The worldwide threat of generic drugs

FOR THE 16 YEARS THAT DR. BRIAN Westerberg, a Canadian surgeon, worked volunteer missions at the Mulago National Referral Hospital in Kampala, Uganda, scarcity was the norm. The patients usually exceeded the 1,500 allotted beds. Running water was once cut off when the hospital was unable to pay its bills. Patients often couldn’t access the medication they needed, so on some early trips, Westerberg brought drugs over from Canada. But as low-cost generics made in India and China became widely available through Uganda’s government and international aid agencies in the early 2000s, it seemed at first like the supply issue had been solved.

Then on Feb. 7, 2013, Westerberg examined a feverish 13-year-old boy who had fluid oozing from an ear infection. He suspected bacterial meningitis but couldn’t confirm because the CT scanner was broken. The boy was given intravenous ceftriaxone, an antibiotic that Westerberg thought would cure him. But after four days, the