Beware of Hospital Targets

[bumblebee]

My other half had a bit of a stomach ache last night and so we went to Pattaya Memorial hospital. She has insurance from her job but alas only for the first 800 baht and she has to pay the balance of anything over.

Well in this case the bill came to 3000 B, ouch. I asked her why so much and she said she forgot to mention the 800 limit to them and so wanting to reach their sales targets, it is a business after all, they upped the treatment to make more.

Something to keep in mind when getting private medical treatment in Los for sure.

[Snick]

Also watch our for medicine and vitamins.

 

They will vastly overcharge you, decline the vitamins and get 7 days of any non-restricted medicine and then refill at Boots or any other pharmacy.

[seven]

i had this ripoff at the Pattaya-Bkk hospital. Bill was 3000, but useless pills/paracetamol was at least half

[pacman]

Also watch our for medicine and vitamins.

 

Be very careful when buying antibiotics & other medicine in Thailand & most other places in Asia. Too many pharmacies sell fake drugs. When I was treated for pneumonia in the Bangkok Pattaya Hospital I was advised to only get my medicine from them. Of the 200 or so pharmacies in Pattaya, only a few sell genuine product, the rest sell cheap imported fake drugs. China & India are the main offenders, they copy the pills, the packaging, everything except for the active ingredients.

 

This explains why we read that Viagra bought in Asia doesn't work. And the number of Chinese in China who died from not receiving correct medicine in the last year that statistics are available for was almost a million people.

 

These fake drugs have started appearing in UK pharmacies in recent years. Arrests have taken place but with the money involved we haven't seen the last of them.

[Snick]

I think you are exaggerating. I doubt there are any problem buying from name brand stores like Boots and Watson, I have never had any trouble with them.

The only places I would avoid are the drug stores around Nana, when I bought some antibiotics there it was a shit antibiotic that had been withdrawn in most places and near expiration.

And if you buy Viagra on the street, you get what you deserve.

[pacman]

I didn't suggest ALL pharmacies are bad. But I do believe there are enough doing the wrong thing that it is worth posting a warning. The hospital I was in employed a European doctor who spoke several languages whose job it was to inform tourist patients about their procedure & the dangers they faced in Pattaya. And the one he stressed most clearly was that the pharmacies were not to be trusted. I remember him saying I would be back in care if I took follow up medicine bought from most outlets. 

 

I only have his word to go on but he was most insistent. And I also agree that it would be surprising if Boots or Watsons sold counterfeit drugs but if those companies employed local pharmacists who saw a chance to make a little profit on the side, I would not be entrusting my life on the belief that they are men of conscience who would never do such a thing. For other requirements they are the least worst option.

 

You on the other hand are free to buy from wherever you wish. My advice was aimed at any BM who may find themselves ill sometime in the future while on holiday. If they think they can judge a pharmacy based on its size, location & cleanliness, they need to think again.

 

This is not idle forum chat about who makes the best cocktail or serves the coldest beer. 

[rxpharm]

pacman, of course the good doctor could not have been telling stories to make you buy the medications only from his hospital, because he is more ethical than the pharmacists you malign?

 

Yes, there are problems with fake drugs in LOS, but there are measures being implemented to reduce the problem.

 

A "real" pharmacy in Thailand is licensed by the Thai Food and Drug Administration and must have their license publicly displayed in the drug store. In addition to this the Pharmacy Council of Thailand has started an accreditation program to standardize good pharmacy practice. I am uploading an example of their seal, which would be displayed in an oak framed silver plaque.

A drug store also must have a licensed pharmacist on site during operating hours.

Of course all this doesn't mean the pharmacy doesn't have fake drugs for sale, but the possibility is reduced.

Here is a presentation from the Thai Food and Drug Administration in conjunction with the Ministry of Public Health about the counterfeit drug problem.

 

http://www.authorstream.com/Presentation/Dabby-18261-Tangkeo-problem-increasing-affecting-developed-developing-countries-1-2-3-Counterfeit-Dru-as-Entertainment-ppt-powerpoint/

 

With the transcript below:

 

 

Slide1: Global to Local Overview of Counterfeit Pharmaceuticals Ms. Werawan Tangkeo Deputy Secretary General, Food and Drug Administration Ministry of Public Health, Thailand

The problem is increasing and it is affecting both developed and developing countries (1): The MHRA, with assistance offered by Pfizer Ltd., is recalling Counterfeit Lipitor Tablets 20 mg. (28’s) Lot.No. 004405K1 Exp. date 11/2007 and Lot.o.067404K3 Exp. date 05/2007 (19 July 2006, 03 August 2006) The MHRA, officials seized 5000 packets of counterfeit Tamiflu in early 2006, estimated to be worth £500 000. The MHRA, with assistance offered by Abbott Laboratories Ltd., is recalling the counterfeit Reductil 15 mg. Capsules (14’s) Batch no. 65542 expiry date 01/2007 (02 Sep, 2004) The MHRA, with assistance offered by Lilly ICOS UK Ltd., is recalling the counterfeit Cialis 20 mg. Tablets. (4’s) Batch number A031410and A041410, expiry date 06/2006 (23 Aug, 2004) The problem is increasing and it is affecting both developed and developing countries (1)

The problem is increasing and it is affecting both developed and developing countries (2): A Dutch consumer bought Tamiflu 75 mg. capsules on internet . (Lactose + ascorbic acid) (21 December 2005) US FDA issued an alert about fraudulent flu remedies, including counterfeit prescription Oseltamivir (Tamiflu) medication. (January 2006) U.S Customs Seizes 51 shipments of Fake Tamiflu® (generic) at an air mail center in San Francisco, California. (Nov., 2005) US FDA Warns Consumers About Counterfeit Viagra® and Lipitor® purchased between the Maxico border, (May,2005) US FDA Warns Consumers About Counterfeit Drug purchased in Maxico; July 30, 2004 (Zocor® 40 mg. Lot. K9784 exp. Nov. 2004; Lot. K9901 exp. Dec. 2004; Carisoprodol® 350 mg. Lot. 68348A) The problem is increasing and it is affecting both developed and developing countries (2)

The problem is increasing and it is affecting both developed and developing countries (3): Counterfeit Armillarisni A injection (treating acute or chronic cholecystitis and chronic and atrophic gastritis) in northeast China's, 11 people died. (BEIJING : Xinhua, May 19, 2006) Counterfeit Viagra® 580,000 tabs. seized in China (December, 2005) The largest ever underground drug-manufacturing ring and seized as much as 550,000 counterfeit drug pills worth NT$ 300 million in the market. (Viagra 50,000; Cialis 70,000; Zantac 20,000; Reductil 50,000; and unknown drug pills 360,000) (Taiwan, December 2005) Counterfeit Velocef® tabs, Zantac® tabs, Augmentin® 2 kgs. seized in India (October, 2005) Counterfeit artesunate and mefloquine in Cambodia, 30 died (1999) The problem is increasing and it is affecting both developed and developing countries (3)

Counterfeit Drug Cases Opened by US.FDA per Year: Counterfeit Drug Cases Opened by US.FDA per Year

What are the different types of counterfeit drugs that WHO have been reported?: What are the different types of counterfeit drugs that WHO have been reported?

What kind of products are counterfeited most?: Until recently, the most frequently counterfeited medicines in wealthy countries were new, expensive lifestyle medicines, such as hormones, steroids and antihistamines. In developing countries the most counterfeited medicines have been those used to treat life-threatening conditions such as malaria, tuberculosis and HIV / AIDS. As the phenomenon spreads, more and more medicines are counterfeited, including expensive ones, such as anti-cancer drugs, and those highly in demand, such as anti-viral drugs. What kind of products are counterfeited most?

Strategy to combat the problem?: Strengthening post-market surveillance Sampling test enhanced (annual sampling plan) Drug quality bulletins on a regular basis Plan for implementation of GDP & GSP Monitoring drug quality and Licences of manufactures, distributors & pharmacies Inspecting and monitoring of drug advertisements. Controlling of on-line drug information service & transaction Penalties by warning, confiscating, fine, withdrawing approvals, suspending & revoking Licences for illegal activities. Strategy to combat the problem?

Strategy to combat the problem?: Strengthening other regulatory areas Test of imported drugs at customs Marketing authorisation for all drugs/imported drugs GMP certification programme Routine GMP inspection plus investigational inspection Strategy to combat the problem?

Strategy to combat the problem?: Co-operation with other government bodies Criminal punishment for manufacturing/ importing/selling of counterfeit drug, working with Thai Crime Suppression Division Control of smuggling, working with Custom Department ASEAN Post-Marketing Alert System (ASEAN PMAS) Strategy to combat the problem?

Strategy to combat the problem?: Encouraging the society’s involvements Educate the public Disseminate information Establishing of Center for Combating Counterfeit Drug (since 1997) National Post-Marketing Alert System (to hospitals, drug stores, Provincial health offices, medical clinics, etc.) Strategy to combat the problem?

Collaboration among involved organizations: Collaboration among involved organizations Import & Export Inspection Division Food and Drug Administration Provincial Health Offices – 76 provincials Police Station Permanent Secretary Royal Thai Police Lamchabang Shipping-Port Klong Taey Shipping-Port Airport Border lines Inspection Division Aranyaprathate (Cambodia) Chiang-san (Lao) Mae Sod (Burma) Sadao (Malaysia) Bangkok Provincials

Counterfeit Drug Cases Investigated by Thai FDA per Year: Counterfeit Drug Cases Investigated by Thai FDA per Year

Thai Metropolitan Police Bureau: Thai Metropolitan Police Bureau January 2006 : Inspector of Thai FDA arrested counterfeits of Reductil 10 and 15 mg at the drug stores in front of Siriraj Hospital. October 5, 2005 : Inspector of Thai FDA arrested drug store in Thonburi district sold counterfeit Primobolan Depot 25 and smuggling counterfeits of Sildenafil (Viagra group) from India. July 15, 2005 : Inspector from Thai FDA and Tak province arrest drug store in Mae sod district sold counterfeits Artesunate.

Thai Crime Suppression Division: Thai Crime Suppression Division October 31, 2002 : The smugglers distributing the amount of Viagra 100 mg of 60,000 tablets has been arrested with all packaging materials. March 20, 2002 : Mr.Gokhan Ozhek, a Turk hiring the employees to do the production of counterfeit Viagra has been arrested, and then all of the employees were exterminated as well following the below : The employees living at the lodging in Bangkae District were captured along with Viagra 100 mg (50,000 tablets), raw materials and production equipment. The employees living at the lodging in Nonthaburi province were captured along with Viagra (40,000 tablets), Valium 10 mg (2,038,000 tablets), production equipment, packaging materials and containers.

Examples of Import Smuggling: January 8, 2007 : The Custom Department found the smuggling counterfeits of Sildenafil (Viagra group) from China amount of 110,000 tablets. December 25, 2006 : Thai Narcotics Suppression Bureau arrested smuggling drugs from Singapore, such as Kamagra 10,600 Tabs. (Sildenafil), Plavix clopidogrel 7,518 Tabs., Nolvadex-D 25,000 Tabs. June 28, 2005 : A Japanese who was traveling to and fro between Thailand and Cambodia for 19 times totally has been arrested by immigration officers of Sra-kaew province, along with the counterfeits of Viagra group in the amount of 3,000 tablets; i.e. Viagra Lot no. 3098603 Exp. Sep.2006, Lot no. B214837311 Exp. Jan.2008, Cialis 20 mg Lot no. A031410 Exp. Aug. 2006 Examples of Import Smuggling

Import Smuggling arrested by Import & Export Inspection Division, Thai FDA (1): November 5, 2006: A Pakistani passenger who fled to Thailand from Dubai with Indian-drugs which contain Sildenafil Citrate as Active Ingredient. June 8, 2005 : A Chinese passenger who came from Hong Kong at the Bangkok International airport, Don Muaeng airport, with the counterfeits of Viagra (11,700 tablets) and Cialis (1,300 tablets). Import Smuggling arrested by Import & Export Inspection Division, Thai FDA (1)

Import Smuggling arrested by Import & Export Inspection Division, Thai FDA (2): May 4, 2005 : A Pakistani passenger who arrived Thailand by Cathay Pacific airline has been arrested along with many kinds of drug products; i.e. Deca Durabolin injection 5,685 vials, Norigest injection 3,124 tubes, Polution Depot 2,393 tubes, Progynon Depot 1,914 tubes, Cellcept 250 mg – 1,200 capsules, and Neoral 10,800 capsules. Import Smuggling arrested by Import & Export Inspection Division, Thai FDA (2)

Smuggling Sildenafil groups from China: Smuggling Sildenafil groups from China

Slide20: Smuggling Sildenafil groups from China and India

Produce Other Own Products: Produce Other Own Products October 31, 1998 : The inspectors of Thai FDA found punches and dies used to produce fake drug products in the manufacturer, in other words, to copy other own products ; e.g. Lasix 500 mg, Betaloc 100 mg, Fulcin 500 mg, Halcion 0.5 mg, Theo-Dur 200 mg. January 1999 : The inspector of Thai FDA arrested drug store in Samutprakarn province counterfeit Lasix 500 mg.

Center for Combating Counterfeit Drug (1): Center for Combating Counterfeit Drug (1)

Slide26: Counterfeit products found along the Thailand - Cambodia boarder during 2004. Labeled "Made in Thailand" or show Thai address All of the products showed fake name and address None of them are in Thai Drug Regulation System. Situation along the border

Counterfeits found in Thailand: Counterfeits found in Thailand 2003 1. Lasix 500 mg 2. Postinor 3. Primolut N 4. Proscar 5. Viagra 2002 1. Artesunate 2. Valium 10 mg 3. Viagra 2001 1. Actifed Syrup 2. Atarax syrup 3. Bisolvon Elixer 4. Rhinathiol Syrup 5. Artesunate 2006 1. Viagra (Sildenafil) 2. Cialis (Tadanafil) 3. Reductil 10, 15 mg. 4. Myda-B 5 gm. 2005 1. Viagra (Sildenafil) 2. Cialis (Tadanafil) 3. Primobolan Depot 25, 100 mg. 4. Reductil 15 mg 5. Counterfeit Herbal Medicine 2004 1. Viagra (Sildenafil) 2. Cialis (Tadanafil)

Counterfeit Artesunate Tablets (1): Counterfeit Artesunate Tablets (1)

Slide30: L/C No. 184815 Mfd. 25-03-05 ยาสิ้นอายุ 25-09-08 15 g.

Slide31: Immediately report to the authorized person : Provincial Health Offices, or Center for Combating Counterfeit Drug, Food and Drug Administration, Ministry of Public Health, Nonthaburi 11000 Tel : 0-2590-7315, 0-2590-7325-6 Fax : 0-2591-8489 E-mail : prakool@fda.moph.go.th, or praphonang@yahoo.com When found suspicious products (1)

When found suspicious products (2): To inform as much more details of the characteristics of each product as possible, e.g. Name and its concentration, Lot number, name and address of the manufacturer, name and address of the place where each product was found. To transfer the suspicious drug products to the authorized person. Using of these drug products should be cancelled. When found suspicious products (2)

 

The seal to look for:

[ciobha]

Most  leading pharmacies now buy there drugs packaged with (almost) copy proof security print, which changes in agreement between the drug company and the packaging company every print run of a specific product. Companies like Boots, Pfizer, MSD, GSK, and Reckitt Benckiser have this as standard on the vast majority of their products now. A special keyfob will read a hidden tangent within the varnish on the printed box or label, and this will flash a specified colour of light which is coded within the varnish to react solely to the keyfob.

 

RX can correct me on this, but I believe the major drug retailers have an agreement that they can allow any product on the shelf worldwide to be randomly tested at any time for counterfeit goods, easily detectable by a simple fob test on the packaging. I cannot see Boots, be it in Thailand or anywhere else, risking their global name to sell a few fake drugs.

[pacman]

pacman, of course the good doctor could not have been telling stories to make you buy the medications only from his hospital, because he is more ethical than the pharmacists you malign?

 

I take your point RX but if forced to choose who I think is the more ethical between the hospital doctor warning about fake drugs & a local pharmacist who may or may not be tempted by the opportunity to make a some extra on the side, regardless of who he works for, I will side with the elderly European gent. Who by the way told me he can't work as a doctor in Thailand, he works part time as a liaison officer, a job he does to help occupy time in his retirement.  

 

 I cannot see Boots, be it in Thailand or anywhere else, risking their global name to sell a few fake drugs.

 

Absolutely! There's no way in the world they would tolerate that. However when it comes to staff, even the Boots HR office can't know if they have a cheat on their payroll. I don't suggest for a second they have but I suspect they might carry out some random checks just to keep everyone honest.