The drugs don’t work

Health Ministry workers empty a shop selling fake medicine in Abidjan, Côte d’Ivoire. Photo: Issouf Sanogo/AFP/Getty

The drugs don’t work

There has been a big rise in heart disease in Africa over the past 25 years. Fake medicines on the market have made the situation worse. Now doctors are beginning to fight for change. Lea Surugue reports.

Patients began arriving at his office with much worse health after taking the medicines he gave them. Then Ibrahim Ali Toure knew there was a health crisis.

Toure is the head of the cardiology department at Niamey University Hospital in Niger. He sees thousands of people every year. Patients are still coming to his office, but he receives everyone without complaining. Most have high blood pressure. It can increase the risk of cardiovascular complications, including strokes, heart attacks, or heart failure if not treated well. He says, ‘I’ve had patients suffer from heart failure after taking medicines.’

In Niger, and in many other sub-Saharan countries, death from heart problems has been on the rise in the past 25 years, and high blood pressure is a big cause. Part of the problem is that many people are not diagnosed in time because the symptoms are usually not easy to see. But successful treatment is also a problem. ‘Only about a third of people with high blood pressure get a correct diagnosis early enough,’ says Toure, ‘but more than half of those then don’t get the treatments they need.’

This situation has recently got worse and in a new way. Even when they get treated, more and more patients come back with worse health.

‘Some patients go to hospital after strokes, others who suffer from heart failure got to hospital after taking medicines. For me as a doctor, it’s terrible to see this after diagnosing high blood pressure successfully, and doing everything to help it,’ Toure says.

This situation is the same in many sub-Saharan countries in the last few years and doctors are very worried about the quality of the drugs they are giving. One in ten drugs sold in developing countries is fake or below standard says the World Health Organization (WHO). And drugs for heart problems are possibly affected more.

Frightening results

African heart doctors have been reporting this for months now, but no one is listening to them when there are no scientific studies to show the problem.

This is why Toure and colleagues in nine other African countries decided to join Marie Antignac, a researcher with the French National Institute of Health and Medical Research (Inserm). They sent thousands of samples of seven cardiovascular drugs from street markets and pharmacies to the Paris lab for analysis. Their study in the International Journal of Cardiology is the first to look at the problem of fake cardiovascular medicine in Africa.

The researchers found that about 16 per cent of all the drugs were of poor quality. From the samples from Niger, almost one in four drugs was a problem. But there was no way of knowing if they were fake or of bad quality.

Photo: Riccardo Lenneart Niels Mayer / Alamy

None of the samples seemed to have poisons in them but some had a very low dose so that they could not treat the disease. ‘Giving patients drugs that do not contain the right dose is almost as dangerous as treating them with poisons,’ Antignac says. ‘This is why patients have been coming back with higher blood pressure.’

Fighting a new plague

In the past, heart disease was not a big problem in African countries. Most of the efforts were to treat infectious diseases, like malaria.

In only 25 years, this has changed completely. Around 46 per cent of adults in sub-Saharan Africa possibly have high blood pressure. Doctors think heart disease is the biggest health problem in Africa after HIV/AIDS, and it has replaced tuberculosis and malaria in the top five causes of death.

‘In Africa,’ says Antignac, ‘non-infectious diseases are slowly replacing infectious diseases as the main cause of death. In Europe, this change came in 300 or 400 years, but in Africa the change is in about thirty years. Most people still think Africa is a place where people die from infections, not from high blood pressure, obesity, or diabetes.’

As a result, action by public health systems is slow. There is research to identify and fight poor quality or fake medicines but not into the quality of other types of drugs sold in African countries, including drugs for heart disease. Research is only starting now with this new study.

For dishonest companies and criminals selling fake medicines, this situation is a big opportunity.

Pernette Bourdillon Esteve is an expert at the WHO. He says, ‘The criminals who deal with substandard and fake medicine are doing it to make money. They look at the market and follow what people want. If more people need a medicine, then with poor regulations and poor technology, there will be a rise of substandard or fake medicines.’

The recent study suggests that it doesn’t matter if drugs are sold in pharmacies or on the street, it is the country they are from which is important. Poor quality drugs seemed to come from Asia, but not so much from Europe or Africa.

‘We need to find which labs in Asia are OK,’ says Antignac. ‘Our Paris lab is also now there for doctors to do tests on samples they send us. Tests are not easy to do in other places because of the big political and economic pressures on researchers.’

But there are other problems. With no health coverage, many families cannot afford medicines.

‘Patients have to pay for hospital and treatments,’ says Toure. ‘I’ve sometimes helped them financially to save lives. When people see a doctor, they often can’t pay for it. Poor quality drugs is just another problem. And now people who can pay may find they have drugs that do not work.’

Lea Surugue is a journalist in Spain. She writes about science and health stories, with a strong interest in humanitarian medicine, women’s health, mental health, and HIV.

NOW READ THE ORIGINAL: https://newint.org/features/2018/04/01/the-drugs-dont-work

(This article has been simplified so the words, text structure and quotes may have been changed).