Prescription drugs overused and abused in the Mideast

It turns out that, in the Middle East, getting access to prescription medications for serious ailments, in the absence of supervision, can sometimes be as easy as picking up an over-the-counter medicine for a headache or the common cold, or so claims a new review published in Pharmacology Research & Perspectives.

In theory, the regulations separating access to either brand of medication is there. In practice, the review cites a “massive problem” of self-medication misuse in the region, particularly with prescription medication, one that eventually leads to greater health risks among patients, including drug dependency and addiction.

Drugs that are used recklessly or sometimes abused by Middle Eastern patients include codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. According to the review, which looked at 72 papers published on the subject between 1990 and 2015, self-medication medicine misuse cannot always be exactly quantified in the region but it seems widespread.

Some of the statistics that the review highlights are quite jarring.

For instance, 73.9% of the Sudanese population have reportedly used antibiotics or antimalarials without a prescription. Equally alarming trends have been observed in Syria, Yemen, Jordan, Tunisia, Egypt and the UAE, with drugs such as amoxicillin or ampicillin being dispensed freely. According to the review, most patients self-medicating on antibioitcs did not even follow through the full course of the medications and took them for less than three days.

Many of the patients follow the advice of relatives, or have a drug prescribed to them by a doctor over the phone. As well, some pharmacists play a role. “People tended to select medication based mainly on advice received from community pharmacists,” says one of the studies cited.

One study said that the majority of the 200 pharmacies under scrutiny in Syria had sold antibiotics without prescription, and in Saudi Arabia, only a single pharmacy had refused to release the medication without a doctor’s prescription.

As well as stacking prescription medications for future use, Middle Eastern patients often used them inappropriately; it’s not uncommon for many to pop antibiotics to treat illnesses unrelated to bacterial infections, for instance, or with incorrect dosages for inappropriate period of time, according to the review.

Exceptional collection of Iron Age weapons discovered in Oman

Bows, arrows, daggers and axes found in Mudhmar Est.

Bows, arrows, daggers and axes found in Mudhmar Est.{credit}© Guillaume Gernez / Mission archéologique française en Oman central.{/credit}

A collection of bronze weapons dating from the second Iron Age (900-600 BC) has been uncovered near Adam, at the frontier between oasis and desert regions in Oman, according to the National Centre of Scientific Research (CNRS), under the French Ministry of Education and Research.

The remains were discovered scattered on the ground in a building belonging to what is believed to be a religious complex, during excavations carried out by a French archaeological mission in central Oman, reads a press release by the centre. The mission, partly in collaboration with Oman’s Ministry of Heritage and culture, began in 2007 setting out to explore the political system, social practices and rituals existing in the region at the time.

The collection discovered in a site known as Mudhmar Est includes two complete quivers and weapons made of metal, including two bows – objects that are unfamiliar in the Arabian Peninsula, according to the scientists.

“These were small-scale models imitating the original objects made of perishable materials (leather), which are not usually found in archaeological excavations,” says the press release. “The fact that they are made of metal implies that they were non-functional. Quivers of this kind have never been found in the Arabian Peninsula, and are extremely rare elsewhere.”

Read more about this discovery here.

 

2014 Year in Review: Nature Middle East highlights

In retrospect, 2014 was a mixed bag for the region – with some significant research produced on one hand, but on the other, in some countries, education, health and sectors in academia received some hard blows as a result of conflict and war.

In Syria for instance, the risk of infectious diseases is at its highest, warned a study published in PLOS Pathogens. The crisis was branded “a public health emergency of global concern” – with vaccine-preventable diseases not only reappearing in Syria but spreading to other countries with the outpouring of refugees, such as Lebanon and Iraq, which itself is reeling from years of damage to infrastructure and a myriad of health disasters.

Outbreaks of polio were reported – years after the Middle East was deemed “clean” – with WHO, UNICEF and ministries of health rushing to contain it. But even the largest vaccination campaign in the region’s history couldn’t reach its target as hundreds of thousands of children remain vaccinated, especially with access to hot zones barred.

Measles and rubella continue to be a burden in Syria, and in one instance, the vaccine killed instead of saved. At least 15 children died last September after being administered vaccines that were wrongly formulated, probably turning families away from seeking it and leaving many children unprotected.

Also in Syria, the lack of medical personnel is forcing untrained volunteers to tend to the injured and sick in hospitals.

Adding insult to injury, a study in The Lancet this year says that civilians aren’t even a priority for hospitals in a country like Syria, torn by civil wars. Fighters take up the majority of the available spots. In other hospitals, doctors risk their lives when they treat patients from the “opposite camps.”

In Iraq, the Islamic State (IS) is spreading its own brand of terror – taking over big universities and closing them down, including the historic University of Mosul. The education hubs are now used as makeshift camps for the militants. An independent Baghdad-based research tells Nature Middle East that soon conducting quality research in Iraq will be impossible. Skilled professors are already migrating in droves, in fear for their lives. “Many won’t come back even if the conflict ends,” says the researcher.

The International Center for Agricultural Research in the Dry Areas (ICARDA) conservation agriculture project that helps local farmers increase food production has been in jeopardy in Iraq since IS takeover. Insecurity, fuel shortages and lack of necessary equipment is breaking them, they decry.

Nearby, an estimated 3,900 schools in Syria had been destroyed or closed down during the first two years of the war. By April 2013, “22% of the country’s 22,000 schools [were] rendered unusable,” according to UNICEF.

The year 2014 also saw a comeback by Middle East respiratory syndrome coronavirus (MERS-CoV), which killed and inflected hundreds worldwide across 19 countries, with most of the infections concentrated in Saudi Arabia, where the virus was first discovered.

Nature Middle East was lucky to exclusively speak to the Egyptian virologist who first identified the virus, telling us the story of “patient zero” who died from an acute respiratory condition which was later revealed to be MERS itself. The mystery of MERS’ transmission was not lifted in 2014, but at least some countries are speeding up research into antiviral drugs that could contain it, or hinder its spread. Still, the fact remains, there are no anti-MERS drugs on the market so far.

In fact, overall things have been going south – health wise – for many in the region; not counting conflict victims and health complications due to war. A silent yet lethal predator, diabetes, has been preying upon the masses – with 35 million diagnosed with type 2 diabetes in the region.

Essentially, we have the  highest prevalence level of  in the world – with 1 in every 10 people living with it. Type 2 is tied to lifestyle, while type 1 has to do with genetics, autoimmune and environmental factors – and the incidence of the latter is rising sharply.

The highest rate of type 1 diabetes is in Saudi Arabia, with a shocking incidence of 14,900 children living with the disease, approximately a quarter of those in the Middle East and North Africa.

But in slightly better news, the region has managed (so far) to evade Ebola, which transmits through direct contact with bodily fluids and gains access to the body through skin abrasions and mucous membranes. The virus, however, has culled many in the central parts of Africa, and has fatality rates of up to 90%.

In terms of research, the region has been more prolific. Nature Middle East‘s chief editor Mohammed Yahia writes about the freshly released Nature Index, which was released in November and tracks where high impact research is being conducted around the world, and it shows many positive trends in the region – with Saudi Arabia leading with 358 papers, followed by Egypt.

Examples of prominent regional research includes one showing how Neolithic North Africans began exploiting cereal crops at least 500 years earlier than previously thought, published in PLOS ONE. The earliest evidence of cereal crop domestication in North Africa comes from the Fayum area of middle Egypt, and dates back to around 4350 BC.

In Lebanon, researchers from the American University of Beirut identified an algae species that can be a possible source of superfood and cheap renewable energy. In neighboring Syria, it turns out, two areas have the world’s highest concentration of wild-growing crops. The potential for these crops, distantly related to today’s agriculturally produced crops, lies in their gene pool, and adaptability – something that can provide breeders with genes that could enhance crop resistance to stresses such as climate change, pests, and disease.

Other breakthroughs include: In Sudan, a stunning discovery of a 3,000-year-old skeleton with metastatic carcinoma challenges the notion that cancer is a modern disease, opening new horizons for specialists to research cancer’s etiology and evolution. The ancient Nubian is probably the first cancer victim in archaeological record. As well, dinosaurs lived in Saudi Arabia, it seems. Fossilized remains identify specific dinosaur species from millions of years ago in the Arabian Peninsula when the area was covered by lush vegetation.

That being said, this year was not easy on the region, and infrastructures that provide the backbone of scientific endeavors have bore the brunt of political upheavals. In terms of progress – if we choose to compare notes with developed countries – we’re only barely inching forward.

Independent or university-backed research in the Arab world, collaborations with world-class institutions notwithstanding, is not enough to help Arab-affiliated researchers catch up with an incredibly prolific West. Governments must step in, opines Nobel laureate Ahmed Zewail and the academic president of Zewail City of Science and Technology Sherif Sedky.

“Renaissance in the Arab world will not be possible without genuine government recognition of the critical role of science in development and policies providing commensurate funding for basic research and reform of rigid bureaucracy which thwarts progress,” the experts say.

And considering it’s politics that seems to be setting the region back, Zewail and Sedky’s words ring true.

It is essentially a tug of war – between competent scientists and experts who’re aspiring to propel this region into the future, and governments staggering to make ends meet for their people, giving science a cold shoulder in the process. The next year may not tell us who wins, but it may very well give us indications – through statistics above all – of who is tugging harder.

Under the microscope: Women & science

Pursuing a science career in the Arab world is challenging, but women embarking on this path may face more hurdles than their male peers.

Why are there very few models of women scientist that young researchers can aspire to? Why do women hardly ever land top managerial jobs in universities and research centres?

On 27 March, 2014, and as part of Egypt’s Science Month, Nature Middle East and Nature magazine’s Arabic Edition hosted a panel discussion with four prominent women researchers, at the American University in Cairo, to explore the issues women in the science industry face, and look at success stories.

The panel included Nagwa El-Badri, the department chair of biomedical sciences at Zewail University of Science and Technology, Rania Siam, the chair of the department of biology at the AUC, Rehab Abdallah, a research assistant at AUC and Sara Serag El Deen, an AUC graduate studying for her PhD in Harvard University.

You can watch the full event now on our YouTube channel, and join in the discussion in the comments below. Do you agree that women scientists in the Arab world face more obstacles than men? And if so, then how do you propose we solve this?