Southern Med Review
Letter to the Editor
The Importance of Medicines Safety Ayyaz Kiani Executive Director, Devnet Consultants, Islamabad, Pakistan.
Address for Correspondence: Ayyaz Kiani, Devnet Consultants, Islamabad, Pakistan. Email:
[email protected]
Citation: Kiani A. The Importance of Medicines Safety. Southern Med Review (2012) 5;2:51-52
There has been a spate of drug related illnesses and deaths reported from Pakistan in the press this year. In November, at least 17 people died in the eastern city of Lahore after drinking toxic cough syrup (1). Earlier in January, an adulterated heart medicine dispensed by the Punjab Institute of Cardiology claimed lives of at least 69 heart patients (2). It seems appropriate to put these happenings in some perspective. Cough syrups have been at the center of several cases of mass poisonings around the world in recent years, often involving accidental or intentional use of industrial solvent - diethylene glycol - as a cheap sweetener by the manufacturers. Diethylene glycol is known for causing severe toxicity and death. The effects of such poisoning can be widened because cough syrup is frequently abused by people who use it to get high. It was the most likely scenario in Panama when at least 94 people died from taking cough syrups in 2006 (3). A 7-year-old boy died in Manila in February this year after he suffered a seizure believed to have been caused by taking cough medicine (4). Another five years old fell victim in Colorado, US on February 12 this year after taking the over-the-counter cough medicine to treat flu-like symptoms (5). Similar incidents are reported from around the world totaling a massive number. Besides such clear incidences of toxicity, some seemingly innocuous medicines like iron supplements may account for more than 30% of reported pediatric medicine related fatalities. Antidepressants, cardiovascular medications, and methyl salicylate follow in frequency of pediatric pharmaceutical related deaths (6). Let us take a few steps back and look at the bigger picture. Prescription drugs constitute the major treatment modality of scientific medicine today. Their utility has from the beginning, however, been overrated as manufacturers and promoters of these chemical drugs promised much more than they delivered. Far beyond not working, the drugs are known to cause incalculable side effects. Even when properly prescribed, these drugs have side effects that can be fatal. The situation would seem even worse considering the potential of human error. Lazarou (7) has shown that there might be as many as 106,000 deaths annually due to medicinal reactions happening in United States causing around $12 billion in economic losses. These
are to be added to an annual figures of 98,000 deaths and &2 billion losses shown by Suh (8) as a result of human errors. But these put together would seem conservative in comparison to another study by Leape (9) has shown much higher estimates figured at 420,000 deaths and $200 billion in economic losses in a year. In a New England Journal of Medicine study, an alarming one in four patients have been shown to suffer observable side effects from the more than 3.34 billion prescription drugs filled in USA in 2002.(10) Besides the incalculable harm caused by the medicines as listed above, the death and suffering caused additionally due to hospital acquired infections, unnecessary procedures including surgeries, negligence and error brought forth by the healer reaches mind boggling dimensions. It would appear that causing harm is a rule rather than exception in the era of modern medicine. A look at the broader picture shows that medicine - as conventionally practiced – has failed to meet effectively many of the challenges of modern health care and instead of being part of a solution has become part of the problem.
References 1. Pakistan investigates cough syrup deaths. http://www. chicagotribune.com/videogallery/73488598/News/ Retrieved 2012-12-15. 2. 69 die from substandard medicine. http://www.thenews. com.pk/article-32278-69-die-from-substandard-medicineRetrieved 2012-12-15. 3. 94 deaths in Panama from tainted medicine. http://www.msnbc. msn.com/id/19611858/ns/health-health_care/t/deaths-panamatainted-medicine/#.UMxTFoMUuaQ Retrieved 2012-12-15. 4. 7 years old boy dies after taking cough syrup. http://newsinfo. inquirer.net/149349/7-year-old-boy-dies-after-taking-coughsyrup Retrieved 2012-12-15. 5. Litovitz, T, Manoguerra A. Comparison of Pediatric Poisoning Hazards: An Analysis of 3.8 Million Exposure Incidents A Report from the American Association of Poison Control Centers. Pediatrics, June 1992, vol 89. P 999-1006 6. Five years old US girl dies of cough medicine overdose. http:// www.telegraph.co.uk/health/healthnews/9206866/Five-yearold-US-girl-dies-of-cough-medicine-overdose.html Retrieved 2012-12-15.
Southern Med Review Vol 5 Issue 1 July 2012
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The Importance of Medicines Saftey
7. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA . 1998 Apr 15;279(15):1200-5. 8. Suh DC , Woodall BS, Shin SK , Hermes-De Santis ER. Clinical and economic impact of adverse drug reactions in hospitalized patients. Ann Pharmacother . 2000 Dec;34(12):1373-9. 9. Leape LL. Error in medicine. JAMA . 1994 Dec 21;272(23):18517. 10. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med . 2003 Apr 17;348(16):1556-64.
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Southern Med Review Vol 5 Issue 2 December 2012
52
