As the recent arrests of at least one hospital owner and several doctors accused of distributing smuggled and counterfeit medicines has shaken the foundations of the medical establishment as a whole, Future Movement MP Atef Majdalani, the chair of Parliament’s Public Health, Labor and Social Affairs Committee, said relaxed inspections of healthcare facilities after the summer 2006 war and the fact that universal health coverage is still a long way off in Lebanon are partly to blame. "In France, this problem does not exceed 5 to 7 percent (of all medicines in the country). In Lebanon, smuggled or fake medicines may reach 15 percent," Majdalani said. "Smuggled and counterfeit medicines are a global problem. We do not want to frighten people into thinking all medicines in the country are fake or unsafe," Majdalani said. He explained Lebanon’s porous land borders make the smuggling of medicines difficult to stop, while airports and sea ports tend to be more secure. Majdalani pointed out that many copies of patented drugs are also entering Lebanon legally as there is no law to stop such practices. "We need to re-examine the law, to put up an amendment to the law that allows the Health Ministry to stop the importation of such drugs," he said.

The MP said that the dangers from counterfeit or fake medicines vary from minor, meaning that the patient does not get any better, to very serious, as would be the case for a diabetic who takes regular insulin shots.

The Drug Importers Syndicate in Lebanon places holograms on drug packaging to identify fake from authentic medicines, he said, but a few importers who are not members of the syndicate do not.
Drug importers prefer to bring in non-generic brand-name medicines because the profit margin is higher, he added. "We sent a recommendation to the National Social Security Fund (NSSF) to encourage the use of generic medicines, by proposing they cover the whole cost of generic medicines for NSSF subscribers. If a patient wants brand-name medicines instead, he pays the difference," Majdalani said. The judiciary recently turned down a request from two forensic doctors, accused of issuing fake medical reports, to be released from jail pending trial. First Investigative Magistrate in Beirut Abdel Rahim Hammoud turned down the request and decided to hold them in custody. Hammoud will soon interview 55 persons accused of embezzling public funds by receiving compensation for war wounds allegedly based on fake medical reports issued by the two doctors. Public Financial Attorney Roukoz Rizk is hearing affidavits of around 100 persons in this case, among them employees of the Ministry for the Displaced.

Majdalani said that doctors filling out false reports are not only violating their Hippocratic Oath, but also violating the most basic human rights. Majdalani explained that doctors entrusted with the lives of their patients are exposed to people’s medical and general problems, and thus are closer to their clients than most other professionals. Doctors also tend to employ compassion before consulting the rule book, he said.

Majdalani praised the Pharmacies Inspection Unit at the Health Ministry and Customs officials for uncovering improprieties at Al-Hayat Hospital, which resulted in the arrest of its owner, Dr. Antoine Saber, and five others for distributing fake or expired medicines. Admitting that a 2001 amendment gave doctors immunity from arrest unless the Order of Physicians was informed of the charge in advance, the MP said that this law only applied to criminal cases involving medical malpractice, and that the act of selling illegal medicines does not full under the umbrella of malpractice.

The Pharmacies Syndicate also carries out inspections of drugstores to control the illegal sale of counterfeit medicines, and informs the prosecutor’s office and fines those pharmacies found violating the law, he said.
"There are always seizures of counterfeit medicines in the country but the press rarely reports on these matters as too much talk on such matters results in loss of confidence by people who begin to think all medicines on the local market are creating a panic," he said.

The MP noted a law currently before the Administration and Justice Committee that would allow a pharmacist to replace one brand of medicine with another, with the prescribing doctor’s approval. "If a patient feels one drug is too expensive, the pharmacist can replace it with another cheaper one. The law now does not allow the pharmacist to do that right now. The doctor writes the name of the medicine on the prescription and under it he can write ’can be replaced’ or not," he explained.

As for whether doctors prescribe specific brand-name drugs in return for financial incentives from the concerned manufacturers, Majdalani said pharmaceutical firms do not pay doctors to sell their drugs. "One should not blame doctors, not because I am a doctor, but because a doctor over time develops trust in certain medicines and only prescribes these medicines. Most doctors in their field of specialty rarely use more than 50 medicines," he added.