Nearly 20% of cancer drugs defective in four African nations

Regulators, Corruption, and Politicization

• Several comments argue that systemic corruption in drug supply is not unique to Africa; they see political decay and “facts don’t matter” culture in Western countries as a risk to regulatory integrity.
• Others defend US regulators, but pushback cites:
  • FDA approval of opioids and the US‑centric opioid crisis.
  • Reports (e.g. based on “Bottle of Lies”) that the FDA has approved generics from factories with known quality failures, sometimes via expedited processes that bypass normal review.
• There is debate over technocracy: some want empowered, evidence‑driven regulators that block unqualified political appointees; others warn technocrats are subject to groupthink, bad long‑term decisions (e.g., one‑child policy analogy), and corruption of “metrics as power.”

Generics, Bioequivalence, and Patient Experience

• Multiple anecdotes describe significant variability in drug effect between:
  • Brand vs generic.
  • Different generic manufacturers of the same drug.
• Points raised:
  • Generics must match active ingredient, but excipients, binders, release profiles, and ±20% bioavailability windows can produce meaningfully different clinical effects, especially for hormones, CNS drugs, anti‑epileptics, and oncology drugs.
  • Some users report needing large dose adjustments when switching to generics; others find no difference and resent brand‑name pricing.
  • One commenter who tested pills in a lab reports ±30% dose variance within nominally identical tablets, saying this is still within spec.

Substandard and Counterfeit Drugs in Africa

• The thread highlights Africa, China, and possibly India as markets heavily targeted by counterfeit or low‑quality medicines, with sophisticated fake packaging and inserts.
• A former industry worker describes strict QC in a large manufacturer (locked zones, multi-site ingredient testing, complex blending to avoid dose segregation), contrasting that with looser or criminal practices elsewhere.
• Some argue imperfect but “likely good” drugs may be better than none in low‑income settings; others counter that sugar‑water or wildly off‑dose chemotherapy is outright fraud and can kill patients or deny them effective alternatives.

Broader Ethical and Political Tensions

• There is a moral debate over why patients in poorer countries receive lower standards of quality and regulatory protection.
• Side discussions touch on US welfare, inequality, and institutional capacity, with some arguing that weakened or underfunded regulators anywhere ultimately enable these kinds of scandals.