What gastric drug sales say about the state of our food safety

Recent reports highlight a substantial shift in Bangladesh's pharmaceutical business, with anti-ulcer drugs dominating sales. Notably, five of the top 10 best-selling medications address stomach disorders. Leading this category is 'Sergel,' a product of Healthcare Pharmaceuticals Limited that has achieved impressive sales figures. 

According to a recent report by a leading local daily, Sergel's sales in the first nine months of this year alone totalled Tk918 crore, accounting for 2.67% of Bangladesh's overall pharmaceutical market.

Sergel contains esomeprazole, a proton pump inhibitor (PPI) that reduces stomach acid output by blocking the H+/K+-ATPase enzyme system in the gastric parietal cells. This mechanism significantly lowers stomach acidity, offering relief from conditions like gastro-oesophageal reflux disease (GERD) and erosive esophagitis.  

Several factors contribute to the rising demand for gastric drugs in Bangladesh. Unhealthy eating practices, such as the consumption of spicy and greasy meals, as well as widespread food adulteration, have led to an increase in gastrointestinal issues among the population. This has driven demand for both over-the-counter and prescription medications to address these ailments.

Bangladesh's pharmaceutical industry has experienced consistent growth in anti-ulcerant medicine sales. Since 2015, this segment has grown at a rate of more than 12% annually, reflecting the increasing prevalence of stomach disorders among the general population. The market dominance of stomach medications highlights the competitiveness of Bangladesh's pharmaceutical sector. 

With over 265 allopathic drug manufacturing companies operating in the country, the top 10 corporations control around 68% of the market. This concentration reflects a highly competitive environment where prominent companies strive to capture significant market share through effective product development and marketing strategies.

The dominance of gastric pharmaceuticals in Bangladesh's pharmaceutical industry is further underscored by the combined annual sales of just three top stomach medicines — Sergel, Maxpro, and Pantonix — which total nearly Tk2,000 crore. This figure does not account for the various brands of gastrointestinal medications produced by other pharmaceutical companies or the widespread production and use of antacids. 

Given that every major pharmaceutical company offers its own versions of gastric tablets, capsules, and antacids, the total annual sales of these medications in the country are estimated to be between Tk10,000 crore and Tk20,000 crore. This striking statistic demonstrates the high demand for gastrointestinal treatments, highlighting both the widespread prevalence of gastric ailments and the profitability of this sector within the Bangladeshi pharmaceutical industry.

The booming gastric medicine market reflects a broader health crisis in Bangladesh driven by food contamination and unhealthy lifestyle choices. Conditions such as cancer and kidney disease are closely linked to the same factors that contribute to stomach issues. 

Prolonged exposure to pesticides, heavy metals, and toxic chemicals in food not only irritates the digestive system but also increases the risk of cancer and chronic kidney disease. Studies have shown that heavy metal bioaccumulation from contaminated food can cause kidney damage and various forms of cancer. 

Moreover, the misuse of medications such as proton pump inhibitors without adequate medical supervision can exacerbate kidney problems over time. This interconnectedness suggests that Bangladesh's health and pharmaceutical sectors face a multifaceted challenge, with rising demand for treatments for multiple illnesses mirroring the increasing consumption of gastric medications. Addressing these concerns requires a holistic approach to food safety, healthcare access, and public health awareness.

The high demand for gastric drugs raises serious questions about the underlying causes of prevalent gastrointestinal issues. In Bangladesh, staple foods such as rice, potatoes, vegetables, fish, poultry, and eggs often contain harmful pesticides, heavy metals, and other toxic substances. The presence of trans fats in cooking oils and fried foods further exacerbates health problems. 

This alarming reality suggests that food contamination may not be accidental but could be the result of institutional negligence or, worse, deliberate actions driven by profit motives. There is speculation that such widespread health crises could indirectly benefit the pharmaceutical sector, which profits from the population's reliance on gastric medications to manage the consequences of food-related illnesses. 

This presents a grim scenario in which public health suffers while the pharmaceutical industry capitalises on the aftermath. While these claims require further investigation, they underscore the urgent need for stricter food safety regulations and an inquiry into potential links between food contamination and the thriving pharmaceutical industry in Bangladesh.

Bangladesh's legal framework protects the right to safe and healthy food, demonstrating the state's commitment to its citizens' well-being. Article 15 of Bangladesh's Constitution outlines the state's responsibility to ensure the basic necessities of life, including food, for its people. Additionally, Article 18 specifies that one of the state's primary duties is to improve public nutrition and health. 

To fulfil these constitutional mandates, the Food Safety Act of 2013 was enacted, establishing the Bangladesh Food Safety Authority (BFSA). This authority is tasked with regulating and coordinating activities related to food production, import, processing, storage, distribution, marketing, and sales to ensure safe food access through scientific measures. 

The Bangladesh Standards and Testing Institution (BSTI) is the national regulatory body responsible for monitoring and enforcing quality control in food products to prevent contamination by pesticides, heavy metals, and other harmful substances. 

However, reports of inadequate testing, monitoring, and enforcement have led to a proliferation of substandard and potentially hazardous food items in the market.

Despite these robust legal protections, the practical enforcement of the right to safe food remains a significant challenge. The prevalence of food adulteration, pesticide and heavy metal contamination, and the widespread use of toxic additives highlight a gap between legal intentions and on-the-ground realities. This disparity calls for more rigorous enforcement of existing regulations, greater public awareness, and enhanced regulatory oversight to turn the constitutional right to safe food from a theoretical guarantee into a tangible reality for all citizens.

The high sales figures for gastric drugs, particularly Sergel, reflect a growing health concern in Bangladesh related to dietary habits and lifestyle choices. The pharmaceutical industry's response to this demand underscores both the challenges and opportunities in addressing the population's healthcare needs. 

As the market evolves, healthcare professionals and policymakers must prioritise preventive measures and public awareness to tackle the root causes of these health issues.

Md Shawkat Alam Faisal is an LLM Student at the University of Rajshahi and an Apprentice Lawyer at the Bangladesh Bar Council.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.