All hell broke loose for the cardiac patients, who consumed medicines supplied free of cost at the Punjab Institute of Cardiology (PIC), in Lahore, and started to die of complications. The hospital would, perhaps, have found ways to hush it all up, as has happened numerous times earlier during the past six decades. But the magnitude was of such a large-scale and the frequency of the casualties was so alarming that soon the media caught the wind and focused its full attention on reporting the rate at which the patients from this single facility were getting severely sick and many breathing their last within a matter of hours. The doctors did not have an immediate antidote without the knowledge of the cause and the administration was stuck in a dead end. The opposition political parties lost no time in utilising the fresh ammunition to fire against the incumbent government aiming at the Chief Minister, as the primary target in a run-up to the general elections expected later this year. Under pressure to show some action, scapegoats were identified among the doctors and officials that were hurriedly shown the door - though it did no good to the patients or to the morale of the hospital staff.

Samples of four suspected medicines/products were sent for analysis to a UK laboratory that found a drug called Isotab, used for blood thinning, to contain lethal quantities of anti-malaria drug. This contaminated drug had been administered in excessive doses to thousands of patients. Most of the victims were over 50 and many had remnants of dengue fever in which the platelet count drops. These patients could not absorb the excessive blood thinning dosage. Over 140 men and women have lost their lives so far and many more are fighting for their survival in various hospitals.

The pharmaceutical company located in Karachi that manufactured and supplied this drug to PIC has since been sealed. The television anchors carried steamy debates and the more enterprising went hunting armed with their cameras and microphones to the pharmaceutical wholesale markets. It is now common knowledge that three categories of products are openly sold in the market over the counter without doctor’s prescriptions. These are termed in their jargon as multinational, national and local. These medicines display batch numbers and expiry dates printed on the covers or on the bottles and are manufactured by any of the many hundreds of pharmaceutical companies that are registered with the central government after careful regulatory scrutiny. These companies are entitled to register a patent brand name for a particular medicine to become its exclusive authorised manufacturer. Any other company can also register a patent of exactly the same product with the same composition, but it has to be under a different trade name. Many of the so-called local medicines are substandard or counterfeit manufactured by shady companies outside the ambit of the drug inspectors.

The pharmaceutical industry is an extremely competitive business. The capital cost of installing a pharmaceutical plant conforming to stringent drug regulations is exorbitantly high that is within the capacity of only the multinational and a few large indigenous companies. The innumerable smaller factories installed at much lower costs invariably compromise on compliance. A new product is developed at considerable expense and time-consuming research, and the companies invest enormous funds in its marketing. Once it succeeds, the pioneer company can dictate its own price structure, seeking disproportionate rewards for its innovation under the protection of the brand registration. To dilute this monopoly and make medicines available at affordable rates, a manufacture of medicines is allowed under generic names. This could   become a double-edged sword in practice due to the inefficiencies and malpractices of government functionaries.

It is quite simple to analyse and replicate a composition. The smaller factories can produce and sell the same medicine as equivalent, at a much lower price due to their lower capital costs and overheads and by compromising on quality controls. However, the network of the government drug inspectors has not been expanded proportionate to the large number of manufacturers spread all over the country, and is not adequate enough to exercise full inspections and control on their process and distribution. Moreover, most companies are reluctant to offer full cooperation. Further, there are not enough testing laboratories in the country. Due to these and other factors, it is not possible to fully guarantee the quality of each batch that reaches the market.

The government hospitals purchase medicines through a tendering process in which the lowest bidder wins the contract. Since the multinationals and quality manufacturers cannot compete in the price war, they have mostly been ousted from government institutional sales and the government hospitals have to procure and dispense medicines manufactured under doubtful quality controls. It has now been confirmed that the batch dispatched to the PIC was adulterated and passed unnoticed through quality control and testing. In my opinion, to term it deliberate on the part of the factory owners will be cruel, although an error or a conspiracy of some sort by an individual or a party could not be ruled out. Unfortunately, the dwindling reputation of our country as an exporter of medicines has been severely damaged.

No inquiry can conclusively and judiciously apportion the blame of this tragedy on a single or few persons or institutions, as the licensing protocols and drug inspections are routinely compromised, spot checks are non-existent, medical and support staff is not diligent and caring in their duties. The whole system is rotten and is unlikely to be overhauled any time soon, until the mindset of the entire nation is revolutionised. This episode is the latest in the countless horror serials that are perpetually being screened in our country. We watch and react to them most passionately while they last and a short while longer. Within a few days, the current episode will also become a forgotten story. No lessons would have been learnt or any thought spared for the plight of the families the unfortunate victims left behind. The deceased will be no more than a few numbers added to the record of hundreds others with similar fates.

This incident is further evidence of the decay of our state in which all institutions are malfunctioning and the people have learnt to live with them without raising a voice and pursuing it to some logical end. Our political masters are too involved in settling their personal scores, occupied in inventing frivolous issues to divert public opinion and to keep themselves gainfully employed - that leaves no time with them to care for the meagre basic needs of the average folks or to improve the mismanaged state institutions and their systems. To serve and facilitate the people is far from the minds of the bureaucracy that is growing more corrupt and unfriendly by the day. The PIC deaths point to the lingering death of our systems. What price will the people have to pay to ignite the conscience of our rulers?

    The writer is an engineer and an entrepreneur.