The Worldwide Threat Of Generic Drugs

FOR THE 16 YEARS THAT DR. BRIAN Westerberg, a Canadian surgeon, worked volunteer missions at the Mulago National Referral Hospital in Kampala, Uganda, scarcity was the norm.

- Katherine Eban

The patients usually exceeded the 1,500 allotted beds. Running water was once cut off when the hospital was unable to pay its bills. Patients often couldn’t access the medication they needed, so on some early trips, Westerberg brought drugs over from Canada. But as low-cost generics made in India and China became widely available through Uganda’s government and international aid agencies in the early 2000s, it seemed at first like the supply issue had been solved.

Then on Feb. 7, 2013, Westerberg examined a feverish 13-year-old boy who had fluid oozing from an ear infection. He suspected bacterial meningitis but couldn’t confirm because the CT scanner was broken. The boy was given intravenous ceftriaxone, an antibiotic that Westerberg thought would cure him. But after four days, the ear was worse. As Westerberg prepared to operate, the boy had a seizure. With the CT scanner working again, Westerberg ordered a scan, which revealed abscesses in the boy’s skull, likely caused by the infection.

When a neurosurgeon looked at the images and declared that surgery was unnecessary and the swelling and abscesses would abate with effective antibiotic treatment, Westerberg was confused. They had already treated the boy with ceftriaxone, which hadn’t worked. His confusion deepened when his colleague suggested they switch to a more expensive version of the drug. Why swap one ceftriaxone for another?