Drugs

There are many situations where a classification system (not just an identification system) for medicines is needed. The problem is the lack of an international standard. The Anatomical, Therapeutic Chemical drug classification system is developed and maintained by the WHO collaborating Centre of Drug Statistics Methodology, Norway. It is a hierarchical, 5-level system, where the fifth level is the chemical substance. More about the ATC (Anatomical Therapeutic Chemical) system can be found at the home page of the WHO Collaborating Centre for Drug Statistics Methodology.

CAPE TOWN, 19 Jun 2006 - South Africa's Western Cape province has so far maintained the lowest HIV prevalence rate in the battle against AIDS, but this could be changing.

According to US health officials, one in 10 medicines sold worldwide is fake, treating nothing but providing about 32 billion (R202 billion) in annual sales for drug dealers.

Retail pharmacists are up in arms about new provisions in the MedicalSchemes Act that allow schemes to bypass them by appointing designatedservice providers to supply cut-price chronic medication. Patients are often not informed that they can go elsewhere and if they do they will probably have to pay a portion of the medicine's cost out of their own pockets, the pharmacists said. The pharmacists, who met at the invitation of the United South AfricanPharmacies - an association of 1 400 community retail pharmacies - felt the new requirements would affect the survival of their profession. The association said there was a public perception that only designatedservice providers chosen by medical schemes would service patients requiring medicines listed in the 25 prescribed minimum benefit conditions. These conditions include asthma, chronic renal disease, haemophilia,epilepsy and glaucoma. According to the act, the specified chronic conditions must be paid for by medical schemes from the risk pool, not the member's savings account from January next year. The act also allows medical schemes to refer members to designated service providers for these particular conditions. The act is intended to protect members from being underfunded for chronic medicines and to prevent the overservicing of chronic conditions. Presentations were made by registrar of medical schemes Patrick Masobe and Board of Healthcare Funders chief operating officer Eugene Mackay on the changes. Discovery Health came under fire for choosing Direct Medicines - a call-centred discounter of chronic medication to medical aid members as its designated service provider. Discovery representative Nick Anderson said it chose Direct Medicines because the two parties would manage the risk that was associated with prescription medicines. Further meetings have been planned between the pharmacists and Discovery Health to find a solution to the problem. Anderson said the pharmacies not designated could still service Discovery Health members who require chronic medicines. He said if the community retail pharmacies charged the same amount for the medicines in the first of medicines for a chronic condition, then their patients would not need to pay the additional amount out of their own pockets. Anderson's presentation was repeatedly interrupted as pharmacists in the gallery interjected that patients on chronic medication were no longer visiting their pharmacies. (Source: Business Day, 26 November 2003).

Not all pills can be relied upon. The world-wide use of fake drugs has increased because they are so easy to make and sell cheaply, says the World Health Organization. It is launching a campaign to clamp down on the use of the drugs, which it warns can be harmful and even deadly. The WHO estimates up to 25% of medicines consumed in developing nations are counterfeit or substandard. They are often used to treat life-threatening conditions such as malaria, TB and Aids. Combating low quality or illegal medicines is now more important then ever. Dr Lee Jong-wook. The problem is also widespread in richer countries, according to the WHO. The US Food and Drug Administration estimated that fake drugs alone comprise more than 10% of the global medicine market - generating annual sales of more than $32bn. A WHO survey between January 1999 and October 2000 found that 60% of fake medicine cases occurred in developing countries and 40% in industrialised nations. The WHO believes that the manufacture of fake medicines is largely a cottage industry, with most production taking place in people's backyard rather than in large warehouses. It said the problem had mushroomed in part due to a lack of deterrent legislation in many countries. International agencies including the WHO and Interpol began a three-day meeting in Hanoi on Tuesday to try to tackle the multi-million dollar problem in southeast Asia. Fake medicines are a growing concern in the Mekong countries of Cambodia, China, Laos, Myanmar, Thailand and Vietnam, where they undermine health programmes, according to the WHO.(Source: BBC NEWS 11 November 2003).Links:http://news.bbc.co.uk/2/hi/health/1912226.stm http://www.who.int/en/

Pharmacists and patients warned to beware of unscrupulous dealers who peddle expired or counterfeit drugs over the internet. South Africans are increasingly being targeted by dubious doctors and pharmacists trafficking drugs over the internet, who send out spam e-mail messages advertising a vast array of painkillers, anti-depressants, weight-loss pills, stimulants and steroids on sale. Customers, who take drugs illegally purchased over the Internet, risk their lives not only because they do so with few controls and virtually no medical monitoring. A worldwide plague of counterfeit medicines means that while the drug may look like the real thing, there's no guarantee that it is. Legitimate online pharmacies require customers to mail in prescriptions from their doctors. But the rogue sites, selling addictive drugs such as the tranquillisers Xanax and Valium, usually set up customers with doctors who will write scripts without a face-to-face examination or any other tests. Maureen Kirkman, the head of scientific and regulatory affairs at the Pharmaceutical Manufacturers' Association, said a local online pharmacy had been closed down when she reported it to the Health Professions Council of South Africa in 1999. Kirkman said authorities from the United States department of justice and customs control were investigating the case of a US citizen who had bought medicine through a website originating in South Africa, and had died of an overdose. The International Federation of Pharmaceutical Manufacturers Associations estimates that one to two percent of the worldwide pharmaceutical market is counterfeit, with the African market worst affected at 25 to 50 percent. The main sources of counterfeit drugs are India, China and Russia. The counterfeits range from medicines that have been repackaged after passing their expiry date, to the repackaging of a substandard medicine that was supposed to be destroyed, to products containing very little or none of the genuine product. While fake medicines are being sold via the Internet, they are frequently stocked by legitimate pharmacies and doctors who have unwittingly purchased them from criminal wholesalers. Jan du Toit, registrar of the South African Pharmacy Council, said his organisation was working to educate South African pharmacists about the problem, and to make sure they bought only from reputable wholesalers - not someone who was selling medicine from the boot of their car. The Pharmaceutical Society of South Africa has warned that large highly organised criminal syndicates have created a profitable industry within the legitimate pharmaceutical industry - counterfeiting, stealing and also releasing sub-standard medicines into the South African market. According to a source, there were four different counterfeit products for the anti-impotence drug Viagra available on the black market. The fakes that have been detected in South Africa include prescription pain tablets, anti-ulcer preparations, cholesterol lowering agents, anti-diarrhoeals and anti-fungal medication, prescribed to AIDS patients. The size of the stolen and counterfeit market was estimated to be worth about R2 billion in 2000. The health department has a team investigating fake medicines, but so far there has been only one successful prosecution - that of three Potchefstroom pharmacists who were found with stolen and counterfeit medicines worth R100 million. They were fined R300 000. Kirkman said, a person who had illegally purchased prescription medicine over the internet and who had been defrauded was unlikely to report the incident and Viagra was a favourite of counterfeiters. (Source: The Sunday Independent, 26 October 2003).

There is great cause for concern over the menace of so-called pharmacies operating through the Internet. Menace is undoubtedly the correct word, because these businesses, far from contributing to their customers' welfare, can actually put them in danger. As a survey by The Star revealed, a number of drug-dispensing websites based abroad offer a wide variety of medicines without requiring a prescription or a doctor's examination. Consequently, drugs such as Viagra, Valium, Prozac and even morphine - all potentially dangerous if taken without medical supervision - are freely available. There is also the very real possibility of them being sub-standard or past their sell-by date. Although it is illegal for South Africans to order prescription drugs online (they face stiff penalties), health authorities are finding difficulty in tackling the problem because the medicines are delivered by courier. Certainly we have not heard of anyone being prosecuted for the offence. While the search for a solution continues we can only endorse and emphasise the warning to consumers by the head of the Medicines Control Council that they buy drugs over the Internet at their peril. As he points out: People need to be aware that drugs are not sweets, chocolates or clothes; they could be harmful to your health.(Source: The Star, 22 April 2003)

The private hospital industry, the largest buyer of medicines after the state, has questioned whether the controversial Medicines Act will drive down the costs of drugs. The Medicines Act, recently the subject of court action, was introduced as a mechanism to make medicines more accessible to South Africans. Rick Hogben, Afrox Healthcare CEO, told delegates at the Conference of Healthcare Funders yesterday that private hospitals were philosophically opposed to parts of the new law, and called for private hospital access to the state tender system as a more effective way of cutting medicine costs. The price of the drug was only one factor influencing the eventual cost. Among the ignored cost drivers was utilisation. Hogben said factors like which product was selected, its quantities, and where and when it was used were equal or greater determinants of the rising costs of pharmaceuticals. He questioned the need for any legislative controls on pricing, citing Afrox's extensive database as evidence that ethical drug manufacturers (those that have to be prescribed) had kept their prices down relative to the depreciation of the rand against the dollar. He said the consumer price index (CPI) for the past year was 6,4%, the rand had depreciated against the dollar by about 18% over the same period and the prices of ethical drugs to Afrox had increased by about 10%, showing restraint on the part of manufacturers. Earlier, Fiona Robertson, the BHF's chief tariff officer, told delegates that of all medicines prescribed in SA, only 20% were generics, the rest originals. Bada Pherasi, former chief director of medicines in the health department outlined the government's reasons for introducing changed medicines legislation. Consumers, Pherasi said, had for too long had to adapt to the needs of healthcare providers. The relationship between the healthcare industry and consumers was too unregulated. (Source: Business Day, 10 July 2001)