Jun 20, 2007

Poisoned Cough Syrup in Panama

Cough syrup has recently been linked to possibly hundreds of deaths in Panama. A component that originated in China which was thought to be glycerin but was actually a type of antifreeze was mixed into the medicine.

Here is the full story from the L.A. Times:

Tracking Panama's poison 'medicine'
An antifreeze element mistakenly put in cough syrup is blamed for dozens of deaths.
By Chris Kraul
Times Staff Writer

June 20, 2007

PANAMA CITY — When 4-year-old Allan Gutierrez died a year ago, the symptoms he displayed, including severe nausea, violent heart palpitations and "ascending" paralysis, baffled doctors.

Since then, his condition has become known only too well to Panamanians who have friends or relatives among the hundreds of identified victims.

The culprit is not a microorganism, but diethylene glycol, a toxic automotive antifreeze component that was mixed mistakenly by this country's social security agency into 450,000 bottles of cough syrup for distribution to the poor. At least 20,000 were distributed across the country.

Ingestion of the toxic brew can cause kidney failure, chronic headaches, high blood pressure, and in the current Panamanian episode, there have been at least 67 confirmed deaths. Fatalities here actually may have exceeded 300, officials say.

The fatal ingredient originated in China. It was shipped to a Spanish company and then to the private firm Medicom in Panama that resold it to the country's social security agency, which mixed the "medicine" in its laboratory. The Panamanians thought they got glycerine, a component of many medicines, but in fact got the highly toxic diethylene glycol.

Although the case is still playing out amid much finger pointing, the poisoning seems to be a tragic confluence of confusion over labeling, sloppy controls along the supply chain, and poor to nonexistent testing in the Panamanian labs where the syrup was mixed.

For example, a Chinese investigation found that the product had been labeled "TD glycerin," a misleading name that could be confused with glycerine, a harmless, more expensive sugar substitute.

And the Panamanian firm had ordered glycerine, and didn't know that the chemical it received was not in fact medicinal.

Panama's social security agency lab could have averted the disaster if it had properly tested the syrup, officials said.

"The terrible sin of Panama is having a system where you have a production laboratory mixing medicine that doesn't adequately test components," said Jorge Motta, a Stanford-educated doctor who is director of the Gorgas Memorial Institute, a research institution specializing in tropical medicine.

Last week, after an autopsy was performed on Allan's exhumed body on orders of the attorney general's office, and tell-tale signs of the toxic chemical were detected in his remains, his name was added to the official list. His family now becomes eligible for a share of $6 million that the government has set aside for a victims fund.

More than 50 exhumations have been ordered, and hundreds more are pending. In an interview last week, prosecutor Dimas Guevara said 500 claims had been filed by apparent victims and their families. In at least 369 of these cases, he said, the reported victims had died. The figures don't include deaths that may have been caused by the cough syrup but for which no proof is available because the victims' remains had been cremated, or were badly decomposed, or in the case of indigenous tribespeople, had not been made available to the government.

The crisis has caused a severe erosion of confidence in the health system, and has even dented President Martin Torrijos' popularity. Many Panamanians are unhappy with the pace of the investigation. Twelve people have been arrested, including six employees of Medicom.

The others detained are government officials, including social security agency Director Rene Luciani and two former directors, Juan Jovane and Rolando Villalaz. Many Panamanians complain that the three were charged June 5 only after China made Panama look lax by sentencing the former head of China's top food and drug safety watchdog to death May 29.

The official, Zheng Xiaoyu, had pleaded guilty to corruption and accepting bribes in connection with the poisoning scandal.

It also became known last week that the United States is not immune. Colgate-Palmolive Co. warned that counterfeit Colgate toothpaste containing traces of the same antifreeze component had been found on store shelves in New York, New Jersey, Pennsylvania and Maryland. No deaths have been reported from the counterfeit toothpaste.

But in Panama, the poisoning scandal is playing out every day in the newspapers and on television and will continue indefinitely as the government slowly recovers the syrup, exhumes the bodies of victims, examines survivors and brings the responsible government and company officials to justice.

At first cloaked in mystery, the puzzle surrounding the cause of the deaths was solved last fall when scientists at the Centers for Disease Control and Prevention in Atlanta provided assistance in the inquiry. They quickly determined that an infectious disease was not the cause because neither family members nor doctors of victims seemed to catch it.

The investigation soon focused on cough syrup that many of the victims had taken. An analysis of the syrup revealed that the 27 barrels of what the social security agency thought was glycerine to make cough syrup contained diethylene glycol.

The antifreeze component has a sweet smell and taste, officials said.

Widespread poisonings in the 1930s due to diethylene glycol were a factor in the formation of the U.S. Food and Drug Administration to protect Americans from bogus drugs.

Torrijos has promised to tighten regulations and invest in better facilities at the social security agency's test labs, and is considering merging the agency with the Health Ministry.

--

chris.kraul@latimes.com

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