Pakistan's Killer Meds, Warring Feds

People across Pakistan are thinking twice before taking medication after the recent deaths of more than 120 patients who were prescribed contaminated heart medication at the Punjab Institute of Cardiology (P.I.C.), a leading government facility in Lahore. The drugs were laced with lethal quantities of an antimalarial drug and administered in excessive doses.The P.I.C. scandal confirms the urgent need for investigations into quality control at drug-testing facilities, licensing protocols for the pharmaceutical industry and the training of doctors at government-run hospitals. In 2006, the World Health Organization found that 40 to 50 percent of all medication available in Pakistan was counterfeit.

But instead of galvanizing attempts to reform the public health sector, this latest crisis has sparked political mudslinging intended to sway voters in the run-up to general elections in 2013.

The problems in Pakistan’s health sector are endemic: limited human resources, spotty regulations, rampant corruption. And regulation is all the more important because in this country most medication is available over the counter and at low prices. Prescriptions are mere formalities.

While reporting in December 2009 on Pakistanis’ habit of self-medicating for stress and depression, I visited dozens of pharmacies in Karachi. Clumsily handwritten notices pasted above overstocked shelves claimed that sleeping pills wouldn’t be sold without prescriptions. But I walked away from counter after counter laden with barbiturates, antidepressants and anti-anxiety medication. Sometimes the pharmacists even recommended the best cocktail of drugs to ensure a good night’s sleep or an “easy feeling.”

It is a travesty, then, that these recent deaths from contaminated heart medication have not yet prompted any reform of the health sector.

Worse, they’ve become fodder for opportunistic politicking. Since 2010, the health ministry of Punjab has been under the purview of the provincial chief minister, Shahbaz Sharif, a leader of the Pakistan Muslim League-Nawaz (P.M.L.N.). The P.M.L.N. is the main opposition to the ruling Pakistan Peoples Party (P.P.P.) in national politics, but it dominates Punjab Province. Sharif’s opponents in the P.P.P. have seized on the P.I.C. tragedy to slam him for mismanagement and corruption, and for hogging control of 15 provincial ministries. Last week,,, Sharif surrendered control of eight ministries, retaining the health portfolio. Giving up on that ministry would have been like admitting defeat before his political adversaries.

Lawyers affiliated with the P.P.P. have also filed charges of high treason against Sharif’s son Hamza for owning a controlling share of a pharmaceutical company that allegedly supplies substandard medication to health facilities in Punjab. (No such drastic action has yet been taken against the Karachi-based factory that supplied the contaminated medication to the P.I.C.) These inflated charges have not yet been backed by evidence, and so for now they look like another attempt to disparage the Sharif name and cash in on ambient public ire.

Sharif, in turn, claims that the string of drug-related deaths in Lahore is a conspiracy against his government. In interviews he has said that the contaminated drugs came from Karachi, a hub for his political rivals in the P.P.P. and the Muttahida Quami Movement, implying that the defective medication was transferred to Punjab in order to malign his reputation. His advisers have also been blaming the P.P.P.-led federal government for the P.I.C. deaths: pointing to the 32 licenses Islamabad issues to pharmaceutical companies every day, they claim it does too little to prevent the proliferation of substandard medication.

While the politicians are trading accusations, the lives of more than 300 contaminated patients are still in danger. And Pakistan’s pharmaceutical industry, which contributes $200 million annually in exports to the country’s ailing G.D.P., is taking a hit: in recent days, Sri Lanka, Afghanistan and four African nations have banned the import of medication manufactured here. Yet the Pakistan Pharmaceutical Manufacturers Association’s rational calls to establish a regulatory authority in order to restore domestic consumers’ and importers’ confidence have been lost in the political din.

Even when poor governance proves fatal, in Pakistan officials prefer to politicize the problems rather than implement much-needed reforms.