05/02/2026
The following message is courtesy of Dr Raffaella Ravinetto, Public Health Department, Institute of Tropical Medicine Antwerp, Belgium.
Dear Friends,
I am happy to forward this message from Elizabeth Pisani and the STARmeds research group! It will be of great interest for all those who work in pharmaceutical policies and systems, with particular focus on research related to quality and pricing of medicines. Have a nice reading!
Raffaella
------------------------------------------------------------------------------------------------------------------------------------
"The final planned paper from STARmeds group has just been published (attachedI, this one a (I think unusual) kiss-and-tell of the mistakes we made in amoxicillin quality testing, and what we learned from it.
I take the opportunity to post links to all the papers published from this collaboration, led by Univeritas Pancasila in Jakarta (and kindly funded by UK taxpayers, whom we thank). See all links with a short explanation here below.
I also draw attention to the full, sample level dataset, which is available for download and reuse, along with metadata in English and Indonesian, and very detailed methods. It includes all assay, dissolution and uniformity test results, as well as prices and other details (included meds are amoxicillin, cefixime, amlodipine, allopurinol and dexamethasone). We encourage you and your students to use the data for your own, to answer all the interesting questions that we either didn’t think of, or didn’t have time for. Please tell us what you find!
Our main findings, and associated papers (in embedded links in the headlines) include: 1. Are quality medicines affordable? Evidence from a large survey of medicine price and quality in Indonesia: The cheapest medicines are just as likely to pass assay, dissolution and uniformity of assay tests as the most expensive brands/versions of the same product 2. Are quality medicines affordable? Evidence from a large survey of medicine price and quality in Indonesia: For some medicines, the most expensive brand we found was priced at over 100 times the cheapest. Prices often varied three or four-fold for the very same brand, depending on the outlet. However, affordable options were always available, even in remote rural areas. 3. A randomised survey of the quality of antibiotics and other essential medicines in Indonesia, with volume-adjusted estimates of the prevalence of substandard medicines | PLOS Global Public Health: Because they deliberately seek out a variety of brands, samples taken for studies are rarely representative. Weighting results by market size of different brands or manufacturers affects results dramatically; in our survey it slashed prevalence estimates by 47%. In Indonesia, bad medicines don’t sell well. 4. chrome-extensio://efaidnbmnnnibpcajpcglclefindmkaj/https://pmc.ncbi.nlm.nih.gov/articles/PMC12709451/pdf/BLT.24.292994.pdf (copy-paste the link in your browser to open it): Because of a missing flask size, we made an error in early testing of amoxicillin; we suspect others have done the same, possibly affecting results of other published studies. 5. Full article: On paper; in practice: measuring compliance with official pricing policies in a large field study of essential medicines in Indonesia: Though Indonesia has elaborate rules to cap prices of unbranded generics and to introduce transparency for branded medicines, these are regularly ignored or flouted, especially by hospitals. 6. Value for money of medicine sampling and quality testing: evidence from Indonesia | BMJ Global Health: Surveillance based on random sampling from the market is expensive. Random sampling may be useful in markets with very high prevalence of poor quality medicines. However in Indonesia, where prevalence is low and most essential medicines are made domestically, the regulator may achieve the same goals more cost-effectively by investing more in oversight of production.
7. Making intersectoral stakeholder engagement in medicine quality research work: lessons from the STARmeds study in Indonesia: Researchers should engage with policy audiences from the planning stages of their work. It’s hard work, but ultimately worthwhile,
While I have your attention, data from a similar but smaller study of cardiovascular drug quality are also available.
Elizabeth & STARmeds