Saturday, February 24, 2007

Deadly Fake Anti-Malarial Drugs

Photograph Copyright Stephenie Hollyman

Click Here to View Slideshow on the anti-malarial wonder drug, made from artemisinin. This herb, also known as wormwood is now being grown in Tanzania by Awaarusha farmers. Photos Copyright Stephenie Hollyman 2007.

Indeed my heart sank yesterday while reading In the World of Life Saving Drugs, a Growing Epidemic of Deadly Fakes, in The New York Times Science Times , which says that in Southeast Asia " 53 percent of the antimalarials bought were fakes."

Estimates of the deaths caused by fakes run from tens of thousands a year to 200,000 or more. The World Health Organization has estimated that a fifth of the one million annual deaths from malaria would be prevented if all medicines for it were genuine and taken properly.

“The impact on people’s lives behind these figures is devastating,” said Dr. Howard A. Zucker, the organization’s chief of health technology and pharmaceuticals.

Internationally, a prime target of counterfeiters now is artemisinin, the newest miracle cure for malaria, said Dr. Paul N. Newton of Oxford University’s Center for Tropical Medicine in Vientiane, Laos.


If you click above you can view a slideshow of photos I took in Tanzania of a village where the live-saving herbal plant artemisin annua is being grown in Tanzania.These photos are part of my ongoing multimedia project on malaria called " Fever Zone". Also include ( the white folks) are photos of agri-biz growing artemesin in Tanzania.


In May of 2005 while traveling to document malaria I was thrilled to see how well artmemisinin worked against chloriquine-resistant strains of malaria. In fact I had a chance to try out this wonder drug first hand-- thank god not conterfeit-- in Tanzania after my blood smear proved positive for malaria falciprium on a Friday afternoon. While photographing a woman with malaria who had dropped into a coma in a neighborhood clinic ouside of Dar es Salaam, I suddenly found myself dizzy, sweating heavily, and about to wretch. At first I thought it was a sympathetic reaction. But as I photographed the symptoms worsened. And I recalled that I had been weak all day.

I asked the nurse at the clinic to test my blood for malaria and continued working.

One half hour later the clinic's doctor approached me laughing, saying that I must take my subject matter--malaria-- quite seriously, because I had caught it. " Welcome to Tanzania" he boomed out as he wrote me a prescription for artesunate pills.

My WHO driver took me to a reputable pharmacy where I bought this life-saving medicine before retreating to my hotel to recover. After sleeping around the clock between taking pills during what became my malarial " Lost Weekend" I awoke on Monday. Weak but recovered.

By Tuesday I was back at work. I was lucky. If I had taken counterfeit artesunate I might have died. With excellent reporting Donald G. McNeil Jr. details the peril in which these counterfeit drugs place their users.
Many of the fake artesunate pills found by Dr. Newton’s team were startlingly accurate in appearance — and much more devious in effect than investigators had suspected.

Not only did the pills look correct, as did the cardboard boxes, the blister packing and the foil backing, but investigators found 12 versions of the tiny hologram added to prevent forgery.

In one case, even a secret “X-52” logo visible only under ultraviolet light was present, though in the wrong spot.

Another hologram was forged by hand, Dr. Newton said, by someone who obviously spent hours with a pin and a magnifying glass making tiny dots on a circle of foil to imitate the shimmer.

But the most frightening aspect appeared when the pills were tested. Some contained harmless chalk, starch or flour. But the latest, he said, contained drugs apparently chosen to fool patients into thinking the pills were working.

Some had acetaminophen, which can temporarily lower malarial fevers but does not kill parasites. Some had chloroquine, an old and now nearly useless antimalarial.

One had a sulfa drug that in allergic people could cause a fatal rash.

And some had a little real artemisinin — not enough to cure, but enough to produce a false positive on the common Fast Red dye test for the genuine article.

Those would not merely fool a laboratory, Dr. Newton noted. They could also foster drug-resistant parasites, so if patients were lucky enough to get genuine artemisinin treatment later, they might have already developed an incurable strain and could die anyway.

Such resistant strains could spread from person to person by mosquito and ultimately render the drug ineffective, as already happened with chloroquine and Fansidar, two earlier malaria cures.

“We make no apology for the use of the term ‘manslaughter’ to describe this criminal lethal trade,” Dr. Newton and his co-authors said last year in an article in The Public Library of Science Medicine. “Indeed, some might call it murder.”

1 comment:

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