Adulterated medicine grabbed public attention recently following an incident in Cologne, in which a mother and her unborn child died after taking a glucose solution prepared at a pharmacy. Many people are now asking themselves: How dangerous is medicine prepared in local pharmacies? Maria Kristina Parr, a professor of pharmaceutical chemistry at the Institute of Pharmacy, Freie Universität Berlin, studies anti-doping, metabolism, quality testing, and counterfeit medicine. In September, she co-organized an international workshop for experts on “Fake Medications,” which took place in Egypt with the support of the Freie Universität’s liaison office in Cairo.

Professor Parr, should consumers be worried about purchasing medicine at a pharmacy in the wake of the Cologne incident?

If consumers go to a reputable pharmacy, there is no need for concern. In Germany, we have the luxury of having great pharmacies where you can buy safe medical products that have been thoroughly tested.

But the contaminated glucose solution came from a reputable pharmacy in Cologne.

It is difficult to draw conclusions from this specific case, since the investigation is still underway, and we don’t have all the details. But there is a general problem surrounding solutions prepared for glucose tolerance tests, namely that statutory health insurance schemes do not cover the costs for the packaged product made by the pharmaceutical companies. Instead, they only pay for solutions produced by pharmacies -- but the production and sale of these solutions is hardly lucrative for the pharmacy.

How do the pharmacies test the quality of the medical products that they produce themselves?

Each pharmacy is responsible for the quality of the products it sells. How they test the quality is up to them with several methods available. The pharmacy itself has to cover the costs for testing, so quality assurance gets factored into a cost-benefit calculation. In order to make it cost effective for the pharmacy, production and testing of a glucose solution shouldn’t take more than five minutes total. The health insurance companies have decided to cover the costs of the proprietary solutions through the end of the year in light of the Cologne incident. But the decision has caused shipping delays since, up until now, demand was minimal.

Are all pharmacies allowed to make their own powders, solutions, and creams?

Yes, they purchase the active ingredients from wholesale retailers, which they then process in a small laboratory.

How does quality control work for pharmaceutical products from drug companies?

There are very good testing procedures in place for industrially produced pharmaceuticals. Every batch of medicine is checked during production.

What about imported medicine?

Most regulations apply across the EU. Distribution and manufacturing standards have been harmonized. Random sampling is used to test products that come from outside the EU, but of course, they cannot check every single package. The further a pharmaceutical product travels, the greater the chance that something could go wrong.

In your opinion, is it safe to use medicine purchased online?

You don’t have to go far to find a pharmacy in Germany. There might not be one in every tiny village, but there is one in every small town. So, in my opinion, there is really no need to buy medicine online. There are reputable pharmacies that can ship your medicine, but that means the customer doesn’t have the opportunity to consult with the pharmacist and ask questions concerning dosage, allergies, or drug incompatibility. When you order pharmaceuticals online, your run a greater risk of getting cheap products without knowing where or how they were produced.

In September, you organized a workshop on counterfeit medicine in Cairo with Freie Universität’s laison office. What were some of the most important findings?

The workshop brought together participants with various backgrounds, including scientific research, regional quality control agencies, local businesses, and even a United Nations adviser from the Office of Drugs and Crimes. It was great to discuss the topic from so many different perspectives.

The first step was making it clear that falsified medicine poses a real problem. According to the WHO, there is a large amount of falsified medicine on the market around the world. The unfortunate thing is that poor people in particular often become victims of this criminal practice. They cannot afford industrially produced pharmaceuticals in countries where health insurance does not provide full coverage for them. If a family has to cut costs on food in order to afford medicine, they will naturally try to save money and buy cheap medicine from street vendors, which is often falsified.

This is why it was important to us to hold an interdisciplinary workshop, where experts from fields like social and cultural anthropology also participated. For example, Dr. Mustafa Abdalla from Freie Universität’s Institute of Social and Cultural Anthropology was there and shared insights into social and local contexts. The ensuing conversations quickly made it clear that in the future pharmacy researchers and medical anthropologist need to work closer together in order to tackle the problem of counterfeit medicine holistically. Professor David Cowan and postdoc researcher Ivana Gavrilovic from King’s College London are other important partners and cofounders of our initiative.

To what extent can research help combat the problem?

The issue of fake medications is extremely difficult to comprehend, especially from a researcher’s point of view because there are so many facets to consider. It is also difficult to gain the trust of victims in this kind of context. Imagine if someone approached you in front of a doctor’s office and asked you to show them your prescriptions. Without local partners who are already known and trusted, it is practically impossible to make headway in this highly sensitive area.

There has also been a follow-up meeting in London with Reychad Abdool from the United Nations Office on Drugs and Crime (UNODC). At the meeting, we agreed to work together to include other countries and researchers from those countries in the project. In my research group, we are currently working on the topic of adulterated medications with an Alexander von Humboldt visiting professor from Thailand and one of her doctoral students.

There has also been some preliminary planning done regarding training workshops for participants from African countries, perhaps offered as summer school programs. We are also interested in deepening connections between researchers from Egypt and other African countries. To support this effort, we awarded the researcher with the best poster at the Cairo workshop an invitation to Freie Universität Berlin.

Anne Kostrzewa conducted the interview.

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This text originally appeared in German on November 15, 2019, in the campus.leben online magazine of Freie Universität.