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Dr. Anderson: How Safe are Pharmacies
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Dr. Anderson: How Safe are Pharmacies
Doctor Eric Anderson, a charter diplomat of the American Board of Family
Practice and a former president of the New Hampshire Academy of Family Physicians,
is a regular contributor to Travel Tips 'n' Tales. He is widely traveled
and published, having written a travel health column for Travel 50 & Beyond
and a weekly online column, Ask The Doctor, for The New York Times Syndicate.
Dr. Anderson invites you to send your questions regarding travel health
issues to firstname.lastname@example.org
Eric Anderson MD
Question: Can I truly depend on drugs I buy in pharmacies overseas?
The short answer is no - not consistently.
Travelers should carry
twice the medications they need when visiting foreign lands -- one lot
in your hand luggage and the other in your checked suitcases. Then if your
luggage goes astray, you have a backup in your possession, or if you are
robbed, you have extra bottles back at your hotel.
Carry your medication in
its original marked bottles and have a duplicate
prescription from your doctor. If you extend your stay and start to run
out of medication, go to a qualified physician (he may give you his own prescription) and
ask where you should fill it.
What's the long answer?
OK. There are two issues here.
First, is it still potent, or could it have degraded into a chemical with
toxic side effects? For example, that can happen with tetracycline, an antibiotic often
used in the tropics.
Second, is it counterfeit? At The World Health Organization held in Geneva in April, 1999, reports said 2,500 people died in Niger in 1995 after they had been given a fake meningitis vaccine.
First Issue: Is it still potent?
Basically, it depends on whether the medication in the pharmacy has been
stored properly and for how long. It's quite complicated, because, at one
extreme, if you're filling a physician's prescription in a professional
pharmacy in a Western European country like Germany or the United Kingdom
you shouldn't have any difficulties but, on the other hand, if you are
buying antibiotics or antimalarials from drug stores or other sources in
developing countries like Nigeria or parts of Asia like Thailand you might
A study published in 1997 in the Tropical Medicine and International Health magazine
found that of the 96 samples of medications bought in the developing world and
then subjected to sophisticated chemical analysis, one-third were substandard by
Western world parameters. Contrary to the long-held suspicions of many
Western physicians at that time, the problems were due not to widespread
fraud but to either poor quality control at the foreign manufacturers or to
the high temperature and humidity of the area in question. However, that was
five years ago before pharmaceutical companies cottoned on
to the second issue: counterfeit drugs.
Second Issue: Is it counterfeit?
This has now become a significant concern and although there has been a lot
of posturing by international
agencies since 1997 I don't see much in the way of results to help you and
me when we travel.
For instance, the Food and Drug Administration (FDA) and the UK's Medicines
Control Agency (MCA) made a great show in February 1998 of joining forces to
combat international traffic in counterfeit pharmaceutical chemicals. The
press had a field day in this "creation of an informal model for future
international projects that was going to focus on achieving results, not
generating paperwork." The project received from then Vice President Gore
his Hammer Award, "a down-to-earth symbol of his National Partnership for
Reinventing Government, a five year-old, major initiative to make the
government work better for less." The program was to honor federal employees
and their partners who joined forces to cut red tape, streamline procedures
and get back to basic concerns of consumers.
And the results? More committees, more meetings.
The World Health Organization(WHO), for instance, reported from Geneva in
April 1999. that in 771 cases of counterfeit drugs, about 59 percent
contained no active ingredients, 17 percent contained an incorrect amount of
active ingredients, 16% contained quite different active ingredients and
only 7 percent contained the correct amount of active ingredients.
Unbelievable! It was at this meeting that the report was read that 2,500 people had died
in Niger in 1995 after they had been given a fake meningitis vaccine.
At the World Health Assembly in May 2000, again in Geneva, the headlines had
become COUNTERFEIT DRUGS: COTTAGE INDUSTRY OR ORGANIZED CRIME? Said Dr.
Yasuhiro Suzuki, WHO Executive Director of Health Technology and
Pharmaceuticals, "A deadly combination of demand for cheap drugs and fat
profit margins makes counterfeit drugs irresistibly attractive to greedy
criminals. Clearly, there is an urgent need for action if unnecessary human
suffering is to be stopped."
So did things get better?
In October 2001 a conference in Moscow brought together 200 leading
government and industry experts to discuss strategies for stemming the tide
of counterfeit drugs swamping the Russian Federation. "Counterfeiters of
medicine are terrorists in their own right," said Nikolay Gerasimenko,
Chairman of State Duma Health. "These criminals prey on the health and lives
of Russia's sick and poor, and seek economic gain by exploiting those whose
lives depend on high-quality."
And finally at the 50th Annual Meeting of the American Society of Tropical
Medicine and Hygiene in Atlanta in November 2001 Michael D. Green, a chemist
in the CDC Division of Parasitic Diseases, reported "Counterfeit malaria
drugs are a widespread problem in many parts of the world, especially in
southeast Asia where surveys determined 38% of samples of the malaria drug
artesunate purchased at retail outlets contained no active ingredients
whatsoever. "In 1999," he continued, "More than 30 malaria deaths in
Cambodia could be linked to inadequate treatment due to counterfeit drugs."
Green felt a simple $100 gadget to test urine samples could be used by
governments to test for drugs that lacked active ingredients but so far,
this so-called refractometer has only been used in the laboratory.
So what does all this mean? (I did say it was the long answer).
I think it
means you can't rely on far-off government agencies to look after you. If
you are going on a long trip and are not prepared to travel with double
doses of your regular medications then you have to take personal
responsibility for your needs and come up with your own Plan B.
Have a Plan B in place before you leave
Leave an International FedEx envelope and a credit card number with your
next door neighbor or regular pharmacist. Or if you are going to be staying
overseas at a long established, reputable hotel, mail extra medicine to
yourself for arrival. Me? I'd rather carry double.
This problem is not going to go away and it's not limited to medications as anyone who has bought a
"Rolex" for $20 in Hong Kong knows. Just last month Steve Smith, managing
director of Eveready Batteries (Kenya) said 40 percent of the batteries sold
in that African country are counterfeit. But that's another story.
» » More articles by Dr. Eric Anderson
NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult
with your personal physician before following any medical advice and to please read the Travel
opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.