Blood In Their Hands

On December 11^th, 1945, in his Nobel lecture, the father of penicillin, Sir Alexander Fleming, warned of antibiotic misuse in the future. “The time may come when penicillin can be bought by anyone in the shops,” he said, “that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

The English bacteriologists provided an apt illustration:

“Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Mr. X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.”

Sir Fleming probably never imagined a scenario where deliberate, profit-driven underdosing would be a contributing factor to antibiotic resistance.

In South Africa where many patients are developing and dying of drug-resistant ailments, Fleming’s ‘Mr. X’ are the officials at National Department of Health and price gouging pharmaceutical companies that routinely engineer artificial drug shortages in public health facilities.

Sample these extracts from Stop-Stock-Out:

• August 12, 2016 – Patients at Jamela clinic in Limpopo Province received a quarter of their usual monthly supply of the antibiotic Doxycycline due to a shortage. Medicine Developers International cc is the company contracted by the National Department of Health to supply Doxycycline
• May 16, 2016 – At Xurana clinic in the Eastern Cape extended shortage of Bactrim, an antibiotic, was reported and patients endured treatment interruptions. Apparently the facility had been borrowing stock from other neighbouring clinics that could not afford to share anymore. On May 31, 2016, Xurana was asked to make a special order, as Bactrim was no longer in the Department’s catalogue. Also in short supply at the same clinic were Erythromycin 500mg and Ceftriaxone 250mg. [The response was that all the drugs were not in the current catalogue, but uSpiked Investigative Team can confirm that in the current Tender, HP02-2015AI, a supplier called Dezzo Trading 392 was contracted by the department to supply R8.54 million worth of Ceftriaxone 250mg - Editor.]
• April 25, 2016 – shortages were reported for Co-trimoxazole 480mg and Ceftriaxone 1g at Mpoza Clinic in the Eastern Cape. Patients were reportedly being sent away without treatment. A total contract value in excess of R130 million for the two antibiotics was shared between Dezzo Trading 392, Austell Laboratories (Pty) Ltd, Akacia Healthcare (Pty) Ltd., Gulf Drug Company (Pty) Ltd., and Medicine Developers International cc.

[These are just a few of the reported cases of shortages. As we continue analysing data and records we have obtained from the Department of Health, we hope that some sensible person can stop the devastation. – Editor]

The Raiders of Healthcare: a free for all sans regulations

The problem of runaway costs of drugs that rarely reach public health facilities has festered in South Africa.

Initially worth R2.235 billion, the price of the current tender for the supply of anti-infective (antibiotics, antifungal, antiprotozoal and antiviral) medicines has escalated by R355 million, an average of 16% hike in just a few months of the tender being awarded.

On Wednesday, September 30, 2015, Khadija Jamaloodien, the National Director for Affordable Medicines at the Department of Health signed off part of the tender. More suppliers were contracted shortly after, with Biotech Laboratories (Pty) Ltd. withdrawing from award to supply a portion of three million units of procaine penicillin.

A few months into Contract No. HP02-2015AI, the usual suspects emerged to request permission for price increases. By August 2016, the national department of health’s bill for anti-infective medicines had rocketed by an extra R355m.

What is the justification for price hikes ranging from 4% and 33%? How much are the bribes paid to certain public officials to overlook these clearly suspicious requests for hikes? Dodgy suppliers should have a difficult time explaining why ‘market forces’ only affect them, and not other contracted suppliers.

The Greed Chart: How big and small pharma are killing the populace

We have called it tender rigging, extortion, collusion, anti-trust and price fixing. But, it is really worse than that. The price gouging is purely immoral, and considering the grave consequences, it is a conspiracy to commit mass murders. Patients who shouldn’t have died have lost their lives. Others are doomed because they have become resistant due to the shortage of drugs (what Sir Fleming called under-dosage), or they have opted for alternative, inappropriate medicines.

uSpiked’s ongoing investigation into the plunder at the health department continues to identify unscrupulous pharmaceutical suppliers. Among the rot are also a few good companies that have so far managed to resist suspect tender deals.

On the good list are some of the top ten pharmaceutical companies, most of them headquartered in the US. They include Merck & Co, which operates locally as MSD (Pty) Ltd, Johnson & Johnson, through a local subsidiary, Janssen Pharmaceuticals (Pty) Ltd, and Pfizer Inc. German multinational, Bayer, which has had multiple run-ins with the US Justice Department over price rigging, has also kept its contract prices in South Africa.

Maybe the big stick wielded by the US Justice Department through the Foreign Corrupt Practices Act is helping to keep US companies in check. Nevertheless, health department officials should have the courage to boot out the bad apples.