Recently there was an incident of people dying because of consuming a syrup with the trade name of Tyno-SF. The incident raised some very important issues which have been deliberately sidelined by the concerned authorities for years. According to preliminary reports some people were reported dead after consumption of a so called toxic syrup in some localities of urban lahore. The report immediately created a media stir and reporters started discussing the issue like professional medics in no time. I myself saw certain over enthusiastic reporters discussing the highly technical issues with laymen on street and asking for the scientific opinions of a common man who hardly seemed to be even a 8th grader. Conspiracy theories started pouring in, and being a medical doctor, i witnessed some of the strange theories of toxicities which would even leave top notch toxicologists scratching their heads.

As frenzied media kept up the live reporting, the Punjab Government in its usual panic and knee jerk reflexes took a head on approach to the problem by seizing the concerned syrup, which came to be known as Tyno-SF made by a local pharmaceutical industry in Lahore. Within 24 hours the local stock was seized, the distributors and owners of the pharma industry were apprehended and sent behind the bars and the syrup was labelled as dangerous to human health. As 19 deaths were attributed to the toxic syrup, perhaps some sane brains within the Punjab Health Department ultimately thought of conducting forensic autopsies on the bodies of the deceased to ascertain the actual cause of death, and carry an epidemiological investigation into this strange incident.

As local courts remanded the distributors and owners, the autopsy and forensic reports added an another dimension to the story. The reports confirmed that these deaths were caused by dangerous levels of contraband drugs, which the deceased individuals had taken. The epidemiological investigations also revealed that the deceased were mostly found in graveyards and public parks early in the morning, and were regular drug addicts. Close interviews by relatives also confirmed that all these individuals were drug addicts, who used the concerned syrup to enhance the ecstasy caused by the contraband drugs. Laboratory reports of the syrup also found that the ingredients were quality passed, in the proper amount and no toxic chemical was found in random checks on the seized batch of the syrup. Hence came the drop scene of this whole saga.

However this drama raises certain important issues, which can be highlighted as under

1. Media frenzy and misreporting
2. Lack of public awareness
3. Jumping to conclusions on highly technical matters by non professional people

Media frenzy is evident from the fact that reporters started discussing highly scientific issues with a common layman who has no knowledge of pharmaceutical sciences. This simply gives birth to conspiracy theories, which spread like jungle fire and misleads the common public. Since the media still has to learn a lot about sensible reporting, half baked reporters hysterically, presenting their own theories, make a mockery of an incident which requires scientific investigations before any conclusions can be arrived at.

Lack of public awareness is also evident as people don’t understand, what can be dangerous for them, when and how. In a country where any type of drug is available as over the counter, and even a 3 years old kid can buy a strip of diazepam from anywhere, people need to understand the importance of common drugs used, and the precautions exercised. In a society where education levels are at lowest ebbs, it is equivalent of living in a fools paradise, but then the media instead of getting busy in sensational reporting, should play its due role in educating masses on important areas of health too.

The third issue of jumping to conclusions on highly technical matters compounds the whole issue. The media instead of taking health professionals and pharmacists on board, straight away jumped to conclusions and fixing responsibility and instead preferred taking technical opinions from rickshaw drivers. The issue was purely a technical one because the concerned syrup contained dextromethorphan, an anti cough medicine and an anti allergic medicine named chlorpheneramine. Both these drugs are safe and Licensed to be used as over the counter drugs. It is simply not possible for both drugs to kill someone in the amounts contained per 5 ml of the syrup, even if consumed half a bottle. The most such doses will do, will make a person whacky, but still the lethal doses are many times more as compared to the one contained in that syrup.

The only possibility is when such drugs act synergistically with other potent drugs causing central nervous depression like many contraband drugs with addictive potential. In such cases even minor amounts of such safe drugs can augment the CNS depressing effects of narcotic drugs and cause death by respiratory depression or cardiopulmonary collapse. This theory seems to be most plausible as all the deceased were found to be drug abusers who were using the syrup along with other contraband drugs at night time in graveyards and public parks, which is a relatively safe place for drug abusers from prying eyes of police and other law enforcing agencies.
People need to understand that medicines should always be used on advice of a registered medical practitioner and in case of any doubt it is better to ask your physician instead of taking risks.

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