http://www.iht.com/articles/2007/05/05/asia/web0505-toxic-46350.php


A trail of poisoned medicine leads back to China



By Walt Bogdanich and Jake Hooker Published: May 5, 2007




A syrupy poison, diethylene glycol, is an indispensable part of the modern 
world, an industrial solvent and prime ingredient in antifreeze.
It is also a killer. And the deaths, if not intentional, are often no accident.

The kidneys fail first. Then the central nervous system begins to misfire. 
Paralysis spreads, making breathing difficult, then often impossible without 
assistance. In the end, most victims die.

Many of them are children, poisoned at the hands of their unsuspecting parents.

Over the years, the poison has been loaded into all varieties of medicine - 
cough syrup, fever medication, injectable drugs - a result of counterfeiters 
who profit by substituting the sweet-tasting solvent for a safe, more expensive 
syrup, usually glycerin, commonly used in drugs, food, toothpaste and other 
products.


Toxic syrup has figured in at least eight mass poisonings around the world in 
the past two decades. Researchers estimate that thousands have died. In many 
cases, the precise origin of the poison has never been determined. But records 
and interviews show that in three of the last four cases it was made in China, 
a major source of counterfeit drugs.
Panama is the most recent victim. Last year, government officials there 
unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine, with 
devastating results. Families have reported 365 deaths from the poison, 100 of 
which have been confirmed so far. With the onset of the rainy season, 
investigators are racing to exhume as many potential victims as possible before 
bodies decompose even more.

Panama's death toll leads directly to Chinese companies that made and exported 
the poison as 99.5 percent pure glycerin.

Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching 
halfway around the world. Through shipping records and interviews with 
government officials, this pipeline was traced from the Panamanian port of 
Colón, back through trading companies in Barcelona and Beijing, to its 
beginning near the Yangtze Delta in a place local people call "chemical 
country."

The counterfeit glycerin passed through three trading companies on three 
continents, yet not one of them tested the syrup to confirm what was on the 
label. Along the way, a certificate falsely attesting to the purity of the 
shipment was repeatedly altered, eliminating the name of the manufacturer and 
previous owner. As a result, traders bought the syrup without knowing where it 
came from, or who made it. With this information, the traders might have 
discovered that the manufacturer was not certified to make pharmaceutical 
ingredients.

An examination of the two poisoning cases last year - in Panama and earlier in 
China - shows how China's safety regulations have lagged behind its growing 
role as low-cost supplier to the world. It also demonstrates how a poorly 
policed chain of traders in country after country allows counterfeit medicine 
to contaminate the global market.

Last week, the U.S. Food and Drug Administration warned drug makers and 
suppliers in the United States "to be especially vigilant" in watching for 
diethylene glycol. The warning did not specifically mention China, and it said 
there was "no reason to believe" that glycerin in this country was tainted. 
Even so, the agency called for all glycerin shipments to be tested for 
diethylene glycol, and said it was "exploring how supplies of glycerin become 
contaminated."

China is already being accused by U.S. authorities of exporting wheat gluten 
with an industrial chemical, melamine, that ended up in pet food and animal 
feed. The FDA recently banned imports of Chinese-made wheat gluten after it was 
linked to pet deaths in the United States.

Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, 
Bangladesh, Argentina, Nigeria and India.

In Bangladesh, investigators found poison in seven brands of fever medication 
in 1992, but only after countless children died. A Massachusetts laboratory 
detected the contamination after Dr. Michael Bennish, a pediatrician who works 
in developing countries, smuggled samples of the tainted syrup out of the 
country in a suitcase. Bennish, who investigated the Bangladesh epidemic and 
helped write a 1995 article about it for BMJ, formerly known as The British 
Medical Journal, said that given the amount of medication distributed, deaths 
"must be in the thousands or tens of thousands."

"It's vastly underreported," Bennish said of diethylene glycol poisoning. 
Doctors might not suspect toxic medicine, particularly in poor countries with 
limited resources and a generally unhealthy population, he said, adding: "Most 
people who die don't come to a medical facility."

The makers of counterfeit glycerin, which superficially looks and acts like the 
real thing but generally costs considerably less, are rarely identified, much 
less prosecuted, given the difficulty of tracing shipments across borders. 
"This is really a global problem, and it needs to be handled in a global way," 
said Dr. Henk Bekedam, the World Health Organization's top representative in 
Beijing.

Renwick McLean and Brent McDonald contributed reporting.


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