Muhammad H Zaman
Oxford University Press
2018 | 280pp | £21.99
ISBN  9780190219444

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Muhammad H. Zaman – Bitter Pills

In 2006, hundreds of people in Panama died after consuming a contaminated cold medication. The tragedy happened after an ingredient was replaced with a toxic substitute by a rogue chemicals trader in China. But how could such a thing happen? How could barrel-loads of toxic material pass between multiple countries, across international borders and find its way onto pharmacy shelves without being properly tested?

In Bitter Pills, biomedical engineer and expert in international health Muhammad Zaman gives an extensive account of the challenges facing drug regulators worldwide. He describes how the complex global supply chains involved in pharmaceutical manufacturing can allow substandard drugs and counterfeits to slip through the net. He also explains how the origins of regulatory bodies across many different countries has led to systemic problems with their capacity to enforce safety standards.

The book is a fascinating read, and is filled with informative case studies. Before reading Bitter Pills, I’d never given much thought to how regulatory frameworks in India or Ghana might be influenced by those countries’ colonial histories, and how this might impede today’s drug regulators as they try to safeguard the public. Nor had I considered the effect of external political and economic pressures on the ability of countries to police the standard of drugs sold within their own borders. It’s alarming to think that so many people across the world may not truly know what is in the medicine they rely on.

Zaman’s personal experience and expertise helps to paint a detailed picture of the difficulties facing regulators and quality controllers. The watchdogs in many developing nations are hampered by inadequate access to training and equipment, while ineffective legislation makes their task even harder.

Unfortunately, the book is significantly let down by the writing style. The author has a habit of writing in lists, and often takes several pages to explain things that could be summarised in a single paragraph, which gives the whole thing a repetitive feel that sometimes verges on unreadable. This is a real shame, because Bitter Pills’s message is an important one, and I’d love to be able to recommend it without this caveat.

Bitter Pills is an informative guide to a serious topic, and I’m glad Zaman is bringing the spotlight to the issue. It’s certainly packed with thought-provoking stories that should give policymakers and the public plenty to chew on. But it’s a laborious read.