When Byculla was Gambia
The death of 70 children due to adulterated cough syrup made by an Indian pharma company has hit headlines. The fact that these were children who must have been given a syrup for what’s likely to have been a harmless cough has made this case particularly heart-breaking.
Sanjay Nagral
Oct 16, 2022, Hindustan Times
Until recently, many of us hadn’t heard of a country called Gambia. One of the smallest countries in Africa with the population of a Mumbai suburb, Gambia is now in the news every day for an embarrassing and tragic reason. The death of 70 children due to adulterated cough syrup made by an Indian pharma company has hit headlines. While death due to spurious drugs is unfortunately not new, the fact that these were children who must have been given a syrup for what’s likely to have been a harmless cough has made this case particularly heart-breaking. Add to that the image of Indian pharma as a global player supplying cheap drugs and vaccines to other countries. Gambia is miles away and the pain of the mothers will soon recede from our public space.
In 1986, Jagan Phadnis was a reporter with Marathi newspaper Maharashtra Times. Most reporters on the Mumbai beat at the time would have contacts in hospitals. In January, Phadnis was informed by sources in JJ Hospital at Byculla that there had been unexplained deaths attributed to a contaminated drug and that notices were put up not to use it. Govind Talwalkar, the then editor, encouraged Phadnis and his colleague Prakash Akolkar to dig deeper. They did a series of reports exposing a trail of corruption, collusion and delayed action by various actors.
Bapu Thombare was the first to die on 21st January, Dawood Dholakia the 14th & the last on 7th February. The kidneys of these ordinary people were found to be severely damaged. They had received a commonly used drug called glycerol for other indications which was later found to be massively contaminated with glycol. I was then a resident doctor at KEM and remember our horror when we heard that the drug under question was glycerol - something we were routinely using in our patients. For some time, the government was quiet. But a ferocious, dogged campaign by the press, public outcry and outrage by opposition parties put pressure on them to appoint an inquiry commission.
It’s difficult to now know what they were thinking when they appointed a High Court judge, Justice Bakhtawar ‘Bomi’ Lentin, to lead this. Lentin took his job seriously and dived deep into the trail of the contaminated drug. After examining hundreds of documents and cross-questioning officials from the state, the Food & Drug Administration and JJ Hospital over two years, he submitted a scathing report of the chain of events. How batch number 27 of Alpana Pharma’s glycerol contaminated with very high doses of industrial glycol killed the 14. He indicted the then health minister Bhai Sawant and the previous one Dr Baliram Hiray for being lax and favoring certain FDA officers and pharma companies and creating fertile ground for corruption. Sawant resigned a little before the report was submitted.
The 289-page report is a classic example of how an investigation into public probity and corruption should be done. Lentin’s use of what we may now call Tharoor-esque English to describe the shambolic state of drug quality regulation made it even more noticeable. The report did lead to a shakeup in the FDA and drug regulation system. Heads rolled and the FDA modernised and tightened its regulatory mechanism. Today, as the government has announced an inquiry into Maiden Pharma, the Gurugram based company which manufactured the cough syrup that killed Gambian children, it seems chillingly relevant. Even the contaminant under investigation is glycol once again.
It is tempting to think that such incidents involve small fringe companies situated in shadowy by lanes. And that if we stick to using drugs from large reputed companies we would be safe. That’s a risky trope. For one, many big pharma subcontracts the manufacture of drugs to smaller units and only then markets them. They are also not risk free. In the mid 90’s, Dinesh Thakur, a senior scientist in one of India’s most reputed pharma companies, Ranbaxy, notices data manipulation and falsification in his work. Unlike many of us who would only whine in private, Dinesh decided to blow the whistle after systematically collecting evidence. In what is perhaps one of the biggest implosions in the history of modern pharma, Ranbaxy collapsed. For those interested in a blow-by-blow account of this saga, Katherine Eban a US based writer’s 2019 book ‘Bottle of Lies’ is mandatory reading. At your own peril though.
Corruption is a global phenomenon. Transparency International’s data shows that healthcare is one of the most affected sectors. In 2018, I coedited a book called ‘Healthcare corruption in India’ which attempted a deeper dive into the historical processes, drivers and power structures that contribute to corruption in Indian healthcare. One of its obvious worrying features is that it affects our day-to-day lives, illness and death. But it is also increasingly clear that when corruption is viewed only as individual failing of a few bad apples rather than the fallout of a system which thrives on profits at all costs with kickbacks and favors as integral components, it needs a different approach. But for the mothers in distant Gambia who lost their little ones, this would be meaningless and just dispassionate sterile analysis. And so also the families of the 14 Mumbaikars. Maybe a collective apology is more in order.