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Study finds modest drop in illegal medicines’ prevalence

September 6, 2020

A review of studies looking at the prevalence of substandard and falsified (SF) medicines around the world has found a small drop between 2013 and 2018.

Getting a reliable estimate of the prevalence of the quality of medicines is known to be a challenge, however, and the authors of the review in the British Medical Journal Global Health propose a unified method to improve accuracy in the coming years.

The review of 33 studies finds that the prevalence of SF medicines remained high, with one in four (25 per cent) drugs falling into this category in 2018, down from 28.5 per cent five years ago. That said, variability between the studies in sample size, design and other variables make drawing any conclusion from that figure problematic.

“Is it appropriate to combine individual medicine quality studies, to generate a global SF medicine prevalence?,” asks co-author Dr Bernard Naughton Oxford University, adding: “We understand why this is done, but we discuss some limitations to this approach.”

A key limitation of current medicine sampling studies is that while their methodological quality is improving, according to a scoring system known as the Medicine Quality Assessment Reporting Guidelines checklist (MEDQUARG), they still sometimes do not take into account or record individual study context.

They propose using a standardised methodology to allow reviewers to compare studies like with like, based on recording the specific context from which the samples have been collected.

“In order to provide more accurate prevalence data to support more detailed policy decisions we propose recording the context of the study environment using the adapted version of the Johns et al framework described in our article,” Naughton told

Doing so would allow researchers to combine prevalence data from similar contexts, and that in turn could help with making “more detailed policy decisions and SF medicine prevalence prediction based on contextual changes.”

“COVID-19 is an example – we should recognise moving forward that a global pandemic context can cause an increase in SF medicines, as described in a recent Lancet Global Health publication,” he added.

The Lancet paper – published in June – says that the COVID-19 pandemic “threatens a global surge in [SF] medical products, not just for those directly related to COVID-19.”

It goes on: “Many products essential for COVID-19 treatment and prevention are at risk, including face masks, hand sanitiser, and diagnostic tests, and false claims have been made for prevention and treatment.”

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