Envisaging an Adulterated Food and Counterfeit Drugs free Country

*Dr. Arvind Kumar, President, India Water Foundation

Only in India we are liberal with the health concerns, Will you eat this Wheat? the Supreme Court asked while refusing to entertain pre-arrest bail pleas of two Madhya Pradesh-based businessmen who are accused in a food adulteration case. Among man’s everyday needs, food plays a major sustaining role. From the simple dish to the most elaborate haute cuisine, food preparation is as varied and rich as a man’s taste. The lure of riches and general apathy towards mankind has led to adulterants being added to food from the simple stones in rice to the more harmful brick and boric powder. An ICMR report showed 51 per cent of foods in India were contaminated with pesticides, of which 20 per cent had levels exceeding the Maximum Tolerance Limits (MTL). An estimated 600 million – almost 1 in 10 people in the world – fall ill after eating contaminated or adulterated food and 420 000 die every year, resulting in the loss of 33 million healthy life years as per WHO estimates. Food adulteration has been a persistent problem in recent years especially in India with authorities uncovering several cases. In its first ever country-wide survey on milk adulteration conducted in year 2011, the Food Safety Standards Authority of India found that of the total 1,791 samples tested throughout the country at least over 68 per cent i.e., 1,226 samples were either diluted with water or mixed with harmful detergents. As India is facing the worst effects of COVID-19 pandemic and continue battling against the devastating second wave, we encountered a new emerging problem of fake drugs and medicines during this crisis. The high demand of medicines and medical equipment during the second wave of COVID-19 resulted in huge surge in urgent requirements which boosted the trade of medicines and other essentials for treatment of COVID 19 patients. The unregulated trade open medicines and equipment along with reselling of medicines like Remdesivir vials, antibiotic and saline solution also created the path for smuggling and black-market demand. As per World Health Organization (WHO) report “About 10.5% of medicines sold in low and middle-income countries, including India, are substandard and falsified.”What exactly is food adulteration? Food adulteration is when substandard, harmful; substances are mixed with natural food, spoiling their nature and quality. Adulterated food is extremely harmful to our health, robbing our bodies of essential nutrients. However, despite being a major issue, adulteration continues across the country. One of the reasons is that it fuels business. But at what cost? Why do companies engage in adulteration? The answer is simple—increasing profit margin. While it’s unethical and government laws deem it an illegal practice, adulteration continues rampantly even today. This is due to loopholes that exist in regulations and the lack of strong implementation of the laws.

Greed and profit lure towards adulteration

Even notable brands are sometimes entangled in these scams. Adulteration exists in almost every product we consume – groceries, medicines, liquor and even milk and honey. Around 68.7 per cent of milk and milk products sold in India is not as per the standards laid down by the Food Safety and Standards Authority of India (FSSAI). As per the member of the Animal Welfare Board of India, the most common adulterants are detergent, caustic soda, glucose, white paint and refined oil.If you are thinking food adulteration merely involves adding colors to vegetables and fruits, think again. Chalk powder in salt, chemicals in turmeric powder, coriander powder with sawdust, brick powder with chili powder, etc., is a glimpse into what food adulteration is. Unknowingly, we consume these on a daily basis, risking our health. The 2018-2019 Food Safety Standards Association of India (FSSAI) Report alarmingly revealed that 28% of food samples were adulterated and that adulteration had doubled since 2012.

Perils of Adulteration and Counterfeiting food and drugs

Adulterated food is dangerous because it may be toxic and can affect health and it could deprive nutrients essential for proper growth and development of a human being. The worst part is some adulterated food even causes cancer, the most life-threatening disease. Also, in many cases many pregnant women who consumed such adulterated food ended up with miscarriages because of poor fetus growth and in some extreme cases the women died while delivering babies. Just to make more profit and money, risking other’s lives is absolutely an unethical practice. But they do not bother at all.

The central government, on its part, is trying everything possible to control this “crime”. In India, the ministry of health and family welfare is completely responsible for providing safe food to the citizens. The Prevention of Food Adulteration Act, 1954, has laid down guidelines to provide pure and wholesome foods to consumers. The Act was last amended in 1986 to make punishments more stringent and to empower consumers further. But the government is planning to enforce harsher punishment now. The FSSAI has issued the draft amendments to the Food Safety and Standards (FSS) Act, which was passed in 2006 but the regulations were notified only in 2011. Among the key amendments, the FSSAI has proposed to include a new section to crack down on food adulteration.

It is not known at the time of consumption of medicine that it is a spurious drug. Therefore, if the drug is not effective a patient usually thinks that the diagnosis is wrong and either he consults another physician or ends up having a series of diagnostic tests including blood, x-rays, ultra sound, Ctscan, MRI etc resulting in an increased medical expenses, mental agony and absence from work or studies. If there are certain toxic effects of the medicine then it is usually assigned to an allergic reaction of the medicine and the physician might change the medicine. The toxic medicine is then completely forgotten and is not pursued any further. If the medicine is fatal then usually the death is assigned to the disease or the negligence of a doctor or the hospital Even when spurious drugs do not endanger life, they can leave the patient seriously ill and those with inadequate potency can induce drug resistant bacteria i.e., they will not respond even when right medicine in right dosage is given.

While the government is working towards making India self-reliant, a potential shortage of drugs and an inward-looking approach could pose another challenge—the perils of counterfeit drugs. The Central Drug Standards Control Organization (CDSCO), the drug regulatory authority of India conducted a nationwide survey in 2009 and announced that of “24,000 samples that were collected from all over India and tested. It was found that only 11 samples or 0.046% were spurious. In 2017 a similar survey found 3.16% of the medicines sampled were substandard and 0.0245% were fake. Those more commonly prescribed are probably more often faked. Domestically produced generics have often come under the scanner for failing quality tests. This is especially alarming at a time when the world is anxious about the adequacy of basic medicine supplies, given the reduced production and increased demand mostly everywhere. India has been battling the challenge of substandard drugs for a while. The problem was in the spotlight when the government launched its Jan Aushadhi initiative, in which five medicines were reportedly recalled in a span of 20 days because of quality lapses. There were also reports of this number rising to 11 in four months.

Stringent Laws and Punishment

Due to its outdated laws, lack of infrastructure and awareness of the public for standards and quality, India finds it difficult to implement stringent food safety regulations. Investment in food safety infrastructure, i.e., laboratories, slaughterhouses, quarantine facilities, is low. Besides, to ensure that safe food enters the country, the government should set up robust laboratory infrastructure to improve food testing facilities and manufacturing practices to maintain hygiene standards. People need to be very cautious when they buy products from stores and malls. They should check for standards like ISI standard mark, Agmark for quality products, FSSAI standard mark, date of packing and date of expiry etc. If none of the prescribed standard marks is there, then they should totally avoid buying such products. Awareness among stakeholders like vendors and middlemen by education and regulation go hand in hand. Prevention of food adulteration in turn prevents food wastage. Digitalization and Revolutionized technology that present scenario of food safety with improved strategic planning can aid to combat this widespread problem. There should be a single window- one organization to address all kinds of adulteration whether food or counterfeit medicine. At a time when we are talking about making India self-reliant, we must not forget that we have also had feedback from drug regulators around the world for discrepancies in our manufacturing quality. In other countries the punishment for food and medicine adulteration is execution or life sentence. As a result, these kinds of incidents are not repeated. What India needs is a regulatory mechanism that is geared for quality and armed against fake drugs, that not only promises an influx of innovative drugs from around the world, but also ensures that our patients have access to superior quality products. Combating counterfeit drugs should be a key objective of the exercise. The government must focus on dealing strictly with those who engage in food adulteration. One way of doing this is by hiking the penalty, including making it analogous to attempt to murder in some extreme cases of adulteration. It is equally important to regularly check food stuff for adulteration and ensure speedy trials through specific fast track courts.