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Shortage of essential medicines

Short supply of drugs is the great inconvenience to users

By Syed M. Aslam
Mar 26 - Apr 01, 2001

An acute shortage of essential drugs is playing havoc with the health of tens of thousands of patients across the country. It has also resulted in inflating the prices of these drugs by as much nine-times the company prices. The shortage is caused in part by the government policy to restrict the manufacture and marketing of tranquilizers last year as well as pretext of shortage of raw materials by the manufacturers, majority of them multinational pharmaceutical companies operating in the country.

Shakil Nagar, the secretary of Wholesale Chemists Council Pakistan, said that some of the most essential drugs for treating acute epilepsy, high blood pressure, stomach pains, and tranquilizers are either not available altogether or becomes available only every now and then way above the company prices.

For instance, Dalintin tablets used in acute cases of epilepsy sells for Rs 500 per 100 tablets whenever it is available over nine-fold the company price of Rs 55.40 per hundred tablet. A minimum of two or a maximum of two tablets is required daily by epilepsy patients. Dalintin, a research product of Parke Davis manufactured here in Pakistan, is not available in the market at any price as enquiries from around the country keeps pouring in Karachi.

While substitutes of Dalintin, both local and imported, are available they do not suit those who have been using it for a long period and have thus become used to it biologically. The substitutes just don't work given the nature of disease which has roots in the functioning of the brain. This forces the long-time users of the medicine to buy the drugs at nine-times its company price whenever it becomes available or use the available substitutes which can pose grave risks to their health. Can the patients of such a horrible disease as epilepsy should be allowed to be treated with an indifference bordering on cruelty?

Obviously not. Shahid suspects that the perpetual shortage of Dalintin for last many years is not orchestrated by distributors, wholesalers and retailers alone. He further suspects that only the chosen retailers are supplied the medicine as and when it finds its way into the market. He claimed that the manufacturer is blaming the shortage of imported raw material required for the local manufacture of the medicine. Why, in that case, no measure is taken by it to address the issue to solve the problem once and for all as after all this has been going on almost a decade, he asked.

The similar is the case with Lescol, a capsule imported by Novartis for treating high blood pressure. The medicine, 28 capsules of 20 mg. which carry a company price of Rs 535.70, is not available in the market at present at any price despite the lifting of the ban to import any drugs last year. The government has withdrawn the ban a few months ago but the drug still remains unavailable in the market to the great anxiety of users, he added. Shahid thanked the government for withdrawing the ban which in part was influenced by the presentation given by the Council convincing it that drugs imports claims less than 0.1 per cent of the budget much less than the foreign exchange spend on such items as tea and pan, etc. However, he added, the concerned MNC has failed to provide any reason for the unavailability of the drug saying only that it would be made available once it becomes available.

Buscopan, a tablet manufactured locally by MNC Maerck, Sharp and Dome (MSD) is not available in quantities necessary to meet the demand for an entirely different reason, Shahid said. In the local market 100 tablets of this widespread 10 mg tablet for the treatment of stomach pains is not easily available and that too between Rs 150-200 way above the company price of Rs 60. While the MNCs the worldover are not allowed to export their products directly to a country, the great demand of Buscopan at any price has given the company enough incentive to export the drug to many countries, particularly in Africa. It is the responsibility of the Drug Controller to ask the MNC that whether it is meeting the demand of the domestic market before it tempts to export the drug overseas. The situation, Shahid alleged, has become so bad that even the exporters are buying Buscopan from the local wholesalers to meet the increasing demand in the overseas markets. The price of the resultant shortage thus is borne by the users who are forced to pay higher prices for the medicine.

While appreciating the government policy aimed at preventing the misuse of tranquilizers by asking the manufacturers to restrict production and marketing of such drugs last year alongwith asking the retailers to keep record of prescriptions, Shahid said that genuine users of these drugs are suffering from their shortages. The policy has given pretext to create an artificial shortage of these drugs and to sell them at inflated prices.

For instance, he said, one such drug Tryptanol manufacutured by MSD in 10 mg, 25 mg and 50 mg potencies is selling five-times the company price. The company price of 100 tablets of 10 mg and 25 mg are Rs 40.30 and 90.70 respectively but the perpetual shortage of the medicine for last year-and-half has resulted in the black-marketing of the same. Hundred tablets of 10 mg and 25 mg is selling for Rs 200 and Rs 300 respectively. The company price of 20 tablets of its 50 mg variation carry a company price of Rs 31.65 is just not available at any price currently.

There are many more medicines which are currently in short supply to the great inconvenience of users. PAGE has highlighted only a handful of cases.