Contaminated and inferior medicines sold in pharmacies in Pakistan are a serious problem. This was made pretty obvious when a few years ago many poor patients being treated at the Punjab Institute of Cardiology (PIC) died after consuming contaminated ‘free’ medicines. Sadly such contaminated or even entirely ‘spurious’ medicines are usually available at the low end pharmacies that cater to the poor. Also, many medicines available in government hospitals that are provided to the poor often free of cost are frequently not really what they are supposed to be.

Now, dear readers most, if not all, of you are going to become totally unhappy about how things have gone down the proverbial tubes during the last few decades and how much better things were in the good old days. Well sadly the good old days were not all that good either, at least as far as medicines for the poor are concerned. Forty four years ago I served as a house surgeon in the department of cardiac surgery in Mayo Hospital in Lahore. And so perhaps a few stories from those times might illustrate how things were even then.

First, my late father, a practicing general physician (GP) in Lahore, impressed upon me during my days in medical college the importance of getting medicines from reliable producers and manufacturers. In those days, many GPs also dispensed medications to their patients. Therefore, the quality of medicine was of utmost importance since the reputation of the doctor also depended upon the medicine dispensed being able to do what it was supposed to do.

When I started my house job in Mayo Hospital in 1971, it was a well-known fact that many of the medicines for ordinary patients were essentially nothing but chalk. However, important medications needed for sick patients admitted to the hospital could be found if you knew the ‘right’ people in the medical stores. And it did not involve money; you just had to convince them that the patient really needed that particular medicine. But the situation in general was perhaps not too different from what it is now.

Here a story. As the junior house surgeon in the department of cardiac surgery I was the low man on the medical totem pole. In 1971, our department was developing the capability to perform open heart surgery. The department had acquired what today seems an extremely primitive heart lung machine that was basically a bag called a ‘bubble oxygenator’ attached to a couple of roller pumps. The pumps pulled the blood out of the body, ran it through the bag where the carbon dioxide was removed and the blood now full of oxygen was pushed back into the body bypassing the heart and the lungs.

Of course we were not yet ready to start operating on humans so the experimental stage training was done on dogs in the ‘dog lab’. Being, as I mentioned above, the low man on the totem pole, my job included acquiring stray dogs from the Lahore Municipal Corporation, making sure they were housed properly in the ‘animal house’ (not to be confused with the great movie of the same name). On the fateful day which fortunately happened only once a week, it was my responsibility to get two dogs from the animal house to the animal lab. Why two dogs, well not to gross out my readers I will use technical jargon and just say that one dog was needed to ‘prime the pump’.

I don’t want to go into the nitty-gritty of what happened in the animal lab but I do want to talk of the transportation of the dogs to the animal lab since that is relevant to our discussion about spurious medicines. Prior to transportation the dogs were fed a ‘patawa’ (mixture) of flat bread, a small amount of meat curry and a liberal dose of a sedative. After about an hour passed the dogs were then taken to the lab. And there was the rub. Instead of becoming sedated, the dogs became extremely ferocious requiring the several able bodied ‘ward boys’ to drag each snapping, barking and resisting dog to the lab. Clearly the ‘sedatives’ fed to these dogs had no sedative in them while the food definitely reinvigorated them. Or perhaps the dogs knew what was in store for them.

The point then is that inferior medicines were being provided to the poor (including those poor, poor dogs) even before I arrived in Mayo Hospital forty four years ago. So it is obvious at least to me that spurious and inadequate medicines were being manufactured and sold to public hospitals at that time and I am sure they were also being sold to poor patients at a cost much less than that of the ‘branded’ medicines.

Besides making me extremely suspicious of what went on in the ‘local’ pharmaceutical industry, my experience with the dogs made me and the dogs I met thereafter extremely uncomfortable in each other’s presence. Fortunately, before the year was over I was in the United States, just in time for Christmas revelry before starting my ‘internship’ in a county hospital in a New York City suburb. And the hospital I joined was already performing open heart surgery on humans, and the difference between what we were attempting in Mayo Hospital and what was routinely going on in the US was indeed dramatic. Today heart surgery in Pakistan is done quite as well as it is done in the US.

Concerning the quality of medicines available in Pakistan today, I can say without any reservation that most products sold by reputable pharmacies and manufactured by well-established companies are completely reliable. Sadly, there are shady ‘operators’ that produce inferior products and sell them to pharmacies in smaller towns that cater mostly to poor patients, or else to public hospitals where dishonest employees buy these ‘medicines’ for financial incentives. But there are two areas where it is important to be careful even when buying medicines that are manufactured or sold by reputable companies.

First are those that belong to ‘alternative medicine’ category. There is little control on how these medicines are manufactured, what they contain and what scientific studies have been done to prove their efficacy. Mixing such medicines with potent medicines for heart or kidney problems that many sick patients might be taking can produce dangerous cross reactions.

The second area of concern is ‘dietary supplements’ usually of an herbal origin that make dubious health claims. These claims are often unsubstantiated but the worse thing is that some of these supplements don’t even have the advertised herbal ingredients. Just a week or so ago, the Attorney General of the State of New York asked some major health supplement selling stores to stop selling some commonly used herbal supplements like Gingko Biloba and Ginseng since the samples of these supplements being sold did not even contain any of what they were advertised to contain. One of these stores/manufacturers is thought of as the provider of very reliable dietary supplements in Pakistan. And that really is my message for today. Most magic potions don’t really work.