Why medicines are unavoidable for us?
Medicines
are often necessary to treat diseases, manage chronic conditions and improve
overall health and quality of our life. Medicines play a crucial role in
treating various illnesses and diseases, helping to cure infections, control
symptoms and improve outcomes. For individuals with chronic conditions like
diabetes or high blood pressure, medicines are often essential for managing
symptoms and preventing complications. Medicines can significantly improve
quality of life by alleviating pain, reducing discomfort and allowing
individuals to live more active and fulfilling lives. But they should be taken correctly and under
the guidance of a healthcare professional. Medicines come in various forms,
including tablets, capsules, liquids, injections and topical applications, each
designed for specific purposes and methods of administration.
What is the common composition or constituents of a
medicine (tablets & capsules)
A drug in the form of
tablet or capsule usually has basic ingredients (chemical composition), excipients
and drug binding agents respectively. Excipients are ingredients other the
active pharmaceutical ingredient (API) which are added to the chemical
composition to facilitate drug absorption, stability and manufacturing. They don’t
have medicinal properties. Excipients help in the production of tablets and
capsules. Common examples of excipients are lactose and cellulose. In addition
to excipients, disintegrants are also added during drug manufacture because it
helps the tablets and capsules to break down as soon as they come in contact
with the gastrointestinal fluid and helping the chemicals to release in our
body. Sodium carboxymethyl cellulose (NaCMC) is commonly used as a
disintegrant. Common binding agents
used in tablet and capsule preparations include natural polymers like
starch and gelatin, as well as synthetic polymers such as polyvinylpyrrolidone
(PVP), polyethylene glycol (PEG) and microcrystalline cellulose
(MCC). Corn starch, potato starch and
wheat starch are well-known for their binding and disintegrating properties. A protein derived from animal collagen is used in
capsule shells and as a binder. Various edible colours are
used for making the drug colourful and preservatives are also added in the drug
manufacturing procedure to prevent microbial growth and to maintain the
stability of the drug. All these items play a vital role in making
pellets or granules and tablets remain in shape until they reach their target
by holding all ingredients (API and excipients) together in any solid dosage
form.
Discounts in medicine and fake medicines: Further
consequences
The lure of a discount in medicine may not be always
healthy. We have to be very careful and watchful when buying medicines with
hefty discounts because they may not be working properly as expected and
sometimes may be failed to recover from diseases as well as may be dangerous
too. Authorized retailers do not have the ability to give us hefty discounts
because it cuts into their retail margins on price controlled medicines at 16
to 20 percent (we usually receive nowadays) respectively and thereby creating a
doubt is the ingredients and the binding excipients of the medicine is
fulfilling quality control (95 percentage in our country while 99 percentage in
EU & US)! Recently, “Central Drugs
Standard Control Organization” (CDSCO) of our country has come out with its
list of “Not Standard Quality” (NSQ)
drugs listing more than 50 drugs which includes some well-known multinational branded
pharma company drugs. NSQ drugs typically refer to medicines that don’t meet
quality set by regulatory authorities. But four major multinational pharmaceutical
companies/brands mentioned they have clarified that the tested sample drugs
were spurious or counterfeit and thereby raising concerns to the common people
how they can be identified. Not all discounted medicines are always bad, as
some retailers may indeed can manage discounts through authentic sourcing from
companies. Fake
medicines or counterfeit drugs are those deliberately and fraudulently
mislabeled or falsified regarding their identity, origin or composition,
potentially containing harmful or ineffective ingredients. Every morning as we
start taking our prescribed medicines into our hand, we are trusting that they
are authentic. Worldwide, though counterfeit medications are more common nowadays
recent studies show approximately 10-40% of medicines are counterfeit sold in
low and middle income countries. In US & EU, less than 1% of medicines sold
in retail pharmacies are counterfeit.
We usually find the medicines with up to
20 percent discounts which are manufactured by either local pharma or non-branded
pharmaceutical companies while very few branded pharmaceutical companies
provide us discounts. Even if they give discounts (up to 10 percent) that is
for the market competition with the highly discounted drugs. Market study
reveals generic medicines are cheaper than company branded
drugs because manufacturers of generics don't need to invest in extensive
research and development, clinical trials or marketing as they are replicating
already approved drugs, leading to lower production costs and prices. When a pharmaceutical company develops a new drug, it
invests heavily in research and development, including clinical trials to
ensure the drug is safe and effective. Generic drug manufacturers,
however, don't need to repeat these expensive processes because they are making
copies of already approved drugs. Brand name drug manufacturers spend a lot
of money on marketing and advertising to doctors and the public. Generic
drug manufacturers, on the other hand, spend less on marketing, as they are
relying on the established reputation of the brand name drug. When
a new drug is created, it is protected by patents that stop others from making
copies of it for a certain period. Once the patent expires, other
companies can make generic versions without repeating the expensive research
and testing. This increased competition among generic manufacturers drives
prices down. Generic drugs must meet the same
standards for safety, quality, strength, purity and efficacy as brand-name
drugs but they don't require the same amount of research and development as
well as approval of the brand drug's ingredients is already complete. Generic medicines (discounted) are generally safe and effective, it's
crucial to ensure they are sourced from reputable, licensed pharmacies to avoid
counterfeit or unsafe drugs.
How to identify a fake or counterfeit drug?
According to the national drug survey reports the
percentage of NSQ Drugs in India has been found to be at 3.16 per cent and that
of spurious drugs at 0.0245 per cent. There are plenty of features to
identify fake medicines. These include packaging, appearance, prize, source,
lack of security features (bar and QR code) in the strip that can be scanned
but results may not be matched ideally and sometimes unusual smell. If we have
a careful look at the strips of the drugs or capsules we shall certainly find they
don’t appears like a genuine medicine as they are found in poor quality, inconsistent packaging,
blurry printing or damaged packaging. Tablets or capsules might have a
different size, shape, color or coating compared to the genuine product or show
signs of damage like cracking, bubbling, or crumbling. If the price of a
medicine strip is significantly lower than usual, we should be very careful as
this could be a tactic used by counterfeiters. Genuine medicines often have
security features like holograms, tamper evident seals or unique bar codes
which may be missing or poorly replicated on fake products. Generic but genuine
medicines are labelled with the product name, the details of the manufacturer
such as pharma company name and physical address and its expiry date. Also,
while purchasing medicine, we should check the batch number which can be used
to trace when and where the product was made. All of these are the ways by
which physically we may suspect and identify a fake medicine but it really
takes laboratory testing to confirm 100% if a medication is authentic or
counterfeit. For these purpose, C (carbon), H (hydrogen) and N or S (nitrogen
& sulpher) elemental analysis is most important. Based upon drug’s
molecular formula we can easily find out percentage of C, H & N/S for both
genuine drug as well as fake drug. The values obtained in C, H & N/S
obtained in fake medicines will be certainly far away from the desired level.
In a first look on the medicines to be purchased if we simply do find abnormal discounts and cross-checking the QR code
on the label, on the spot we can identify a fake medicine.
What to do if we have purchased fake or counterfeit medicines by
mistake?
While
opening the strips of tablets or blisters of capsules, we must ensure that the
medication is intact. Make sure yourself that the blisters have not been
tampered with and the seal hasn’t been broken. The blisters must all look the
same and possess an expiry date and the name of the product. If the product is
packaged as loose tablets or capsules in a bottle or dispenser packaging, we
need to ensure that they look uniform with no obvious discoloration, mottling,
chipping or mould. Fake medicines will not fulfill these criterion and they
will not work like a genuine medicine as well as could result in many side
effects due to improper combinations of ingredients or substandard chemicals as
ingredients, excipients and binding materials. If we see, there is no
improvements after consuming the prescribed medicines for a period of minimum 3
to 4 days, we should stop taking the medicine and consult our chemist followed
by consultation with the doctor. The most common fake medicines are the most
popular medicines like painkillers, antibiotics to treat infection, anti-malarial,
anti-retroviral, sexual stimulants and weight loss medications.
What happens if we continue consuming fake medicines
for a long period?
Substandard
and falsified (SF) medical products severely impact public health, leading to
severe and often fatal consequences. Patients may unknowingly consume
medications that contain toxic substances or incorrect dosages, resulting in poisoning,
treatment failure and exacerbation of diseases. These products can accelerate
the spread of drug-resistant infections, making once treatable conditions
deadly. The economic toll may also be serious as families deplete their savings
on ineffective treatments and health systems waste precious resources. Our
trust for healthcare providers and systems erodes, leaving communities
vulnerable and fearful. Counterfeit or fake medicines may be harmful to our
health because while being passed off as authentic, may contain the wrong
ingredients, contain too much, too little or no active ingredient at all or
contain other harmful ingredients. This can lead to serious health risks,
treatment failures and even death.
Who is at risk?
Everyone is
at risk of encountering substandard and falsified medical products, including vulnerable
population countries, lacking social protection countries with weaker health
systems, individuals buying medical products from unauthorized sources
(including online).
