Medicine: Quantity vs Quality

Last week, InterAction hosted the QUAMED and OFDA for a Joint Briefing on Quality of Medicines in Humanitarian Assistance Programs.  As representatives discussed the dangers of substandard medicine and procedures to try to counter it, I couldn’t help but keep replaying a bus-ride from last summer…

“If you have a cough, you should drink one of these everyday” instructed the salesman. My eyes darted around the rickety old bus as the salesman held up a package of medicine that you would usually inhale through a nebulizer.  As I was thinking of how dangerous that could be, everyone else was intently listening to him explain the variety of over-the-counter and prescribed medicines from his box.  By his fabricated instructions, I could tell that he was not a pharmacist or a health professional; he was just a Haitian salesman trying to make money off medicines that he got from…

Well, I have no idea where the medicine originated from or how it got into the hands of that salesman.  Turns out, in many poor countries, sometimes even health professionals don’t know the quality of medicine that they are prescribing.   Patients often receive counterfeit, substandard, expired, and/or improperly stored medicine because formal government regulation of medicine is quite uncommon.  But when countless people are dying of treatable diseases, isn’t some sort of medicine better than no medicine?  Some agree, yet others worry that inferior medicine could do more harm than good, especially when it is prescribed or taken incorrectly.

The discouraging fact is that we don’t have enough research to fully support either side of this debate.  Out of the World Health Organization’s (WHO) list of 350 essential medicines, the WHO only regulates about 50 of these medicines—mostly those that treat HIV/AIDS, malaria, and tuberculosis.  We do not know how the other 300 medicines are being produced, and if they are produced incorrectly, we do not know their effects.  For some medicines, manufacturing and storing shortcuts, such as adding too little of the active ingredient or not keeping the medicines in temperature-controlled environments, may not have significant consequences; for others, substandard medicine could build resistance (like what’s happening with multidrug-resistant tuberculosis) or cause negative side effects.  But if countries put into place strict regulating systems, we risk diminishing the drug supply because countries may not be able to cheaply or effectively import and distribute medicine.

We stumble, once again, upon the familiar debate: quantity versus quality.  People are dying because they do not have access to medicine; at the same time, non-quality medicine could do a lot of harm, especially to the population’s health.  As always, there is no clear winner in this debate.  Quantity and quality are team players in the field of medicine—both are needed to treat patients and improve population health.  So, we must work alongside the countries and donors to create effective regulatory systems that ensure proper quantity and quality of medicine.