corruption link ignored in contaminaed Valsartan problem

this is cross posted from my main blog.

CNBC notes another batch of Valsartan, a medicine used for high blood pressure and heart failure, has been found to be contaminated with small amounts of a cancer causing chemicals.

But missing from the story: Where was it manufactured?

From Sciencemagazine.

In this case, the valsartan recall was originally traced back to a problem with the material from Zhejiang Huahai Pharmaceuticals. 

Remember that name: ZHP.
That’s the Chinese manufacturer who made the API itself. but some of it was repackaged.
however, it wasn't just ZHP: the newest batch recalled? That was made in India.

the article goes into details about manufacturing, but if you continue reading you find (TADA!) the source of the problem:

But how do you get N-nitroso compounds from the amines, and why was the solvent switched? Well, the classic industrial syntheses of these molecules involved reacting an aryl nitrile with tri-n-butyltin azide (often formed in situ from the trialkyltin chloride).

ZHP themselves appear to have introduced a cheaper, higher-yielding route using just sodium azide and zinc chloride in an aprotic solvent like DMF...

italics mine.

 The excess azide is consumed at the end of the process using sodium nitrite – but nitrite under acidic conditions will give you some nitrous acid, and nitrous acid will react with secondary amines to give you N-nitrosoamines. That would seem to be the root of the problem. Well, one of the roots. The second problem is that no one apparently picked up on the N-nitroso contaminants for years.

so it's also the first world drug companies who are at fault for trusting the manufacturers were being honest and following manufacturing protocol

and after ZHP got away with it, apparently other manufacturers decided they could get away with it too.

why is this little fact important? Because those of us in third world countries know there is a huge problem with contaminated, fake, and substandard medicines mainly from China, and also India and other third world countries.

Yes, much of the medicine is generic but by US/European/Israeli companies, but the dirty little secret is a lot of the world's medicines are outsourced to companies who can manufacture it cheaper.

and the Science magazine article naively wonders what is behind the problem.

 So we’re going to have to think about the way that synthetic routes in the generic API business are monitored, it would seem. People seem to have missed that changing the chemistry for the sartans could lead to this problem, so what else are we missing?

again, italics mine.
Anyone here in Asia could tell you what you are missing:
uh, it's the culture of corruption that is the problem.

World Health Organization article on this problem estimates one out of ten medicines sold in third world countries are fake, counterfeit, substandard or have toxic additives.:

No countries remain untouched by this issue — from North America and Europe through to sub-Saharan Africa, South East Asia, and Latin America. What was once considered a problem limited to developing and low-income countries has now become an issue for all.

With the exponential increase in internet connectivity those engaged in the manufacture, distribution and supply of substandard and falsified medical products have gained access to a global market place. This extends both to consumers and business forums. ...

However, it is in low- and middle-income countries and those in areas of conflict, or civil unrest, where health systems are weak or non-existent that bear the greatest burden of substandard and falsified medical products.

Measles in the DR Congo

AlJ reports:

Nearly 90,000 suspected cases of airborne infection recorded since January, health minister says....
Ilunga added the mortality rate was estimated to be at 1.8 percent, a figure which translates to more than 1,500 deaths.

actually, I suspect the death rate is higher: often the children get better after the rash disappears, then they die one or two weeks later because Measles causes "anergy" or lowered immune system response, and die of pneumonia or tuberculosis.

 "To stop the chain of measles transmission and prevent future epidemics, at least 95 percent of the population have to be vaccinated," he said. More than two million children were vaccinated in April, according to the health ministry, with anothe

r immunisation campaign covering a further 1.4 million others set to be launched "in the coming days".

typhoid in Los Angeles

....

the NewAmerican has an article on the trash problem in Los Angeles.

Typhus is a disease born of filth, most commonly spread by contact with the feces of fleas. It is most often reported in the third world or places such as POW camps where hygiene is of little concern. Last year, Los Angeles County reported a record 124 confirmed cases of the disease, enough to be classified as a full-blown outbreak. So far, in 2019, more than 50 cases have been reported. The reason? Fleas are attracted to rats and rats are attracted to huge piles of food-waste infused garbage, like the ones that currently litter vast portions of downtown Los Angeles. 

he overburdened sanitation department does the best it can, but it simply doesn’t have the manpower necessary to keep up with the gigantic piles of filth that spring up quickly and are left to grow and rot for months at a time. A spokesperson for the city’s Department of Public Works reports that the current backlog for trash pickups around the city’s homeless encampments stands at approximately 8,400, with an average of six calls per site.

the Atlantic article (March) about the problem in Los Angeles among the homeless.

Los Angeles recently experienced an outbreak of typhus—a disease spread by infected fleas on rats and other animals—in downtown streets. Officials briefly closed part of City Hall after reporting that rodents had invaded the building. People in Washington State have been infected with Shigella bacteria, which is spread through feces and causes the diarrheal disease shigellosis, as well as Bartonella quintana, or trench fever, which spreads through body lice.*

Hepatitis A, also spread primarily through feces, infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio, and Kentucky, primarily among people who are homeless or use drugs.

Public-health officials and politicians are using terms like disaster and public-health crisis to describe the outbreaks, and they are warning that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public-health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A in San Diego County, syphilis in Sonoma County, and typhus in Los Angeles County. “Typhus,” he said. “A medieval disease. In California. In 2019.”.....

. Bubonic plague could be next.

NPR article from August 2018. So it means it's not a new problem.

Medical journal Article about the Hepatitis outbreak in SanDiego that started in 2016.

The hepatitis A outbreak affected 588 individuals. An epidemiologic and morphologic review of the cases with a focus on the UCSD patients was performed. No common sources of food, beverage or drugs have been identified that have contributed to this outbreak. Mode of distribution is likely direct person to person transmission. The health department initiated an extensive public vaccination and education campaign, distributed hygiene kits, deployed portable bathroom and hand washing and declared a local public health emergency. Due to the extensive public health campaign, the outbreak seems to be under control as of January 2018.

the epidemic started in 2016, but the WAPO finally noticed it in 2017, explaining how "power spraying" with bleach and other basic public health hygiene methods were being used to control the disease.

Actually the hepatitis epidemics was the harbinger of these plagues, and it is due to neglect by local governments. And that epidemic was noted as a problem a couple years ago. (2016-2018), meaning it can't be blamed on Trumpie boy, but wait and they will manage to politicize the problem.

Ah, but their priorities are in place: They banned Plastic straws.

cross posted to my regular blog.