5th October 1997


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Insearch of that brand

Many cannot afford the more expensive brands of insulin. Frustrated patients are crying foul while the government keeps mum about the resumption of imports.
Tharuka Dissanaike reports
Sunil Jayewardena has been a diabetic for many years. He has been dependent on insulin injections for the past 12 years, to replenish his body's low production of the hormone which controls sugar levels. Jayawardena cannot do without his daily dose of Insulin.

His very survival depends on the drug. He is among thousands who have been searching high and low for their familiar brand of insulin for the past couple of months- in a panic for they never found it in stock. Boots Insulin Lente, the cheapest variety of insulin available in the market, has been out of stock for some time and no authority or organisation is taking responsibility for the sudden disappearance of this drug from the market.

Ms. H. Perera ( not her real name), another patient, totally insulin dependent is put in a terrible position for the lack of Boots Insulin. "I use three to four vials a month, and I simply cannot afford the other brands. I have used this insulin for a long time and was quite comfortable with it," she said.

Suffering from diabetic complications - a varicose ulcer- the sudden non availability of the drug has put an immense strain on her and her family. "I am using the expensive human insulin at present. But pharmacies promise that Boots will be available in a couple of weeks." She also said that after switching to the other brand, she had developed headaches and adds that she never had after effects using Boots.

While it appears to be common knowledge that Boots Insulin Lente was imported from the manufacturers in India by the State Pharmaceutical Corporation (SPC), the Health Authorities deny this. According to them, a private company is responsible for the importing of the drug. Repeated attempts to contact the Chairman of SPC proved unsuccessful. His secretaries assured us that he received the numerous messages we left for him, but said he had not instructed them further.

There appeared to be a clear mis-communication between the health authorities and the State Pharmaceuticals Corporation on the issue of importation of Boots Lente. It was no secret that the SPC imported Boots insulin. This was confirmed by sources within the corporation.

But Dr. Ajith Mendis of the Drug Regulatory Authority, speaking to us on the advice of Dr. Reggie Perera, Director General of Health Services said categorically that Boots was imported by a company called Lanka Medicals. To prove this he faxed us a data sheet with details of registered insulin brands and the companies who are the local agents. According to this data sheet record numbers 2461, 2462 and 2463 are all for Lente Insulin from Boots, India and are all registered with the Drug Regulatory Authority stating Lanka Medicals as the importer.

"When we contacted them," Dr. Mendis said, "We were told that Boots is not manufacturing Insulin even in India and therefore they cannot import the drug."

But Manager- Insulin Department at Lanka Medicals, Delroy Jones totally denied that they ever imported Boots Insulin Lente. "We only import a brand of insulin from a Danish company called Norvo- Nordisk." The company denied importing any brand of insulin from India and strangely enough Lanka Medicals is registered again in the list as the importer of insulin produced by Knoll of India. "It is the SPC that brings down Boots Lente insulin," Jones said.

Dr. Mendis declined to comment on the activities of the SPC, when The Sunday Times inquired as to whether SPC should not secure stocks of insulin to be distributed at least to the Osu Sala outlets. If Boots Insulin is unavailable, for whatever reason, is it not the duty of the SPC to ensure that other low cost brands are available in the market since insulin is a life saving drug, which cannot be replaced by other drugs? Nor can patients ignore prescribed doses for more than a couple of days.

"All state hospitals have ample stocks of insulin, so no one can really say that there is a shortage of insulin," Dr. Mendis said. "Any person can call over at the government clinics or hospitals and obtain their dose of insulin."

But most patients deprived of the Boots Lente insulin see little option but to resort to the more expensive brands. The price difference between Boots Lente, which is an animal insulin in semi- purified form, selling at Rs. 225 per vial and other brands- mostly purified human insulin- selling between Rs. 550 - Rs. 750 a vial, is great. Many cannot afford it. Frustrated patients are crying foul while the government keeps mum about the resumption of imports. "We just want to know when we can buy the cheaper insulin." a patient complained. "Even though we are buying the human insulin now, we cannot afford to sustain this."

According to statistics of the Sri Lanka Diabetes Association, there are around 10,000 insulin dependent patients in the country. This is only a fraction of the total one million diabetics, a grim picture of the country's situation.

An insulin dependent's body produces only 10 percent or less of the required volume of the hormone. This means that the patient has to take daily doses of insulin to keep up bodily functions. Many children too are among this number of insulin dependants. The disease is quite prevalent in the rural areas also.

Dr. Mahen Wijesuriya, President of the Association took the problem regarding the non-availability of insulin in his stride. Dr. Wijesuriya said that it is better for patients to use the human insulin brands since it is a refined product and has few side effects. "Although patients may find the Lente (animal) insulin cheaper than Humulin (human), they can use the Humulin vial longer, and then the price difference does not amount to much," he said.

Dr. Wijesuriya admitted that a patient could die of lack of insulin, since the sugar level in the blood would rise uncontrolled. But he was quick to add that any patient in real need could always go to a government hospital. "The problem is that most do not like to stand in OPD queues," He said that the Association is trying to work with the government to ensure that the human insulin is used more often and its use promoted among the public. "It is easier to use, can be kept outside refrigeration and a better drug to which the whole world is turning to."

Patients contacted by The Sunday Times, though having used Humulin brands for the past few weeks in the absence of Boots Lente are not all that impressed with the change. What they all require, is to have a cheaper and reliable brand available to them as Boots Lente had been. It is reliably learnt that SPC is negotiating with several companies abroad to obtain other brands of low cost insulin. The problem appears to be, as much as mis-communication between the state health bodies, a lack of communication flow from the Ministry of Health and /or SPC to the public informing them of the technical difficulty of obtaining the drug and that imports will resume once another supplier is found.

"Why cannot the government tell us what is happening?" Jayawardena asked perplexed. "The entire problem is that the lack of Boots Lente came as a shock to the public and we are still in the dark." Ms. Perera said.

Another patient, Eric Jayamaha, insulin dependent for the past 36 years, had written a strongly worded letters addressed to the SPC Chairman and Minister of Health early September. He appealed to the Minister to secure stocks of the type of insulin produced by Boots India, or an equally potent drug at an equitable price, "without allowing diabetic patients who are insulin dependent to languish in "limbo" until the State Pharmaceuticals Corporation makes up its mind. In fact this should have been done long before they stopped supplying the Boots Insulin to the market."

In a reply to this letter, Dr. K. Velummylum, Deputy Director General of Health Services directs the SPC to import this life saving and urgent drug so that it may be available at an affordable price. He also requests the SPC to investigate into the lack of stocks and submit a report to the Ministry.

But when can patients hope to see an affordable brand in the market ? This is what the public needs to know from the officials of the Health Ministry and the State Pharmaceutical Corporation.

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