Letters

Outdated drugs may be useful

EDITORThe personal view by Woolrich-Burt about her work in Nepal highlighted many of the problems of trying to provide healthcare in poor countries.¹ Examples include the inappropriate medicines that may be donated and freighted out at considerable cost, the precious money wasted on multiple consultations, and the belief that the more medicines swallowed the more effective the cure.

I disagree with just one of her pointsthat outdated drugs should be thrown away. Often in situations pertaining to developing countries, the alternative to outdated medicine is no medicine at all. When we had more surgery to do than we had anticipated I have used lignocaine at least 10 years out of date, stored away in a hospital pharmacy in the middle of the country, without any apparent loss of its effect. I have found that even biologically active drugs such as freeze dried hyaluronidase seem to retain their potency even years after an expiry date. When unable to sleep because of jet lag, I have benefited from very outdated temazepam.

This issue of drugsor even of sterile wrapped equipment, such as intraocular lensesthat are past their expiry date is unfortunately an extremely sensitive one with customs officials and the like in developing countries. I understand the point of view of someone without any scientific training who sees a label stating that something has expired on a certain date and feels it is his or her responsibility to destroy or confiscate it to protect the country from the condescending benevolence of the rich Western world.

The reality is that medicines do not expire: patients expire. Medicines, like old soldiers, just fade away, usually very, very slowly. It would be much better for all concerned if medicines were instead labelled in a manner such as "after xxx [date] this drug can no longer be guaranteed to be 100% effective, especially if it has been stored in hot or very light conditions."

John Sandford-Smith, emeritus consultant ophthalmologist. 
Leicester LE2 2PE jsandfordsmith{at}compuserve.com