CHENNAI, TAMIL NADU, INDIA — Although the Indian federal government has failed to amend its laws to properly combat the counterfeit and substandard drug trade, regional and local officials are beginning to clamp down on this odious business. Driven by increased media coverage and public outrage, courageous individuals are fighting back. 

Some are well placed to do so, such as Anbumani Ramadoss. The Health Minister of India until last month, Ramadoss appears to have driven most substandard dugs out of his home state of Tamil Nadu. Others are doing their part at a lower political level. 

In Patna, the largest district of the 38 that make up the Indian state of Bihar, magistrate Jitendra Sinha directed drug inspectors to launch an intensive drive to check the stocks of city medicine shops. His office has received complaints about the sale of fake and expired medicines near the Patna Medical College and Hospital. 

“Some of the medicine shop owners are not giving receipts to customers, saying they would thus have not to pay taxes,” Sinha told The Times of India recently. But, as he explained, this not only causes revenue loss to the government but also facilitates sale of fake medicines. Sinha’s work has led to recent investigations and removal of many fake suppliers from the Patna area. 

According to local investigators like Delhi-based Suresh Sati, the greatest supply of fake medicines comes through complicit pharmacists who pass off fakes as real products, making a hefty profit while endangering lives. But fake drugs enter the supply and distribution chains in other ways too, notably through corrupt deals between a hospital’s buyers and drug sellers. 

Perhaps the worst story of all is of patients at the Osmania General Hospital in Hyderabad who were given fake anesthetics. One patient who was supposed to be under anesthetic for two hours woke up after 30 minutes.

Late last year, a senior divisional medical officer, Ranjit Das, exposed the supply of fake drugs to Danapur Railway Hospital. He encouraged the Khagaul police to investigate three pharmaceutical companies after the patients failed to respond to drugs, including antidepressants and painkillers, supplied by these firms. The drugs were tested in laboratories in Kolkata and Delhi and confirmed to be substandard. According to India's Drugs Control Agency, many had at most 11 percent to 12 percent of the active ingredients they were supposed to contain—enabling them to pass basic tests but failing to properly treat patients. Additionally, a different Mumbai-based company supplied adulterated insulin to the Danapur hospital, until this was also detected in tests. And it took raids by the Delhi-based Central Bureau of Investigation to expose a medical scam involving purchase of near-expired medicine, at the Danapur and other hospitals. 

Under pressure to act against such dangerous activities, Federal Railway Minister Lalu Prasad established a high-level committee of medicine experts to improve drug purchases at railway hospitals (which are managed by the government-run Indian Railways, one of the largest employers in the world, and serve railway workers). But so far, at least according to private-sector investigators, the problems persist, even after the efforts of medical officials at the Danapur and other railway hospitals. 

In the state of Orissa, police investigators confirmed late last year that a thriving racket in the supply of substandard drugs and transfusion fluids for government hospitals was being undertaken by corrupt officials of the state health department. The officials, who were responsible for purchasing and storing drugs, are suspected of working with illegal manufacturers. Private investigators have had no success in bringing those responsible to justice. 

And perhaps the worst story of all is of patients at the Osmania General Hospital in Hyderabad who were given fake anesthetics. One patient who was supposed to be under anesthetic for two hours woke up after 30 minutes. In the end the hospital’s doctors had to give three times the normal dose to ensure patients stayed unconscious throughout their procedures. This outrageous practice happened because the authorities did not prosecute the company, Galpha Laboratories of Baddi in Himachal Pradesh, that was supplying the substandard drugs, even though the complaint has continued for over a year. At last it appears that prosecutions of this and other local companies will occur later this year. In the meantime the suspect companies are prevented from tendering for major hospital contracts. 

While there are some good and many bad news stories, at least the public is becoming more aware of the problems it faces. As long as media pressure continues and officials from the top on down work to rid India of bad drugs, then corrupt state and local politicians who are paid to ignore bad actors will soon be exposed and India’s drug supply should improve. For the thousands killed every year—mainly in India but also overseas, including probably the United States—it cannot come too soon. 

Roger Bate is the Legatum Fellow in Global Prosperity at the American Enterprise Institute and the author of Making a Killing, a book about counterfeit drugs. 

FURTHER READING: Bate previously wrote for The American on India’s counterfeit and substandard pharmaceutical products in “Bad Medicine” and “Fighting Fake Drugs in India.” In “Fake!” he reported on counterfeit medicine in Africa. Graeme Wood writes about an unlikely management guru in “The Indian Railway King.”

Image by Darren Wamboldt/the Bergman Group.