole covers and hub caps sold by addicts to by their drugs.
This led to virtually ignoring the manufacture of spurious and substandard medical pills and capsules. This illegal business has therefore flourished to the extent that now even legitimate manufacturers stand allegedly accused of misusing their license and unafraid of the consequence of abusing the Drugs Act 1976.
We have to wait for facts when the fake drug case is heard, on June 2 when testimonies of the prosecution witnesses will be recorded and June 19 when the case will be heard. The applicants have pleaded that there should be an immediate ban on sale of spurious and substandard drugs, but will that ensure the end of this heinous practice? I do not think so. As long as the majority of people are poor they will go to the cheapest source of medicines and to the quacks who prescribe them. Even warning the public will not end the problem because to the poor a doctor is a doctor; how do they know he is quack? And a pill is a pill; how can they test its quality?