Still on helping someone

You have never really lived until you have done something for someone who can never repay you.

Help someone!

Today, I will make somebody smile… 🙂 How about you?

Don’t worry

“Don’t worry when you are not recognized, but strive to be worthy of recognition” Abraham Lincoln

Florence Nightingale

Let whoever is in charge keep this simple question in her head- how can I provide for the right thing to be always done? Florence Nightingale

Heart of the Healthcare

Nurses are the heart of the healthcare. Donna Wilk Cardilo

Fake drugs: A time bomb from which no one is safe

From Abia to Zamfara, the battle to save Nigerians from the onslaught of fake drug merchants is being fought on a daily basis. While the National Agency for Food and Drugs Administration and Control slug it out with the merchants of death, medical experts warn of the dangers of fake drug use, just as industry chiefs discuss what they do to protect their patents and members of the public that use their products. SOLAADE AYO-ADERELE reports -Punch

The battle for the pharmaceutical drug users’ pockets is being fought with tenacity by fake drug manufacturers and merchants, just as regulatory agencies and licensed drug manufacturers struggle, not just to protect the integrity of their products, but to also save users from the fatalities that attend substandard drugs intake.

Considering the drug distribution processes in the country, which is still heavily unregulated, especially in the rural areas, it is not a surprise that the authorities of the National Agency for Food and Drugs Administration and Control have continued to wage war against these merchants of death who fake pharmaceutical products with the sole aim of cashing in on the ignorance of the people.

The Director-General of NAFDAC, Dr. Paul Orhii, explains that counterfeit pharmaceutical drugs are fraudulently produced or mislabeled to look like real patented or trademarked products manufactured by a licensed pharmaceutical company, which are purchased by consumers who believe them to be genuine.

“The fake pills may look identical to their genuine counterparts but they may be incorrectly formulated and produced in sub-standard conditions. They could have the right active ingredient but at the wrong dose, as they are never subjected to the same regulatory scrutiny as legitimate medications,” Orhii explains.

Before any new therapy can be used, he says, a thorough identification of its toxicity and safety is required. Therefore, drug toxicology and safety pharmacology are central to the chemical and pharmaceutical industries. “This is one rule fake drug manufacturers don’t observe,” Orhii says.

He says one reason it is so difficult to identify counterfeit medicines is because they appear strikingly similar to the genuine products. “But, worse is the fact that fake or substandard drugs often have incorrect amounts of active ingredients — if ever they are present at all.”

Quoting the World Health Organisation on the ingredients found in fake drugs, Orhii says, “Some counterfeits have little or no active pharmaceutical substance, as many of them contain innocuous ingredients like chalk, flour, talcum powder, corn starch, or sugar;” none of which can produce the desired pharmacological effects expected of a genuine medicine.

Indeed, the WHO has estimated that between eight and 10 per cent of the world pharmaceutical market is made up of counterfeit drugs; while counterfeit drug markets in developing countries account for between 10 and 30 per cent of the supply chain. Orhii however assures that NAFDAC has been able to reduce counterfeit drugs in the Nigerian market to less than five per cent through aggressive use of new technology.

Yet, the fake drug industry is a multi-billion naira business in Nigeria.

According to NAFDAC’s Director of Enforcement, Mr. Garba Macdonald, in 2010 alone, the agency destroyed fake drugs worth N1.6bn; while in 2011, the total amount of substandard drugs that were confiscated and subsequently destroyed was N627m.

Before one could conclude that the supply of fake drugs is mellowing out since the amount of fake drugs destroyed in 2011 was smaller than that of 2010, however, Macdonald explains that it is because in 2011, NAFDAC “did not carry out major destruction exercise as it did in 2010.”

Indeed, in 2010, NAFDAC impounded several truckloads of substandard drugs as they were being brought into the country via the Nigeria-Seme border. The estimated market value of the drugs seized in one haul was N500m, according to Orhii.

Asked if it was the biggest seizure the agency had made so far, Orhii said it wasn’t. He says his agency recently seized one air shipment of counterfeit drugs worth $3m, thus underscoring the dangers posed by fake drug merchants to the economy and to the consuming public.

On February 21, 2012 alone, NAFDAC sealed off three drug stores belonging to patent medicine dealers during an inspection tour of Eleme and Okrika Local Government Areas of Port Harcourt, Rivers State. The owners reportedly escaped arrest by running away on sighting the agency’s officials.

The drugs, worth several millions of naira, were said to be among those that have been banned from being imported or sold in Nigeria, while some of them have expired.

Also, in Awka, Anambra State, NAFDAC destroyed fake, expired and substandard drugs and cosmetics worth N279m on Friday, February 24, 2012. Macdonald says the dealers in four states under its Enugu Zone voluntarily surrendered them to the agency, following an enlightenment campaign.

At Apapa Port recently, a 1x20ft container of Ferozin capsules worth N37m was intercepted; and at the Tin Can Island Port, 29 large packages of pain-relieving though habit-forming Tramadol worth N18m was also seized.

Again, on Monday, February 20, the Lagos State Task Force on Counterfeit, Fake Drugs and Unwholesome Processed Foods shut down 14 illegal drug stores in Ebute Meta and Oyingbo areas of the state, while four operators of the shops were arrested.

The State Commissioner for Health, Dr. Jide Idris, says the operators were engaged in drug distribution without licence from the regulatory authorities, and they had also failed to locate their shops at a recommended distance from the market, as stipulated by the law.

Orhii also says, following an alert that most medicines being sold in drugstores in Ogbe-Ahiara, Afor-Ogbe markets in Ahiazu Local Government Area of Imo State are counterfeit, the agency will soon beam its searchlight on the market and arrest the situation.

Macdonald explains that counterfeiting, diversions and cargo thefts are all part of a growing criminal enterprise, which also includes the deliberate adulteration of drugs and consumer products to maximise profits.

Indeed, recently, Ogun State Ministry of Health sponsored a full-page advertisement in a number of national dailies, listing various types of drugs purportedly stolen from its custody, thereby reaffirming the nation’s haphazard and unsafe drug distribution system.

Talking about the dangers posed by fake drug use, consultant/lecturer, Lagos University Teaching Hospital and Chairman, Nigerian Medical Association, Lagos State branch, Dr. Edamisan Temiye says the public health risk is unquantifiable.

“The public health risk for taking counterfeit drug is enormous, because users of these substandard medications actually hope to treat a health condition. So, when they use counterfeit medicines, they may be going untreated, and this can result in treatment failure, organ failure, increased resistance to treatment (in the case of anti-malarials that contain insufficient active ingredients) and, in extreme cases, death.”

Again, he says, public confidence in health-delivery systems may be eroded following use and/or detection of spurious, falsely-labelled, falsified or counterfeit medicines.

Though Nigeria lacks data on deaths resulting from counterfeit drugs use, WHO says some 700,000 people die worldwide annually from counterfeit drugs; while, as recently as 2009, more than 80 Nigerian children died after being given My Pikin syrup for teething pain, which turned out to be counterfeit.

Asked what types of drugs are likely to be counterfeited, Orhii and Temiye list pain relievers, antibiotics, sexuality-enhancing drugs, weight loss drugs, as well as anti-retrovirals (HIV medications) as ones preferred by counterfeiters, probably because of their high volume of use for the treatment of diseases that are of public health interest.

They say both branded and generic products are subject to counterfeiting; and that all kinds of medicines have been counterfeited, from medicines for the treatment of life-threatening conditions to inexpensive generic versions of pain-killers and antihistamines (used to treat allergies).

Others include drugs for the treatment of asthma, epilepsy, hypertension, and malaria.

In an earlier interview, the Chairman, Lagos State Chapter of the Association of Community Pharmacists of Nigeria, Mr. Anieh Felix Anieh, notes that drug ccounterfeiting is greatest in regions where regulatory and enforcement systems for medicines are weakest.

“We have discovered that drugs are sometimes displayed and distributed in unregistered premises, which is against what the law says,” Anieh says.

Quoting the 2005 Registration of Pharmaceutical Premises Regulations and the Pharmacists Council of Nigeria Act of 1992, he says all drugs retail premises must be registered  and wholly owned by a registered pharmacist or in partnership with one.

“This has not always been so in Nigeria, and it’s one reason why we still have incidents of fake, substandard or counterfeit drugs,” Anieh explains.

On Wednesday at a press conference to announce the seizure of yet another consignment of fake drugs, Orhii details the extent that NAFDAC has gone to take the battle to rural areas where, he says, fake drugs are found in huge numbers.

“What we have observed is that some of the drugs that have been wiped out of circulation in urban areas have found their way to the rural areas, particularly drugs that have been banned and those whose production has been stopped.

“They also include others that NAFDAC has not registered,” Orhii says.

Orhii says NAFDAC is working with other agencies and the private sector, as well as the governments of India and China — countries of origin of most seized fake drugs in Nigeria — to help protect the nation’s drug supply from the threat of counterfeits.

He however laments that while China stipulates the death penalty for drug counterfeiters, in Nigeria, the highest penalty secured so far for those convicted of fake drug manufacture or distribution is four-month imprisonment term.

According to NAFDAC’s Head of Legal Team, Mr. Kingsley Ejiofor, about 110 cases instituted by the agency against counterfeiters are still pending in the various courts, though it has so far secured 52 convictions.

He decries cases of delayed trials, while he also notes that in many instances, the police have been unable to get the accused arraigned in court.

Again, he says, when the judge presiding over a case is transferred, the process of filing such a case has to be done afresh, with the attendant frustrations and subsequent delays.

Since convictions have been minimal for drug counterfeiters, Orhii says the agency is currently lobbying the National Assembly to impose life imprisonment, upon conviction, on any fake drug merchant or importer; while their assets should be confiscated and sold to pay for any proven cases of damage done by their products to end users.

As parts of its efforts to rid Nigeria of fake drugs, Orhii says NAFDAC has acquired some cutting-edge technologies with which it tests drugs for originality.

One of such is the Truscan, which was used to ascertain the pharmacological quality of some drugs in the presence of journalists on Wednesday.

The Truscan is a handheld scanner that can instantly verify a drug shipment’s authenticity by analysing a tablet’s complex chemical spectrum. 

“Unless the entire spectrum checks out, the drug will show as counterfeit on the scanner, even if it contains some of the properties found in the authentic drug,” Orhii says.

However, the problem of funding has been a major concern for the agency, Orhii says. For instance, he says, a Truscan costs $50,000 and the agency was able to purchase only four, while an international agency has also donated two machines to the agency.

He says for the technology to have maximal impact on the nation’s drug distribution system, NAFDAC must have at least 100 Truscan machines.

He also says the agency currently uses text messaging technology called Mobile Authentication Service, whereby those who purchase medicines can text the drug’s name to 38353, which will give an instant feedback of the drug’s status with the regulatory agency.

“Twenty-three companies have signed up for the MAS,” Orhii says.

He also explains that drug importers are mandated to report all imports to NAFDAC for documentation and to prove that the merchandise is genuine and NAFDAC-compliant.

As NAFDAC attempts to put counterfeit drug manufacturers, importers and distributors out of business, pharmaceutical giants in Nigeria are also doing all they can to protect their products and save the sector.

At the re-launch of one of its high-end products recently, Fidson Healthcare Plc explains that the overall aim is to beat counterfeiters in their game, and to protect the integrity of the company.

The firm’s General Manager (Marketing), Mr. Ola Ijimakin, says by replacing the old Ciprotab tablets with Ciprotab Soflets — a technology patented by Banner Pharmacaps Inc. USA and the first globally — it becomes impossible for the product to be imitated.

Again, he says, Fidson has branded certain medicines in its stable as “ethical,” and as such cannot be found in the regular markets but in designated high-end pharmaceutical stores.

“With this strict regulation of our distribution chain, it’s virtually impossible for anyone to claim that our products have been counterfeited, because then you’d have to explain where you made the purchase. Once it’s not in any of the accredited distribution channels, know you are dealing with a case of counterfeiting,” Ijimakin says.  

In the interim, NAFDAC gives a list of banned drugs to include Analgin injection. Those whose production has been stopped since 2002 include Fulcin tablets (a brand of Griseofulvin 500mg); and those whose importation has been banned as Septrin and all brands of cotrimoxazole, Nimesulide and Phenylbutazone, among numerous others.

Common Painkillers ‘Pose Heart Risk’

BBC

Two common painkillers, ibuprofen and diclofenac, can slightly increase the risk of heart problems if taken in high doses for a long time, data suggests.

People with severe arthritis often take the drugs, which also calm inflammation, to go about daily life, reports the BBC.

The researchers said some patients would deem the risk acceptable, but they should be given the choice.

A study, published in the Lancet, showed the drugs posed even greater risks for smokers and the overweight.

The risks have been reported before, but a team of researchers at the University of Oxford analysed the issue in unprecedented detail in order to help patients make an informed choice.

The group investigated more than 353,000 patient records from 639 separate clinical trials to assess the impact of non-steroidal anti-inflammatory drugs.

They looked at high-dose prescriptions levels, rather than over-the-counter pain relief, of 150mg diclofenac or 2,400mg ibuprofen each day.

They showed that for every 1,000 people taking the drugs there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding – every year as a result of taking the drugs.

So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drugs.

“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients,” said lead researcher Prof Colin Baigent.

He added: “So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life.”

He said this should not concern people taking a short course of these drugs, for example for headaches.

However, he did warn that those already at risk of heart problems would be at even greater risk as a result of the high-dose drugs.

High blood pressure, cholesterol and smoking all increase the risk of heart problems.

Prof Baigent said: “The higher your risk of heart disease, the higher your risk of a complication. Roughly speaking, if you’ve got double the risk of heart disease, then the risk of having a heart attack is roughly doubled.”

He said patients should consider ways to reduce their risk, which could include statins for some patients.

A similar drug called rofecoxib (known as Vioxx), was voluntarily taken off the market by its manufacturer in 2004 after similar concerns were raised.

There are more than 17 million prescriptions of non-steroidal anti-inflammatory drugs in the UK each year. Two thirds are either ibuprofen or diclofenac.

A third drug, naproxen, had lower risks of heart complications in the study and some doctors are prescribing this to higher-risk patients.

The drug does a similar job to aspirin by stopping the blood from clotting although this also increases the odds of a stomach bleed.

Prof Alan Silman, medical director of Arthritis Research UK, said the drugs were a “lifeline” for millions of people with arthritis and were “extremely effective in relieving pain”.

He added: “However, because of their potential side-effects, in particular the increased risk of cardiovascular complications which has been known for a number of years, there is an urgent need to find alternatives that are as effective, but safer.”

Prof Donald Singer, member of the British Pharmacological Society and from the University of Warwick, said: “The findings underscore a key point for patients and prescribers – powerful drugs may have serious harmful effects.

“It is therefore important for prescribers to take into account these risks and ensure patients are fully informed about the medicines they are taking.”

NAFDAC raises the alarm over fake Sugar

The National Agency for Food and Drug Administration and Control on Tuesday in Ibadan, Oyo State, alerted Nigerians to fake brand of sugar  in circulation.

The Zonal Coordinator for Oyo State, Mrs Omosola Osinbanjo, said the discovery of the fake sugar  followed the intensive surveillance exercise carried out across the state by officials of the agency.

Osinbanjo said the initiatives of  NAFDAC led to  the discovery of the fake product at a market in Agbeni area of  the metropolis.

She said the  agency’s officials had stormed the area following reports of  the production of  fake St. Louis sugar brand being passed on to unsuspecting members of the public as  fortified sugar.

Also speaking, the state’s  head of the agency and leader of the team which conducted the operation, Mr. Benjamin Haruna, explained that the exercise was routine.

“We had a tip off  that some people were bringing in sugar that was  not fortified and did not carry the logo for certification.

“Initially, we went on surveillance and thereafter went to town and discovered that many shops at Agbeni market and other markets were selling them, ’’ he said.

Haruna told the News Agency of  Nigeria on the sidelines of  the exercise  that the initiative was aimed at  ensuring the mopping  up of  fake sugar products in circulation.

He said erring shop owners would be sanctioned  in spite  of the  confiscation of their goods.

NAN also reports that some fake brands of  fruit juice were also confisticated  during the raid.

NAFDAC raises the alarm over fake Sugar

The National Agency for Food and Drug Administration and Control on Tuesday in Ibadan, Oyo State, alerted Nigerians to fake brand of sugar  in circulation.

The Zonal Coordinator for Oyo State, Mrs Omosola Osinbanjo, said the discovery of the fake sugar  followed the intensive surveillance exercise carried out across the state by officials of the agency.

Osinbanjo said the initiatives of  NAFDAC led to  the discovery of the fake product at a market in Agbeni area of  the metropolis.

She said the  agency’s officials had stormed the area following reports of  the production of  fake St. Louis sugar brand being passed on to unsuspecting members of the public as  fortified sugar.

Also speaking, the state’s  head of the agency and leader of the team which conducted the operation, Mr. Benjamin Haruna, explained that the exercise was routine.

“We had a tip off  that some people were bringing in sugar that was  not fortified and did not carry the logo for certification.

“Initially, we went on surveillance and thereafter went to town and discovered that many shops at Agbeni market and other markets were selling them, ’’ he said.

Haruna told the News Agency of  Nigeria on the sidelines of  the exercise  that the initiative was aimed at  ensuring the mopping  up of  fake sugar products in circulation.

He said erring shop owners would be sanctioned  in spite  of the  confiscation of their goods.

NAN also reports that some fake brands of  fruit juice were also confisticated  during the raid.

About 20 million Nigerians are asthmatic – Don

The Dean, Faculty of Clinical Sciences, University of Ilorin, Prof. Abdulwahab Johnson,  has said that between 15 million and 20 million Nigerians have asthma or symptoms suggestive of asthma.

According to him, asthma affects about 300 million people worldwide and the figure is expected to rise by 2025.

 He said the disease is unarguably more common in the Western world, particularly Britain, United States, Canada, Australia and New Zealand.

He explained that over 100,000 deaths were recorded worldwide from severe asthma, adding that approximately five per cent of asthmatic adults die every year.

Speaking in Ilorin on Monday during the 100th inaugural lecture of the University of Ilorin, he said acute asthma accounts for over 500, 000 hospitalisation globally, many of whom would require emergency room care.

Johnson said globally, between 1.5 million and 2 million children die yearly and that 4,300 children die every day from pneumonia, at the rate of one child every second. He added that pneumonia was responsible for more deaths for children under five years of age than those resulting from measles, malaria and AIDS combined.

He said pneumonia constituted the most pernicious consequence of the interaction between microbial pathogens and the breathing organ of children.

The consultant paediatrician and pulmonologist however said good nutrition, including exclusive breast feeding in early infancy, could protect children from pneumonia and other respiratory illnesses like RSV-bronchiolitis.

He listed other ways of preventing the disease to include un-crowded and well-ventilated housing conditions and hand washing (with soap). Johnson added that reducing the level of domestic pollution from wood-burning and other sources of biomass combustion,  as well as avoiding exposure of children to tobacco smoking, would  protect children from pneumonia.

“In addition to the current Vitamin A supplementation campaign, a government-initiated nation-wide food-fortification scheme with a view to improving the currently low level of zinc in under-five children will surely impact positively in reducing the vulnerability of under- five children to pneumonia and bronchiolitis.

“The respiratory and infectious disease unit of our Department of Paediatrics and Child Health pioneered the use of inhaled medications, especially the use of nebulizers for managing acute, and acute severe asthma in tertiary care facilities in this country.”