A global problem
Many of the pharmaceuticals that are purchased in the developing world are substandard or outright fake drugs. Although there is no global system for monitoring the quality of medicine, study after study reveals pervasive poor quality and products that are worthless or even harmful to patients. Many countries in the developing world do not have the technological infrastructure or regulatory resources to keep low quality medicines off the market shelves. And since the pharmaceutical trade is a lucrative global market, low quality medicine can cross borders and harm people anywhere in the world.
Negligence by manufacturers
- A heart medicine called "Isotab" killed over 200 people in Pakistan when one batch was manufactured using toxic quantities of an antimalarial medicine in place of the inert filler that was supposed to be added. According to the Pakistani government's report (pathology_of_negligence_pic_drug_inquiry_report_2012.pdf) the antimalarial drug got wet during delivery, and was moved into a drum marked "starch". No-one ever changed the label or noticed the substitution.
Deliberate falsification by manufacturers or distributors
- Fortune Magazine has a great investigatory report on Ranbaxy's contribution to this area.
- Even secure supply chains fall victim; see this WHO report on testing company Semler Research faking bioequivalence studies.
New ways to find fake medicines
Paper analytical devices (PADs) are test cards that can quickly determine whether a drug tablet contains the correct medicines. They are cheap and easy to use. They don't require power, chemicals, solvents, or any expensive instruments, so they can be deployed rapidly at large scale whereever a problem with pharmaceutical quality is suspected.
Partnering with regulatory agencies
By sharing our results directly with medical regulatory agencies, we help them quickly discover poor quality medicines in their markets. This enables them to negotiate with manufacturers and distributors from a position of knowledge and to take other regulatory and legal actions to protect patients from poor quality products.
Bringing market forces to bear
In the developing world, most buyers have to trust what the seller tells them about the quality of the pharmaceuticals they purchase. Unscrupulous manufacturers and distributors know that there is little chance that their medicines will be screened in a lab. These paper test cards don't need a lab, and they will enable people all over the world to quickly detect low quality medicines and remove them from the market.
USP's Technology Review report on the PAD is now published.
The paper analytical device (PAD) was developed as a cost-effective tool for field screening of a wide variety of pharmaceutical dosage forms in low-resource settings. The PAD is produced by wax printing on Ahlstrom 319 paper, which is a fast chromatography paper that creates separate reaction lanes and contains trace quantities of chemical reagents to create color changes in response to different pharmaceutical articles. Due to the COVID-19 pandemic, there has been continued upsurge of substandard and falsified (SF) medical products, especially those that claimed to be a possible treatment for the disease (e.g., azithromycin, chloroquine, and hydroxychloroquine), and which the PAD can be used to screen the products for quality. With the help of appropriate analytical techniques and methodologies, a preliminary laboratory study was conducted on all the samples used in the performance validation of the PAD to ascertain the quality status of each sample prior to the validation study on the PAD. The validation study was performed on the PAD by three different scientists using three different brands each of seven finished dosage forms (FDFs), their respective active pharmaceutical ingredients (APIs), SF formulations, and selected fillers (pharmaceuticals excipients). Upon evaluation of all data generated by the three scientists at the end of the validation study, the PAD was determined to be effective in identifying the active ingredients in all the samples collected for evaluation. The technology was also able to detect fillers such as corn starch present in some of the FDFs and formulations labeled to contain them. Results of the laboratory identification tests performed were consistent with those obtained with PAD by all three scientists. All SF formulations were prepared as per the study protocol, and all falsified formulations were correctly identified as falsified by the PAD. However, the PAD was incapable of distinguishing between substandard or degraded formulations (even those with 50% APIs) and good quality products and formulations and their respective pure APIs, making it impossible for the technology to be used to screen substandard products. Only falsified products were able to be identified correctly.