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November, 2017 >>

The challenge of dealing with animal derived ingredients in medical/surgical products

Ali Yawar Alam  ( Strategy Management Department, Directorate of Health Affairs Alahsa, MOH, KSA. )

Abstract

Many pharmaceutical products (capsules, tablets, injections, vaccine, cream) and surgical products (surgical mesh) have ingredients derived from animal sources (pig, cow; not slaughtered as per Islamic law) that are directly in conflict with the Islamic faith and Islamic law.



Animal derived products are used in many fields, e.g. anaesthesiology, psychiatry, orthopaedic, plastic and general surgery.1 The capsule shells used to deliver a lot of medicines are made from the gelatin, which is a protein manufactured by hydrolysis of skin, ligaments, tendons, and bones of pigs and cows.1-3 Some examples of drugs with animal (porcine or bovine) sources are; Amoxycillin, omeprazole, warfarin, prednisolone, oxinorm and heparin (anticoagulant).3 Dressings could have porcine, bovine or human source; examples Hydrocolloids, split skin graft.3 Surgical products/implants (example; Mesh, bone, orthopaedic spacer, matrix haemostasis) could have porcine, bovine or human source.3 Gelatin is one of many types of stabilisers added to vaccines.2 The addition of Alcohol in medication particularly syrup forms is also an added issue.4
The irony of the entire issue is that there is very low awareness of the care provider as well as the care recipient about these non-permissible ingredients in the medical/surgical products.3 If we look deeper in this issue, we find that the problem is not merely lack of awareness; it is the lack of information on the labels on the medical/surgical products regarding the source of the ingredients which have been used in the manufacturing of these products. This highlights the issue of code of ethics in the production of medical products and violation of the rights of the consumers/patients; the right to know, as to what they are taking in their bodies Commenting on the labeling, the sort of labeling done by food products manufacturing industry these days by using various E-codes instead of the actual name of the ingredient is also in violation of the fundamental principles of the consumers right to know, as to what they are eating. A variety of these E-codes mentioned on the labels of these foods, chocolates, bakery items and drinks, if checked online will have non-permissible (animal source) items in them. The patients however put their entire trust on their care providers when it comes to receiving medical or surgical treatment and the contents they contain. As such the responsibility to the major extent is transferred to the care provider. It is not practicable for the care provider to call the manufacturer regarding the ingredients contained in the medical or surgical product, each time.
In this scenario of concealment/non-availability of vital information about the non-permissible items on the medicine/surgical package to the care providers and the care recipients is the challenge of modern day; which need to be dealt with a systematic approach rather than a patch here and there. The first step in this direction would be the realization by the Public health authorities including ministries of health, federal drug regulating agencies, food/beverages regulating agencies and health professional bodies/organizations to consider this as a high priority, high risk and high volume issue, which has deep religious ramifications as well.

Further ideas/suggestions to tackle the highlighted issues are:

 

  • Study the best practices model to tackle this issue, elsewhere, for instance the example of Malaysia to regulate this issue. In Malaysia, appropriate steps and measures have been taken by the respective authorities in certifying and regulating the halal status of medicine and pharmaceutical products.2,4-6 Adopting/adapting the best practices and implementing them is going to be the best possible long term solution to this highly important issue.     
  •  The list for halal and non-halal medicine and the guidelines for medication intake should be produced publicly to guide the care providers and care recipients in choosing their medicine and medication intake.
  • Developing regulation regarding pharmaceutical companies to be responsible for declaring and stating the ingredients used in their pharmaceutical/surgical products label.
  • Developing standards for the National pharmaceutical industry ensuring halal ingredients in the medical/surgical products in addition to standards for quality and safety of medical/surgical products.
  • Accreditation/Certification of the National pharmaceutical industry based on the halal standards developed.
  • Raising the awareness of the medical community by providing access to the resources related to this issue and resources related to alternatives for each pharmaceutical/surgical product.
  • The care providers should communicate directly with the pharmaceutical company by phone or email; if they are suspicious about the ingredients in any medical/surgical product.
  • Raising the awareness of the care recipients to enquire about the non-permissible items in their medical/surgical products from their care providers and ask for alternatives.
  • The medical practitioners should play their role by disclosing the necessary information relating to the halal status, risk and benefit of the medicine to the care recipients.
  • Limiting the import of medical/surgical products from countries which have halal accreditation systems and clear labeling of the products. We have such options available from certain middle Eastern countries and Malaysia.
  • Developing a consortium of Muslim countries for the production of halal medical/surgical products.
  • Ensuring the production of raw materials for medical/surgical products from halal sources in the country (capsule shells, binding agents for tablets from plant sources). 
     

References

1. Eriksson A, Burcharth J, Rosenberg J. Animal derived products may conflict with religious patients' beliefs. BMC Med Ethics. 2013; 14:48.
2. Medicines/pharmaceuticals of animal origin.[Online] [cited 2017April.5]. Available from URL: https://www.health.qld.gov.au/ __data/assets/pdf_file/0024/147507/qh-gdl-954.pdf.]
3. Tatham KC, Patel KP. Suitability of common drugs for patients who avoid animal products. BMJ. 2014; 348:g401.
4. Asmak A, Fatimah S, Huzaimah I, Khuriah AH, SitiKhadijah AM. Is Our Medicine Lawful (Halal)? Middle-East J Sci Res. 2015; 23:367-73.
5. Akasah T. Halal pharmaceuticals: a regulator's perspective - MS 2424.[Online] [cited 2017 April 6] Available from: URL: http://npra.moh.gov.my/images/Announcement/2013/Slides-for-National-Regulatory-Conference2013/Plenary_09-_Halal_Pharmaceuticals.pdf
6. [No author listed]. Medicines derived from animal products [Online] [cited 2017 April 6]. Available from URL: http://www.therotherhamft.nhs.uk/Patient_Information/Patient_Information_Leaflets/Medicines_derived_from_animal_products/


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