Study shows many medicines contain unlabelled animal products
Vegetarians or people with dietary restrictions could be unknowingly consuming animal products through common medicines, writes Richard Lord
People in Hong Kong with dietary restrictions could be unwittingly ingesting animal ingredients, including those banned by religious laws, in the form of everyday medicines.
A new British study found that undeclared products of animal provenance are present in numerous common medications taken globally - and, like Britain, Hong Kong has no official requirements when it comes to the labelling of ingredients of animal origin.
There are some cases in which medicines themselves are sourced directly from animals - blood thinner Heparin can come from pigs, for example, while some popular brands of oestrogen are made from pregnant mare's urine.
But more frequently, problem ingredients only crop up in the administered form of a drug, such as a tablet, often in the shape of fillers, binders and capsules. The three most common are lactose, used mainly as a filler, which comes from cow's milk, and is traditionally extracted using rennet from calves' stomachs; gelatin, used to make capsules, and traditionally made from the skin and bones of cows and pigs; and magnesium stearate, used as a lubricant in tablet manufacturing and to make tablets soluble, and traditionally made from rendered animal fat.
According to an article ("Suitability of Common Drugs for Patients Who Avoid Animal Products") published recently on the website of the medical journal BMJ, these three ingredients in particular are present in 74 of 100 of the most commonly used medications in Britain, including painkillers such as aspirin and paracetamol, and common medications to deal with high blood pressure, heart disease and stomach conditions.
Co-author of the article Kinesh Patel, research fellow in the Wolfson Unit for Endoscopy at St Mark's Hospital in Harrow, London, says the most popular drugs and their ingredients are very similar in Hong Kong; many large drug brands are global, and companies naturally prefer to make a single version of a drug and distribute it globally rather than catering for local markets with specific versions.
The biggest issue, Patel found in his research, conducted with Kate Tatham, research fellow in the Section of Anaesthetics, Pain Medicine and Intensive Care at Imperial College, Chelsea and Westminster Hospital in London, is that the possible animal origin of ingredients is rarely marked on drug packaging or information leaflets; and even when potentially problematic ingredients are listed, crucial information about how they were obtained often isn't.
Lactose, for example, was found in 49 of the 100 drugs tested; only eight of them declared the use of calf rennet.
When the researchers contacted the makers of the 10 most popular that didn't specify, four confirmed the use of calf rennet, one of a vegetarian alternative - and five didn't reply at all. That, says Patel, means that patients concerned about the ingredients of a drug often can't even turn to the manufacturer for information.
"A lot of manufacturers we discussed this with didn't understand the question and didn't see the problem. They'd say: 'Lactose doesn't have rennet in it, so it's OK'. But a lot of vegetarians don't think that. Drug companies are not obliged to talk about the manufacturing processes they use."
Like Britain, Hong Kong does not force drug companies to acknowledge where these ingredients come from.
"There are no particular requirements for labelling the ingredients of animal origins in registered pharmaceutical products," says a Hong Kong Department of Health spokesman.
When ingredients of animal origin are used in pharmaceutical products, manufacturers are only forced to provide evidence that they have taken measures to minimise the risk of transmission of communicable diseases to people.
"The Department of Health will remain vigilant on the global development of labelling requirements for pharmaceutical products," the spokesman adds.
Kalpana Bhende, family physician at Hong Kong's Matilda International Hospital, says that awareness of the issue is low in the city.
"I have never encountered any concern regarding this issue from any patient, and hence never encountered any problems with people not taking their medication."
Of course, the problem is that they might do so without their doctor knowing.
"People lie to their doctors all the time," says Patel. "They stop taking their drugs and lie about it, even drugs that are really important - I've heard of it happening with organ-rejection medication. We've got to make sure people don't have a reason to stop taking their medicine - otherwise it's not doing anyone any good."
The problem of people discontinuing with medical treatments because they're concerned about possible animal ingredients is at its most acute when it comes to dietary prohibitions based on religion; followers of faiths as diverse as Islam, Judaism, Hinduism, Buddhism and Jainism all potentially have to avoid some animal ingredients.
"You wouldn't think that people would stop taking a drug that they need," says Patel, "but then Jehovah's Witnesses who are going to die still refuse blood transfusions [which followers of the Christian denomination believe the Bible prohibits]. There are some very dogmatic adherences."
Confusing the picture further, there's not always agreement within specific religions such as Islam or Judaism about what's allowed and what isn't. A 1995 World Health Organisation conference of Jewish and Muslim scholars decided, for example, that gelatin made from impure bones can itself be pure, but of course not everyone knows this, and there can be differences of opinion between various certifying authorities within a specific religion.
A flu vaccination campaign in Scotland last year was delayed because of concerns among Muslims about pork gelatin in the vaccine. Saudi Arabia and Malaysia have even collaborated on a scheme to make gelatin from camels.
According to Hong Kong's chief imam Muhammad Arshad, medicines containing non-Halal ingredients are allowed in certain circumstances. "If the medicine is a basic need and life-saving then it could be used, on condition that there is no alternative medicine available. If it is not a basic need, just for a small sickness or improvement in a condition, then it is not allowed for a Muslim to use it if he knows it is made of non-Halal items."
The tragedy is that, as Patel says, "all of this is entirely unnecessary". Clear labelling would sort it out to a certain extent; substituting vegetarian alternatives for the most common animal products would sort it out entirely. Rennet from moulds and plants including soybeans can be used to extract lactose, for example, while vegetarian sources of gelatin and magnesium stearate are also available.
"As time moves on, manufacturers will find it easier to go vegetarian automatically," says Patel. "If you go to a hospital now, you'll find that no latex gloves are used because some people have allergies, so we can move on and eradicate problems. Regulations can change."
The only potential issue is cost: "Lactose manufacturers would be up in arms, but the amount of lactose in a capsule is minuscule - fractions of a gram - so it's unlikely to make much difference to the cost in the long term."
In the meantime, better labelling would help everyone - those with dietary restrictions, and those who'd rather just know what's in the medications they're putting inside their bodies. The presence of animal products, says Patel, "isn't a scandal itself, but the lack of labelling is. It should be pretty easy to find out what's in a drug". As it stands, it really isn't. firstname.lastname@example.org