Malaysia: fake viagra is no joke

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By Gan Siew Hua, Monash University Malaysia

PETALING JAYA, July 25 – The challenges of substandard medicines are affecting all regions of the world to varying degrees, but in Asia the situation is thought to be worse, with a estimated at one in 10 medical products in low- and middle-income countries reported to be substandard.

In Malaysia, sexual enhancers make up the majority of substandard drugs, with over 1,000 products found on the market.

The men are more likely to use substandard sexual enhancers, which is not surprising given that Malaysian men were, according to the country’s own health minister, the largest user per capita in the world of Viagra (sildenafil).

This is when the drug was first introduced two decades ago. Although the prevalence of male sexual dysfunction in Malaysia is quite high (26.8-69%), it is still lower than that who reported in Singapore (51.3 to 73.0%) or in Hong Kong (63.6%).

Malaysia’s Greatest Single drug seizure in 2007, worth MYR 14 million ($3.14 million), was ‘Miagra’, a fake Viagra® for the Malaysian and Thai markets.

Counterfeiting on this scale is not deterred by the legal system – the penalty for such an offense is a fine of only MYR 50,000 (about USD 11,000) or three years in prison (or both). Tougher penalties can help stem the problem.

Alarmingly, sildenafil has also been put in coffee sachets which were distributed nationwide. The coffee mix was given to energized drinkers beyond the usual stimulation provided by caffeine, but was later confiscated by the Malaysian Ministry of Health.

It’s a lesson in the risk of Malaysians looking for quick medical fixes. Many prefer to buy cheap drugs without considering their effectiveness or side effects. A culture of self-diagnosis, as well as self-prescription, further perpetuates the problem.

Patient education is essential. A study examination of patient awareness of medicine in Malaysia found that up to 25% of respondents did not understand written information on medicine packaging, while an even higher percentage (29%) did not did not read the recommended storage conditions.

The latter is dangerous given that higher temperatures in tropical countries in Asia can contribute to the degradation of not only substandard drugs, but all drugs. Data from Thailand suggests that improper storage and handling contributed to 5% of substandard drugs.

Patient education should focus on the need to distinguish between good and bad sources of medicines, supporting decision making on trustworthy self-medication as well as on building trust in healthcare professionals.

And yet, the number of educational and promotional activities led by the Ministry of Health remains weak, even if it shows a positive trajectory.

Educational activities have been extended to schools and institutes of higher education. More pharmacists should be empowered to play a greater role in patient education.

Improved oversight by regulatory bodies such as the Ministry of Health is required to ensure that all products sold on the market are registered, bearing in mind that registration numbers can be falsified, used for other substandard products or printed on counterfeit medicines .

One strategy is to integrate a Meditag Hologram on all pharmaceutical products offering easily verifiable safety characteristics.

Another important strategy is to strengthen border control for imports or for the Directorate of Customs and the Ministry of Commerce and Industry to crack down on the smuggling of counterfeit drugs from neighboring countries.

Advertising and creeping sales propagated on social media are areas where law enforcement agencies should regularly and randomly monitor suspicious marketing activities.

Although misspellings in such advertisements may reveal counterfeit drugs, recognizing substandard drugs is more difficult.

Normally, the probability of substandard medicine is higher when there is a lack therapeutic response or in the presence of infrequent adverse events.

The public can do their part by reporting drugs advertised on suspicious websites, especially those that don’t display landline phone numbers or physical addresses.

As more and more people go online, the risk of substandard drug supply and distribution also increases. Import bans on drugs produced by certain manufacturers suspected of producing substandard drugs like Ranbaxy should be imposed.

Raising public awareness of the problem would also be helpful. The World Health Organization had published in November 2017 20 alerts on global medical products as well as regional warnings with technical support in place for over 100 substandard drug cases.

Eradicating or, at the very least, reducing the impact of substandard medicines is a global challenge requiring global cooperation.

Professor Gan Siew Hua is the Director of the School of Pharmacy at Monash University in Malaysia.

Article published with the kind permission of 360info.

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