Contaminated medications kill 34 in Panama

By WILL WEISSERT

The Associated Press

PANAMA CITY, Panama -- First comes nausea and diarrhea. Then the facial muscles relax, followed by kidney failure, paralysis and often death.

It's a medical crisis in Panama, where contaminated cough syrup, antihistamine tablets, calamine lotion and rash ointment have killed 34 people since July. More than 40 others have been hospitalized, at least half in critical condition.

The government has recalled 24 types of medication produced by Panama's national health system, suspended production at all government pharmaceutical factories and even gone door-to-door to issue warnings and collect contaminated products.

But people keep dying.

"We are facing a crisis," said David Abrego, director of a government clinic evaluating hundreds of people who fear being poisoned. "The people are apprehensive. There's a lot of tension and nervousness."

The contaminated medicines contained a chemical cousin of antifreeze, diethylene glycol, which is used to keep glue and cosmetics moist. Officials believe it turned up in 100,000 bottles of cough syrup, 20,000 of which have not been recovered. It is unclear how much of the other contaminated products are still on the street.

The Atlanta-based U.S. Centers for Disease Control and Prevention first traced the outbreak to the cough syrup on Oct. 12, and Panamanian authorities soon realized it involved other medicines as well. On Oct. 18, Panama set up 34 round-the-clock clinics across the nation to identify the sick and perform blood tests for kidney damage.

The Health Ministry said Friday that nearly 50,000 people have had blood tests.

Abrego said officials are particularly worried about rural areas, where information about the contaminated products is scarce. The CDC has four investigators still in Panama, searching remote areas for new cases.

The national health system provides free health care for all Panamanians, 40 percent of whom live in poverty. The country has a large expatriate community, mostly Americans, but they're less likely to have used the government drugs, and none have been listed as affected.

The most damaging contamination has been in cough syrup, which is among the country's most popular remedies.

"It's what we take for any kind of problem in Panama -- the flu, a change in climate that makes you feel bad," said Armando Johnson, a 41-year-old hospital orderly. He, his wife and two daughters all took the cough syrup for head colds and were worried until blood tests found they were fine.

It's unclear how the dangerous cousin to antifreeze got into the medications.

Panamanian authorities have blamed it on an expired batch of glycerin manufactured in Spain. But outside experts are skeptical of that theory because glycerin, which occurs naturally in the human body and is added to many products, is highly stable and unlikely to break down.

Authorities say the Panamanian supplier changed the expiration date from 2004 to 2007 and sold it to the national health service through a Panama City-based shell company.

Deputy Attorney General Luis Martinez says a chemical reaction caused by the old glycerin converted that ingredient into diethylene glycol.

Experts say that's scientifically improbable.

The U.S. Food and Drug Administration is investigating at the request of Panamanian authorities.

Panama detained three people last week, including a lawyer who is a founder of the shell company blamed in the case, but officials have refused to release their names or other details. Arrest warrants have been issued for three others.

Attorney General Ana Martin de Gomez said the shell company has no known address and authorities have not been able to track down the name of the company's owner.

So-called "ghost firms" are common in Panama. Neighboring Colombia is the world's leading producer of cocaine and smugglers looking to launder profits often create phantom companies that register with the government but don't have an office or any employees.

There have been other similar cases of contamination.

Glycerin from China was contaminated with diethylene glycol as it was shipped to Haiti. It was then used in children's medication that killed 86 people between 1995 and 1996.

Medicines contaminated with diethylene glycol killed 105 Americans in 1937 and have claimed lives more recently in Argentina, Bangladesh, Nigeria and India. In most cases, the diethylene glycol was introduced accidentally because of poor quality control during manufacturing.

In Panama, the contaminated medications have created a health scare.

Clotilde De Velasco was among thousands waiting in long lines in Panama City to make sure her vomiting and diarrhea were due to the flu, not the cough syrup she took.

"At least they know what's causing this now. Maybe they can help if there's a problem," said the 74-year-old retiree. Then smiling she added: "When you get to be over 70, dying of natural causes is OK. Being poisoned is not."

Hours later, her blood test revealed she had nothing to worry about.