Juan L. Mercado - Bum Check

Like a bum check, this question keeps bouncing, more so during crises. Only names, places and time change. New threats, like the swine flu, swirl around this old issue, namely: Do expiration dates on medicines mean anything?

In 20 countries, the H1N1 influenza A, for example, affected 1,024 (plus three suspected cases in Cebu) before starting to ebb, BBC reports. Taipeiâ€™s Health Department predicts scientists may come up with a vaccine in three months. Health Secretary Francisco Duque seeks P90 million to beef up anti-viral stockpiles.

DOH has 600,000 capsules of the anti-flu drug, good for 60,000 patients â€œMost of the capsules expire this month,â€ Inquirer reports. â€œ(But) United Laboratories, which donated the medicine, assured the drugs remain efficacious from 36 to 40 months.â€

So, do we trash those expired stocks? Or don't we?

Critics earlier strafed V. Luna military hospital for accepting donations of expiring drugs Our soldiers deserve better than lapsing (and "ineffective"?) medicine, the line went. Food and Drug officials threaten medical missions, from abroad, if they stock drugs with expiry dates shorter than a year.

Use of expiration dates started in 1979, Harvard University's Medical School says in it's Family Health Guide. "It stands for something. But probably not for what you think it does."

Most data on drug expiration stems from an earlier question the Pentagon tossed to the US Food and Drug Administration (FDA): â€œShould the military junk it's over $1-billion stockpile of medicine every two or three yearsâ€

In response, FDA studied more than 100 drugs in military pharmacies. The agency found that 90 percent, of both prescription and over-the-counter medicines, were perfectly good to use--even 15 years after expiration dates.

"(Expiration dates) don't indicate a point at which the medicationis no longer effective or unsafe," the Harvard briefing for US physicians adds. "This is the date at which manufacturers can guarantee full potency and safety of the drug."

"Many drugs, stored under reasonable conditions, retain 90 percent of their potency for at least five years after expiration date,sometimes much longer," notes Brigham Young University Health Center.

A simple device, such as "placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many yearsâ€, the center adds.

Among medicines FDA tests found effective after expiration were: Bayer's anti-biotic Cipro and aspirin; SmithKline Beecham PLC's Thorazine, a tranquilizer. Wyeth-Ayert's antidote to chemical poisoning was still effective 15 years beyond expiration date.

â€œWe extended shelf lives instead of destroying large quantities of still-useful medical products," said Franics Flaherty, who
oversaw FDAâ€™s testing, wrote. This decision saved the US military an initial $263.4 million, after the studyâ€™s completion.

These findings have implications for fund-strapped countries like the Philippines. Here, government clinics are perennially drug-short, from simple aspirins to anti-tuberculosis drugs.

"TB or not TB is the congestion," Woody Allen once joked. But TB is no joking matter here. TB incidence in the Philippines is triple that of Thailand. Death rates for Filipina mothers is 162 in every 100,000 births. Compare to 62 for Malaysians.

This is obscene â€“ and inevitable. Collectors for foreign debt get more (10 percent of GDP) than do health budgets (2 percent), says UNâ€™s Human Development Report. Thus, skilled health personnel attend only 60 out of 100 births here. In contrast, 99 of Thai mothers can count on medical attention.

And poverty opens floodgates to disease. The most violated human right here is the childâ€™s right to celebrate first birthdays. But misinformation deprives sick people of medicine "Is there no balm in Gilead?" cried the ancient writers.

"Unless you have nitroglycerin, insulin and liquid antibiotics,be assured your medication expires years beyond (expiration) date,â€ notes Dr Joseph Mercola. "The major tragedy is many Third World countries needlessly discard drugs that could save lives due to lack of appreciation of this concept," adds this author of Total Health Program.

FDA's Shelf Life Extension Program recognizes expiration dates â€“ often two to three years, have â€œa commercial dimension,â€ reports Wall Street Journal's Laurie Cohen. â€œB relatively short shelf lives make sense from a public-safety standpointâ€¦,It gives enough time to put the inventory in warehouses, ship and ensure it stays on shelves long enough to get used."

Peg expiration dates at no more than one year--if drugs are dispensed in containers other than the original packaging, urges the non-profit group US Pharmacopeia.

"New containers may let in more moisture and heat than the container the manufacturer used for the stability study," says the USP General Counsel Joseph Valentino. The one-year rule is "motivated by product integrity, not by profit."

The Harvard note suggests a rule-of-thumb: If the expiration date passed a few years back, and it's important your drug is absolutely 100 percent effective (as for stroke, cancer, etc.), "you might want to consider buying a new bottle." Or ask your ask your pharmacist.

Indeed, health is better than hard cash. "The poor but healthy man is better than a sickly king," the old Ilokano proverb says."