5 ms·

Honest question, how do you know you're actually getting the correct drug and that it isn't contaminated or cut with something else?

swiley 7y ago
You could send it to a chemist and ask them to do an NMR and have a pretty good idea (provided it’s just one molecule)
rootsudo 7y ago
You can test it yourself, but many times the same manufacturer in the USA is the same abroad. I would say India for Drugs is not a bad idea - if you're worried it's "from" China.
- AnimalMuppet 7y ago
  I have not the remotest idea how I would test a cancer drug for myself to see if it was pure. I suppose I could hire a chemical laboratory, if I could figure out what kind of one would do that kind of work...
  - Scoundreller 7y ago
    > if I could figure out what kind of one would do that kind of work Open up the phone book. I'm sure you can find one within a day. Chemists like money. Especially when it's not even a controlled drug.
  - npo9 7y ago
    > I have not the remotest idea how I would test a cancer drug for myself As someone with only a high school level of chemistry training I would check the melting temperature. Although seriously get it professionally tested. The delta between USA prices and India/China prices is so high a lab test will barely change the margins.
  - phillc73 7y ago
    The first thing to do would be look up the Scientific Discussion or Monograph as filed with the FDA for the brand name product. With the details obtained from there, you'd know what to test for. The first steps would be assay and impurity tests for the active pharmaceutical ingredients (API). If you bought tablets you'd probably want to do dissolution as well. If everything looked fine after that, I'd still be concerned about uniformity. If you just performed dissolution on half a dozen tablets, how do you know all the tablets are the same from the whole supply? Next question is then stability. What happens to the API over an extended time period? Does it deteriorate due to climate or poor storage conditions? The main issue is quality control. Even an approved generic has to file with the FDA (or equivalent of wherever you are) concerning processes, batch sizes, critical quality attributes etc.
- nroets 7y ago
  "You can test it yourself" : If you die, just make sure to leave a bad review on Alibaba. Do your bit to prevent survivor bias.
  - rootsudo 7y ago
    I meant by a reagent test. Not consumption.
- dao- 7y ago
  > I would say India for Drugs is not a bad idea - if you're worried it's "from" China. Then again: https://peterattiamd.com/katherineeban/ https://peterattiamd.com/katherineeban/ > The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45]
  - matwood 7y ago
    Good link. On his podcast, Peter has also talked about generics vs. name brand differences. He had a chemist on who started a pharmacy selling generics where some statistically significant amount of each batch of drugs is tested for chemical verification.
roberte3 7y ago
Probably the best way is to use a mass-spectrometer.
- autoexec 7y ago
  I'm guessing the people who can afford a mass spectrometer can already afford the drug (or at least better insurance)
  - sliken 7y ago
    Heh, well if the drug is $4k a month and you can get the equivalent 5 year supply for $100 that leaves quite a bit of money left over for testing. There are lab services that will run samples through a mass spec and report the results.
- Scoundreller 7y ago
  Hopefully they don't send you an inactive enantiomer! Or an insoluble polymorph. Realistically, a lot of cancer drugs are injectables, ramping up the risk of something going awry when you inject the powder you will have to handle.

swiley 7y ago

You could send it to a chemist and ask them to do an NMR and have a pretty good idea (provided it’s just one molecule)

rootsudo 7y ago

You can test it yourself, but many times the same manufacturer in the USA is the same abroad. I would say India for Drugs is not a bad idea - if you're worried it's "from" China.

AnimalMuppet 7y ago
I have not the remotest idea how I would test a cancer drug for myself to see if it was pure. I suppose I could hire a chemical laboratory, if I could figure out what kind of one would do that kind of work...
- Scoundreller 7y ago
  > if I could figure out what kind of one would do that kind of work Open up the phone book. I'm sure you can find one within a day. Chemists like money. Especially when it's not even a controlled drug.
- npo9 7y ago
  > I have not the remotest idea how I would test a cancer drug for myself As someone with only a high school level of chemistry training I would check the melting temperature. Although seriously get it professionally tested. The delta between USA prices and India/China prices is so high a lab test will barely change the margins.
- phillc73 7y ago
  The first thing to do would be look up the Scientific Discussion or Monograph as filed with the FDA for the brand name product. With the details obtained from there, you'd know what to test for. The first steps would be assay and impurity tests for the active pharmaceutical ingredients (API). If you bought tablets you'd probably want to do dissolution as well. If everything looked fine after that, I'd still be concerned about uniformity. If you just performed dissolution on half a dozen tablets, how do you know all the tablets are the same from the whole supply? Next question is then stability. What happens to the API over an extended time period? Does it deteriorate due to climate or poor storage conditions? The main issue is quality control. Even an approved generic has to file with the FDA (or equivalent of wherever you are) concerning processes, batch sizes, critical quality attributes etc.
nroets 7y ago
"You can test it yourself" : If you die, just make sure to leave a bad review on Alibaba. Do your bit to prevent survivor bias.
- rootsudo 7y ago
  I meant by a reagent test. Not consumption.
dao- 7y ago
> I would say India for Drugs is not a bad idea - if you're worried it's "from" China. Then again: https://peterattiamd.com/katherineeban/ https://peterattiamd.com/katherineeban/ > The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45]
- matwood 7y ago
  Good link. On his podcast, Peter has also talked about generics vs. name brand differences. He had a chemist on who started a pharmacy selling generics where some statistically significant amount of each batch of drugs is tested for chemical verification.

roberte3 7y ago

Probably the best way is to use a mass-spectrometer.

autoexec 7y ago
I'm guessing the people who can afford a mass spectrometer can already afford the drug (or at least better insurance)
- sliken 7y ago
  Heh, well if the drug is $4k a month and you can get the equivalent 5 year supply for $100 that leaves quite a bit of money left over for testing. There are lab services that will run samples through a mass spec and report the results.
Scoundreller 7y ago
Hopefully they don't send you an inactive enantiomer! Or an insoluble polymorph. Realistically, a lot of cancer drugs are injectables, ramping up the risk of something going awry when you inject the powder you will have to handle.