Monday, July 6, 2009

Public Health: Malaysia's little pick me up

Ministry of Health officials raided premises in the northern suburbs of Kuala Lumpur, Malaysia's capital, acting on information that had led them to follow a trail of suspicious coffee mixes back to their source.

The coffee mixes, sold in innocuous packages saying only "beneficial for men" (something of a recognised code in Malaysia for products that are reputed to boost sexual prowess - or desire) had been turning up all over the country, distributed by a quiet network marketing plan that operated mostly by word of mouth. By avoiding the usual distribution channels that rely on publicity, the network had managed to develop under the radar of all the relevant authorities.

Malaysians are seemingly addicted to both supplements. there is a massive array on sale at all pharmacies and supermarkets - even minimarkets stock them or are part of network marketing schemes. "Network marketing" schemes abound with some foreign networks sending significant numbers of foreigners to deliver the sales pitches to new recruits at meetings where zeal is a vital tool.

Malaysians are also hooked on "3 in 1" drinks: everything from tea to oatmeal drinks, from coffee to hot chocolate and all points in between are sold in sachets containing the drink, powdered milk or "creamer" and sugar. And they are extremely popular in a country where many people don't cook and - in traditional apartment blocks - don't even have a kitchen. In such cases, sachet drinks and instant noodles are the primary alternatives to going out to eat.

But this time, what was in the coffee was not a natural addition such as ginseng or tangkat ali. This time it was a chemical called sildenafil. That's the active ingredient in Pfizer's Viagra.

There is a huge worldwide problem with fake Viagra: some of which has no active ingredient, some of which has harmful or even toxic content and some of which has too little (or in the case of a production mishap, too much) of the active ingredient. It's not so long ago that a shipment of a drug branded "myagra" was picked up in Malaysia having been produced in India, where much of the world's counterfeit drugs industry is centred.

However, Malaysia is interesting because it has so many ethnic ties: Indians, Chinese and Malays are all incomers - albeit over a period of several hundred years. And they have all, through cultural or religious ties, kept their links to their homelands.

Therefore counterfeit products from China and India have a ready transit point in Malaysia, despite the best efforts of the authorities to stop it.

The latest find, however, may prove to be from much nearer to home: because most of the coffee mixes referred to above are produced in Malaysia. Tongkat ali is traditionally used in the Malay community: the Chinese and Indians have not taken to it in the same way - probably because its use originated in rural areas and the Chinese and Indians are historically urban dwellers.

The investigation is not complete. 9,000 sachets were confiscated in the raid and now the search will centre on where it was produced and where the sildenafil was sourced from. The likely places are India and China. The distribution network for drugs and counterfeit pharmaceuticals from India into Malaysia is particularly well established. And the find was in the north of the city which has strong Indian links. Therefore, although no details have been released, there is speculation that the source was from India. However, against this is that the distribution network went national very quickly - and the Indian population is largely based in and around Kuala Lumpur. That kind of spread would almost certainly require a Chinese or Malay involvement. As the Malay population has less access to the sildenafil, a link to China would indicate a Chinese network.

As always, in Malaysia, the apparently simple turns into something deliciously complicated.

Worldwide there is a huge demand for viagra with charlatans peddling their wares by e-mail spam and internet sites. The product being sold in Malaysia was not fake. Ironically, it was the inclusion of real sildenafil that creates the risk of prosecution. The product is legal for sale in Malaysia - but only with a prescription.

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