Hi everyone,
I just wanted to share this interesting application of SMS. Counterfeit medicines are common in developing countries. This service allows consumers to verify the authenticity of medicines by sending a code printed on the medicine package to the service via SMS and receiving instant confirmation. Details are available at their website:
http://www.asligoli.org/solutions/

- Usman Raza

 
Cameron Stocks
Replied at 12:44 PM, 4 Nov 2013

Hi Usman,
Thanks for sharing this. I have seen a similar system called mPedigree. You
can read more about it here:
http://www.ttwud.org/casestudy/identifying-safe-drugs-mpedigree#.UnfcpHDIblw

Usman Raza
Replied at 9:37 AM, 5 Nov 2013

Thanks Cameron. This is very similar to AsliGoli, and on a much larger
scale.

Eduardo Viteri
Replied at 10:12 AM, 5 Nov 2013

Thank you Usman. It only works in some countries. Do you know if there is
something similar for Latin America?

Dorn Carranza, PhD MBA
Replied at 10:35 AM, 5 Nov 2013

Hi Usman. Thank you. I am also interested in learning if there is experience using this application in Latin America. Regards, DC

Joaquin Blaya, PhD
Replied at 1:33 PM, 5 Nov 2013

One other question it mentions that it uses a code on the package, but how
do they make sure that counterfeit manufacturers don't also place that
number on their box? Is it because it's constantly changing?


Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/@@
Research Fellow, Escuela de Medicina de Harvard @@http://hms.harvard.edu/@@
Moderador, GHDOnline.org @@http://www.ghdonline.org/>

ReLAB Bamenda
Replied at 2:23 AM, 8 Nov 2013

Thanks for sharing. This knowledge can be applied elsewhere.

Usman Raza
Replied at 12:11 AM, 11 Nov 2013

Hi all,

I don't know of any such initiative in Latin American but there are at
least a couple working in India.

@ Joaquin: Your point is very valid and poses an interesting question. I
understand that the codes are randomly generated for each pill box or
blister pack. I discussed this with colleagues in office and one of them
suggested a simple solution: Mobile phone companies sell prepaid scratch
cards, which consumers scratch to reveal a code that they submit via sms
and get their phone credit recharged. By analogy, drug companies can also
make the pill packs (of better yet the blister packs themselves) with a
hidden code that needs to be scratched for use. The codes would be
generated and coating done automatically by the system without human
involvement. Like phone cards, any box on which number is not hidden cannot
be sold then. Does this sound like an answer?

O G
Replied at 5:09 AM, 11 Nov 2013

Many blister packs have room to print a number on the edge that could be exposed when the foil is peeled back. A box code would register the user with that box and three-character sub codes from each blister pack would get more granular data. It does seem that daily SMS will get poor compliance though.

Joaquin Blaya, PhD
Replied at 5:47 AM, 11 Nov 2013

That sounds like a great idea Usman, I have a feeling that the biggest
limitation would be getting the pharma companies to do it.

I do think that the system you mentioned is a great first step, as with
security, this verification process will always be a game of catch up, in
other words, with any new verification process, the companies producing the
fake meds will start working on how to beat that method and eventually
they'll get it if they try hard enough.

So having this as a first step will solve many problems now, and hopefully
a more complex process can be in place in thenear future.

Hannah Faal
Replied at 1:10 PM, 11 Nov 2013

Dear Joaquin
Thanks for sharing, I checked the asligoli website as well as the
mpedigree website. Both are addressing a great need. Is it possible to
keep track of which drug companies are complying..or possibly which
drugs? Have manufacturers of eye drops joined
? I liked the idea of the SMS being free to the customer.. mpedigree.
Is there any evidence on what percentage of customers are adopting the
method , the trend over the years and is there any evidence on impact
on the number of fake drugs. The drug companies could do that piece of
research.
If it is seen as a gold standard, drug companies will strive for it.
Is it seen as a gold standard?

As another colleague mentioned, one has to go into the minds of the
fake drug manufacturers and preempt steps they may take until they
find it economically not worth manufacturing fake drugs.

A/Prof. Terry HANNAN
Replied at 1:24 PM, 11 Nov 2013

Hannah, I am not so sure pharmaceutical companies are that 'moralistic'. I viewed an interesting documentary film on this topic when I was in New York recently. It is called "Fire In the Blood". You can track its screenings on the web. Terms that came from the film are "political apartheid" (an African AIDS worker who I had met durung my time in Kenya) and "pharmaceutical genocide" by making medications prohibitively expensive to developing nattions (and the underfprivilied) in developed economies. Terry

Joaquin Blaya, PhD
Replied at 1:55 PM, 11 Nov 2013

Also, Hanna, I don't know much more than what is on their website about
what they do and Usman who originally posted has some great ideas about how
to improve it, but also is not part of their direct team. Perhaps
contacting them directly would work?


Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/@@
Research Fellow, Escuela de Medicina de Harvard @@http://hms.harvard.edu/@@
Moderador, GHDOnline.org @@http://www.ghdonline.org/>

Malcolm Brewster
Replied at 8:51 AM, 12 Nov 2013

I tend to agree with Prof Hannan. Developments to support SMS pill authentication by pharmaceutical companies, if they occur, are not very likely to be motivated by corporate social responsibility. I think it more likely that pharmaceutical companies venturing into this field would do so in order to gain a competitive advantage in their industry. Consumer perception of the risk arising from counterfeit medicines may not be very great at present, but would rise dramatically with one headline news story or increase gradually as discussion of the issue broadens. Companies whose products can be authenticated by the consumer would have an advantage over competitors. Inevitably this commercial advantage will be greatest where the market is most lucrative i.e. in higher income countries, and to high income consumers elsewhere. As with all developments there is a risk of creating an inequality between those who can benefit and those who cannot. If, as seems probable if it is pharmaceutical industry driven, medication authentication schemes result in increased medication prices then the relatively poor may be squeezed out of the market for authenticated products whilst remaining easy prey for pharmaceutical counterfeiters.

Usman Raza
Replied at 1:57 PM, 12 Nov 2013

Thanks Prof. Hannan and Malcom for bringing in this interesting aspect into
the discussion.
I agree but feel that the matter would be complicated by other factors
varying in local context. At least in Pakistan, where there is practically
no difference between OTC and prescription drugs, the decision of buying a
particular brand of medicine is largely dictated by the buying power of the
consumer and after that by (a perception of) quality. Consider the average
illiterate rural patient who cannot comprehend much of the information
around this and is too worried about the disease condition already.

In my experience, its very easy for patients to receive a drug other than
that prescribed. Apart from the well educated and aware people like myself,
the typical patient will often be 'advised' by the pharmacist/shopkeeper to
by drug X instead of drug Y because its the same thing but only cheaper.
Alternatively, a patient who cannot afford much will herself ask the
pharmacist if a cheaper version is available. A yet another scenario is a
patient going to a shopkeeper to buy medicine, and the shopkeeper simply
asks what grade medicine do you want (meaning what quality).

These are not exaggerations but routine daily events that I have myself
witnessed. In this context, SMS pill verification might be of interest to
only those companies that are producing relatively better quality drugs.
And in fact, that would be the only useful application. For example, we
have Ciprofloxacin being made in at least 15 different brand names. The
price range of these brands cover is from Rs.120 to Rs.800, and you can
choose which price/brand you want. The SMS pill verification would be
useful to get rid of a fake copy of the Rs.800 medicine. The Rs.120
medicine, manufactured by a local company is not the subject of pill
verification because no body bothers to copy them. I hope I made the point
clear.

Now, the quality of an actual (not fake) medicine which is being legally
produced and sold at a very very low price is a separate discussion and
relates to the overall regulatory environment for drug registration etc in
that country.

Malcolm Brewster
Replied at 6:42 PM, 12 Nov 2013

The example described by Usman illustrates in important issue. Even when a person knows, by good medical advice or otherwise, what would be a safe and effective treatment for their condition they remain in a vulnerable position. Brands of genuine pharmaceuticals at various prices may be indistinguishable from counterfeits. The division between authentic and counterfeit products is an oversimplification though. Some products may be of sub-therapeutic quality containing inadequate amounts of a pharmaceutical and again may not be distinguishable from those of therapeutic quality at the dispensary. As an example Kaur et al 2008 (PLoS ONE 3(10): e3403. doi:10.1371/journal.pone.0003403) found both substandard and therapeutic quality antimalarial medicines on sale throughout Tanzania. Furthermore, although the retail prices were not discussed, sub-standard drugs were produced by local as well as international manufacturers. I am not sure that Usman's assertion that cheap local generics are not targeted by counterfeiters is universally true. Even if it is it may not remain so if it becomes more difficult to copy major brands in the future.

This raised a couple of questions in my mind;

Could SMS authentication be developed in ways that empower vulnerable consumers enabling them to be sure that the pharmaceuticals they obtain are of therapeutic quality?

Can SMS authentication be developed in ways that avoid 'big pharma' creating an exclusive portfolio of medicines which consumers can be confident are both genuine and of therapeutic quality?

Can SMS authentication be developed in ways which do not disadvantage local manufacturers of good quality cheap generics?

.

Usman Raza
Replied at 5:01 AM, 3 Jan 2014

The attached link is to an article recently published in WHO bulletin, that
refers to the Medicines Quality Database which is publicly accessible.

http://www.who.int/bulletin/volumes/92/1/13-130526.pdf

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