off record
Shaukat Ali Jawaid


Medications, Patient Safety,
ADRs and LASA Drugs


Aga Khan University Hospital organized a symposium on Medication Safety last month on December 17th 2016 where medial errors occurring due to the Look Alike, Sound Alike (LASA) drugs in particular were highlighted by various speakers. Earlier PNS Shifa Hospital had also organized a symposium on Patient Safety on February 7th 2013 where Mr. Latif Sheikh the then Director of Pharmacy Services at Aga Khan University Hospital in his presentation had highlighted the medial errors occurring due to LASA drugs. He had also shown packing, injection ampoules and drugs with similar names and advised the healthcare professionals to be careful and avoid these medical errors which at times could be fatal.1

The problem of medical errors due to LASA drugs still remains and has not yet been solved. Even during the AKUH symposium on Patient Safety Dr. M. Aslam Afghani Chief Operating Officer of DRAP disclosed that they had identified a number of such cases and show cause notices have been issued to the companies concerned. Such problems are confronted in other countries as well and in Pakistan where we are reported to have registered over ninety thousand drug formulations, overcoming the problems of LASA drugs may not be so easy and it will take some time before this problems is resolved. However, patient safety covers a much broader area in which Adverse Drug Reactions play a vital role. Without having any system of Adverse Drug Reactions, events reporting, it is not possible to ensure patient safety.

It may be recalled that Prof. Akhlaqun Nabi when he was affiliated with College of Physicians and Surgeons Pakistan as Prof. of Pharmacology had tried to establish an ADR Center there. A workshop was also organized where guest speakers came from UK but this effort did not materialize. Again Dr. Farzana Chaudhry the Drugs Controller in the Federal Health Ministry had also tried to establish ADR Center at FHM but without any success because of the cozy relationship between the healthcare professionals and pharma industry. The pharmaceutical industry does not like the ADRs to be reported though it welcomes such initiatives overseas and the healthcare professionals also do not wish to lose the perks and priviliges they get from the pharma industry by reporting any adverse drug reaction or events. In case we had any such service of ADR reporting, we would not have witnessed the tragedy which occurred at Punjab Institute of Cardiology in which over one hundred fifty precious lives were lost.

World Health Organization publishes “WHO Pharmaceuticals Newsletter” regularly which is prepared in collaboration with the WHO Collaborating Center for International Drug Monitoring from Uppsala Sweden. It carries news about Adverse Drug Reactions (ADRs) Drug-Drug interactions by healthcare professionals from all over the world.2 It provides latest information on the safety of medicines and legal actions taken by the regulatory authorities across the world. It also provides signals based on information derived from individual Case Safety Reports (ICSRs) available in the WHO Global ICSR database (VigiBase) I have been looking at its contents for the last many years and have never found any report from Pakistan. It does not mean that Adverse Drug Reactions are not observed in Pakistan but the fact remains that the doctors are not interested in reporting them. It is also incompetence and inefficiency of the Drug Regulatory Authorities in Pakistan that we have so far failed to develop such an ADR reporting system which is so important to ensure patient safety and eliminate, minimize medical errors.

Healthcare professionals must realize their responsibilities to patients to ensure patient safety and the Drug Regulatory Authorities should also wake up before it is too late, otherwise we will continue to witness tragic incidents like the one seen at Punjab Institute of Cardiology a few years ago. As regards the problem of LASA drugs, even if this is resolved satisfactorily, patient safety can only be ensured by strengthening Hospital Pharmacy, streamlining Community Pharmacy Services wherein each and every pharmacy is headed by a qualified pharmacist. We have a long way to go but let us make the beginning and take the first step.

During the symposium at the AKU, a film prepared by CNN on spurious, counterfeit drugs was also shown to the participants. It would have been much better had the organizers checked the authenticity of this film before it was screened. It gave an impression as if it was some marketing activity by the AKUH to promote its pharmacy services. It is alleged that this film was prepared in India to malign Pakistan and check our drug exports. Dr. Aslam Afghani the DRAP chief deserve to be commended who immediately challenged the contents of this film and also stated that WHO as well as the Drug Regulatory Authority of Pakistan and Pharma Industry has already denied and challenged its contents. While every effort should be made to eliminate the menace of spurious, counterfeit drugs from Pakistan but let us not fall prey to the ploy by our sworn enemies like India by projecting negative image of Pakistan. Any such effort will not only bring a bad name to Pakistan but also shake the confidence of our people in the quality drugs being produced by the Pakistan Pharmaceutical industry which has done a commendable job of making available quality drugs at affordable prices. Such measures will also adversely affect the progress, growth and development of Pakistani Pharma industry which has made huge investment in modernizing, upgrading the manufacturing facilities and in quality assurance. Health officials and Ministers concerned should also be extremely careful while issuing any such statement on spurious, counterfeit drugs and must check and confirm the authenticity of the information which they get before rushing to the media which is ever ready to project negative image of Pakistan.


  1. Patient Safety programme initiated at Armed Forces Healthcare Facilities. Pulse International Feb. 15, 2013. Page-1
  2. WHO Pharmaceuticals Newsletter available at http://www.who.int/medicines accessed on December 26, 2016.
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