Health Affairs is a peer-reviewed journal founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. They recently published a blog addressing substandard drugs and the fight against TB:
Poorly manufactured and fraudulent medicines kill thousands of people around the world each year. For infectious diseases like malaria and HIV, shoddy medicines also accelerate drug resistance and dramatically alter the course of epidemics. With few new drugs under development, recent progress against these major killers in the poorest countries is precarious.
Bad drugs have become a big problem for one major infectious disease in particular: tuberculosis. If we don’t solve this issue, we may see the gains we’ve made against TB slip away.
According to the World Health Organization, global TB cases continued on a slow downward trend in 2011. While this is good news, the disease still claimed 1.4 million lives that year—more than any other infectious disease except HIV/AIDS. Meanwhile, multidrug-resistant TB cases rose to 630,000 worldwide. Resistant TB is deadly and costs significantly more to treat. For example, curing a single case of it in the United States can cost more than $200,000. Treatment takes two years, and the side effects can be severe, including nausea, vomiting, joint pain, and even hearing loss.
The rise in drug resistance is a complicated issue. One key driver is poor adherence to treatment and improper use of medicines. Patients with TB are typically put on a cocktail of drugs for six months, and even completing this regimen is often a challenge. In some countries, most notably India, TB drugs are readily available through private providers, where they’re over-prescribed and improperly used. For example, a 2010 study asked 106 private-sector physicians in Mumbai to write a prescription to treat TB. Only six wrote a correct prescription; most prescribed too many drugs for too long.