These merchants of death
BY
Holding a gun to a victim’s heart and pulling the trigger is not the only way of committing murder. The job can be done just as effectively by means of fake drugs. The only difference is that the person who is shot dead can be considered lucky, in that he is likely to die quickly, sometimes without even knowing what killed him. The sick man who is treated with fake drugs is likely to die a slow and painful death.
These murders by purveyors of fake drugs are seldom reported in the newspapers, except where the victim is a notable member of the society. Then it would perhaps be said of him that he died "after a brief illness."
According to the Director-General of the National Agency for Food and Drugs Administration and Control (NAFDAC) in a statement published last week, "many Nigerians have died and many are still dying either from the indirect effect of taking poisonous fake drugs or from taking a placebo in the place of needed active therapeutic agents."
The only quarrel I have with this statement is with the word placebo. A placebo is "an inactive substance administered to a person who insists on receiving medication or who would benefit by the psychological deception." The fake drugs that have all but taken over the pharmaceutical business in Nigeria are not inactive substances administered for anybody’s beneficial deception. They are deadly stuff, peddled by scoundrels out to enrich themselves without counting the cost to human lives and to the country’s pharmaceutical business. To quote again from NAFDAC’s director-general, the image of our pharmaceutical industry has become "so tainted that Nigeria is regarded as a country of fake drug manufacturers and consumers... fake drugs have been driving patients from either medical practitioners to traditional/alternative medical practice and giving pharmacy a bad name."
Driving patients like me, that is. And the only reason I have not yet bolted to traditional medical practitioner is because of my fear and suspicion of them, and what I have seen in their newspaper advertisements... Perhaps I need to say, before I go any further, that I am not an enthusiastic pill taker or medicine drinker, which should ordinarily put me beyond the reach of those who sell fake drugs.
I have managed to do without those two-tone capsules that some people find it necessary to swallow so after each meal. This is purely a matter of my good luck, for which I am thankful. Where others routinely pop a tablet or two of paracetamol into their mouths, I follow the good advice I was given many years ago; I look for the cause of my "headache" and try to do something about it. There is however a tablet that I have faithfully taken every blessed day since May 1997.
That was the day I experienced what I thought was a heart attack. It turned out not to have been a full-scale attack but a warning shot — which isn’t a great improvement when you are at the receiving end. After a thorough examination, a friend who is also a doctor told me that my blood pressure wasn’t as it should be. I also had what he thought could be angina. To deal with the two problems he put me on amlodipine besylate.
Amlodipine is the chemical name for calcium channel blockers or, put simply, anti-hypertensive/anti-angina drugs. A brand of amlodipine, called Norvasc, is widely prescribed and widely used in Nigeria. Now Nigeria’s merchants of death are doing their level best to destroy the image of the drug by producing fake versions, and in the list of fake and substandard products published by the director-general of NAFDAC last week, Norvasc featured prominently.
The demand and the cost of the drug are high, and under Nigerian conditions that makes it a prime candidate for faking.
Thinking back now, I think I can guess what time it was that the fake Norvasc came into the market. There had been a period of serious shortage, when users of the drug, in their desperation, travelled long distances in search of chemist shops that had some in stock. Their desperation was well grounded for, as the British National formulary put it, a characteristic of some calcium channel blockers is that withdrawal (i.e. an abrupt termination in its use) "may be associated with exacerbation of angina" - not to talk of the underlying hypertension.
At one of the chemist shops that I went, the girl at the counter said: "come back tomorrow, maybe we would have some by then." But on the morrow she would say the same thing. After what felt like forever, supplies again began to trickle in. "Yes," the girl at the chemist shop said with a broad smile, "the drug is now available."
She produced a sachet. No enclosing packet. No enclosed leaflet giving information about the drug — such information as its actions, indications, contraindications, dosage, side effects, etc.
When I took the sachet home and popped a table into my mouth, it crumbled right away, something that had never happened before. I knew then that I had just swallowed a "placebo" intended not for my beneficial deception, but for the beneficial enrichment of some fake drug dealers. And who are these greedy men (and women!), these merchants of death who would kill unsuspecting people in order to make money?
Few, if any, of them are professional pharmacists. A good many of them accumulate some capital from some dubious business, and then invest it in the importation of sub-standard and fake drugs. They are the same people who dominate the 419 business, the fake spare parts business and the narcotic drugs business. They travel to the far east to buy made-to-order fake drugs, and then bring them in by bribing the Customs and, until the new broom arrived, even NAFDAC. One can only pray that the director-general will continue the way she has started.
And while she is about it, she might want to look into the way some of the big foreign pharmaceutical companies seem to take Nigerians for granted, when they are not taking us for a ride. Take Pfizer as an example, in their brand of amlodipine marketed in Nigeria as Norvasc. On the subject of the drug’s side effects, all that Pfizer lists, as side effects are headache, oedema, fatigue, nausea, flushing and dizziness. It then goes on to say that "no pattern of clinically significant laboratory test has been observed.
The British National Formulary lists the side effects of Norvasc as: headache, oedema (i.e. abnormal infiltration of tissues with fluid), fatigue, nausea, flushing, dizziness, gum hyperplasia (excessive formation of cells), rashes, gastro-intestinal disturbance, palpitations, dyspnoea (laboured breathing), drowsiness, mood changes, muscular cramps, athralgia (pain in the joint), asthemia (debility), impotence, urinary frequency, visual disturbance, altered liver function, jaundice and gynaecomasta (enlargement of the male mammary glad).
(If, after reading the foregoing you think that I have an amazing grasp of pharmacology, please disabuse your mind. I have just copied the strange sounding words from the latest edition of the British National Formulary, while their everyday meaning are straight out of the family pocket medical dictionary. I have the privilege of being married to a pharmacist for some forty-three years.)
The above listed side effects, frightening as they seem, are probably less frightening than the prospect of dying from a heart attack or stroke, when hypertension is left untreated. By omitting to tell a would-be user of Norvasc that he could suffer from these side effects, Pfizer is guilty of misleading its customers. In England, where Norvasc is marketed as Istin, the side effects are spelt out more fully.
One final point. Pfizer, thinking that it understands the Nigerian mentality (we had some evidence of this not so long ago), is also not averse to exploiting it. The company thinks it knows that no red blooded Nigerian male would touch a drug whose side effects may include impotence. He would rather die a thousand deaths. That was why Pfizer put out a misleading list of side effects for the consumption of its Nigerian customer. This is wrong, and should be corrected.
Feb 2002