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From China to Panama, a Trail of Poisoned Medicine IN CHINA At least 18 people, most of them in Guangdong Province, died in a month last year after they ingested contaminated medicine. Sign In to E-Mail or Save This Print Single Page Reprints ShareDiggFacebookNewsvinePermalink By WALT BOGDANICH and JAKE HOOKERPublished: May 6, 2007The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die. Skip to next paragraph A Toxic PipelineTracking Counterfeit Drugs Reporter Q & AAsk a QuestionOn Monday, The Times’s Walt Bogdanich will be answering readers’ questions about this article. Submit a QuestionMultimediaVideo Tracing the Path of the Poisoned Interactive Graphic A Poison’s Path Enlarge This Image Du Bin for The New York TimesChemical country The Taixing countryside in eastern China, near the Yangtze Delta. Forty-six barrels of toxic syrup followed a path from a factory in the nearby small town of Hengxiang to Panama. Many of them are children, poisoned at the hands of their unsuspecting parents. The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. It is also a killer. And the deaths, if not intentional, are often no accident. Over the years, the poison has been loaded into all varieties of medicine — cough syrup, fever medication, injectable drugs — a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin, commonly used in drugs, food, toothpaste and other products.Toxic syrup has figured in at least eight mass poisonings around the world in the past two decades. Researchers estimate that thousands have died. In many cases, the precise origin of the poison has never been determined. But records and interviews show that in three of the last four cases it was made in China, a major source of counterfeit drugs. Panama is the most recent victim. Last year, government officials there unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine — with devastating results. Families have reported 365 deaths from the poison, 100 of which have been confirmed so far. With the onset of the rainy season, investigators are racing to exhume as many potential victims as possible before bodies decompose even more. Panama’s death toll leads directly to Chinese companies that made and exported the poison as 99.5 percent pure glycerin.Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching halfway around the world. Through shipping records and interviews with government officials, The New York Times traced this pipeline from the Panamanian port of Colón, back through trading companies in Barcelona, Spain, and Beijing, to its beginning near the Yangtze Delta in a place local people call “chemical country.”The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered — as The Times did — that the manufacturer was not certified to make pharmaceutical ingredients.An examination of the two poisoning cases last year — in Panama and earlier in China — shows how China’s safety regulations have lagged behind its growing role as low-cost supplier to the world. It also demonstrates how a poorly policed chain of traders in country after country allows counterfeit medicine to contaminate the global market.Last week, the United States Food and Drug Administration warned drug makers and suppliers in the United States “to be especially vigilant” in watching for diethylene glycol. The warning did not specifically mention China, and it said there was “no reason to believe” that glycerin in this country was tainted. Even so, the agency asked that all glycerin shipments be tested for diethylene glycol, and said it was “exploring how supplies of glycerin become contaminated.”China is already being accused by United States authorities of exporting wheat gluten containing an industrial chemical, melamine, that ended up in pet food and livestock feed. The F.D.A. recently banned imports of Chinese-made wheat gluten after it was linked to pet deaths in the United States.Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, Bangladesh, Argentina, Nigeria and twice in India. In Bangladesh, investigators found poison in seven brands of fever medication in 1992, but only after countless children died. A Massachusetts laboratory detected the contamination after Dr. Michael L. Bennish, a pediatrician who works in developing countries, smuggled samples of the tainted syrup out of the country in a suitcase. Dr. Bennish, who investigated the Bangladesh epidemic and helped write a 1995 article about it for BMJ, formerly known as the British Medical Journal, said that given the amount of medication distributed, deaths “must be in the thousands or tens of thousands.”t vastly underreported,?Dr. Bennish said of diethylene glycol poisoning. Doctors might not suspect toxic medicine, particularly in poor countries with limited resources and a generally unhealthy population, he said, adding, ost people who die don come to a medical facility.?/p> Medical Detectives Dr. Néstor Sosa helped find the cause of at least 100 deaths in Panama last year: poisonous diethylene glycol rather than glycerin was mixed into cough syrup. The makers of counterfeit glycerin, which superficially looks and acts like the real thing but generally costs considerably less, are rarely identified, much less prosecuted, given the difficulty of tracing shipments across borders. his is really a global problem, and it needs to be handled in a global way,?said Dr. Henk Bekedam, the World Health Organization top representative in Beijing. Seventy years ago, medicine laced with diethylene glycol killed more than 100 people in the United States, leading to the passage of the toughest drug regulations of that era and the creation of the modern Food and Drug Administration.The F.D.A. has tried to help in poisoning cases around the world, but there is only so much it can do.When at least 88 children died in Haiti a decade ago, F.D.A. investigators traced the poison to the Manchurian city of Dalian, but their attempts to visit the suspected manufacturer were repeatedly blocked by Chinese officials, according to internal State Department records. Permission was granted more than a year later, but by then the plant had moved and its records had been destroyed.hinese officials we contacted on this matter were all reluctant to become involved,?the American Embassy in Beijing wrote in a confidential cable. e cannot be optimistic about our chances for success in tracking down the other possible glycerine shipments.?In fact, The Times found records showing that the same Chinese company implicated in the Haiti poisoning also shipped about 50 tons of counterfeit glycerin to the United States in 1995. Some of it was later resold to another American customer, Avatar Corporation, before the deception was discovered. hank God we caught it when we did,?said Phil Ternes, chief operating officer of Avatar, a Chicago-area supplier of bulk pharmaceuticals and nonmedicinal products. The F.D.A. said it was unaware of the shipment.In China, the government is vowing to clean up its pharmaceutical industry, in part because of criticism over counterfeit drugs flooding the world markets. In December, two top drug regulators were arrested on charges of taking bribes to approve drugs. In addition, 440 counterfeiting operations were closed down last year, the World Health Organization said.But when Chinese officials investigated the role of Chinese companies in the Panama deaths, they found that no laws had been broken, according to an official of the nation drug enforcement agency. China drug regulation is  black hole,?said one trader who has done business through CNSC Fortune Way, the Beijing-based broker that investigators say was a crucial conduit for the Panama poison. In this environment, Wang Guiping, a tailor with a ninth-grade education and access to a chemistry book, found it easy to enter the pharmaceutical supply business as a middleman. He quickly discovered what others had before him: that counterfeiting was a simple way to increase profits. And then people in China began to die.Cheating the SystemMr. Wang spent years as a tailor in the manufacturing towns of the Yangtze Delta, in eastern China. But he did not want to remain a common craftsman, villagers say. He set his sights on trading chemicals, a business rooted in the many small chemical plants that have sprouted in the region.e didn know what he was doing,?Mr. Wang older brother, Wang Guoping, said in an interview. e didn understand chemicals.?/p>But he did understand how to cheat the system.Wang Guiping, 41, realized he could earn extra money by substituting cheaper, industrial-grade syrup ?not approved for human consumption ?for pharmaceutical grade syrup. To trick pharmaceutical buyers, he forged his licenses and laboratory analysis reports, records show.Mr. Wang later told investigators that he figured no harm would come from the substitution, because he initially tested a small quantity. He did it with the expertise of a former tailor.He swallowed some of it. When nothing happened, he shipped it.One company that used the syrup beginning in early 2005 was Qiqihar No. 2 Pharmaceutical, about 1,000 miles away in Heilongjiang Province in the northeast. A buyer for the factory had seen a posting for Mr. Wang syrup on an industry Web site.After a while, Mr. Wang set out to find an even cheaper substitute syrup so he could increase his profit even more, according to a Chinese investigator. In a chemical book he found what he was looking for: another odorless syrup — diethylene glycol. At the time, it sold for 6,000 to 7,000 yuan a ton, or about $725 to $845, while pharmaceutical-grade syrup cost 15,000 yuan, or about $1,815, according to the investigator. In Panama Cold medicine containing diethylene glycol killed at least 100 people. Mr. Wang did not taste-test this second batch of syrup before shipping it to Qiqihar Pharmaceutical, the government investigator said, adding, “He knew it was dangerous, but he didn’t know that it could kill.” The manufacturer used the toxic syrup in five drug products: ampules of Amillarisin A for gall bladder problems; a special enema fluid for children; an injection for blood vessel diseases; an intravenous pain reliever; and an arthritis treatment. In April 2006, one of southern China’s finest hospitals, in Guangzhou, Guangdong Province, began administering Amillarisin A. Within a month or so, at least 18 people had died after taking the medicine, though some had already been quite sick. Zhou Jianhong, 33, said his father took his first dose of Amillarisin A on April 19. A week later he was in critical condition. “If you are going to die, you want to die at home,” Mr. Zhou said. “So we checked him out of the hospital.” He died the next day.“Everybody wants to invest in the pharmaceutical industry and it is growing, but the regulators can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”The final death count is unclear, since some people who took the medicine may have died in less populated areas. In a small town in Sichuan Province, a man named Zhou Lianghui said the authorities would not acknowledge that his wife had died from taking tainted Amillarisin A. But Mr. Zhou, 38, said he matched the identification number on the batch of medicine his wife received with a warning circular distributed by drug officials.“You probably cannot understand a small town if you are in Beijing,” Zhou Lianghui said in a telephone interview. “The sky is high, and the emperor is far away. There are a lot of problems here that the law cannot speak to.” The failure of the government to stop poison from contaminating the drug supply caused one of the bigger domestic scandals of the year. Last May, China’s premier, Wen Jiabao, ordered an investigation of the deaths, declaring, “The pharmaceutical market is in disorder.” At about the same time, 9,000 miles away in Panama, the long rainy season had begun. Anticipating colds and coughs, the government health program began manufacturing cough and antihistamine syrup. The cough medicine was sugarless so that even diabetics could use it.The medicine was mixed with a pale yellow, almost translucent syrup that had arrived in 46 barrels from Barcelona on the container ship Tobias Maersk. Shipping records showed the contents to be 99.5 percent pure glycerin.It would be months and many deaths later before that certification was discovered to be pure fiction.A Mysterious IllnessEarly last September, doctors at Panama City’s big public hospital began to notice patients exhibiting unusual symptoms. They initially appeared to have Guillain-Barré syndrome, a relatively rare neurological disorder that first shows up as a weakness or tingling sensation in the legs. That weakness often intensifies, spreading upward to the arms and chest, sometimes causing total paralysis and an inability to breathe.The new patients had paralysis, but it did not spread upward. They also quickly lost their ability to urinate, a condition not associated with Guillain-Barré. Even more unusual was the number of cases. In a full year, doctors might see eight cases of Guillain-Barré, yet they saw that many in just two weeks. Doctors sought help from an infectious disease specialist, Néstor Sosa, an intense, driven doctor who competes in triathlons and high-level chess. Dr. Sosa’s medical specialty had a long, rich history in Panama, once known as one of the world’s unhealthiest places. In one year in the late 1800s, a lethal mix of yellow fever and malaria killed nearly 1 in every 10 residents of Panama City. Only after the United States managed to overcome those mosquito-borne diseases was it able to build the Panama Canal without the devastation that undermined an earlier attempt by the French.The suspected Guillain-Barré cases worried Dr. Sosa. “It was something really extraordinary, something that was obviously reaching epidemic dimensions in our hospital,” he said.With the death rate from the mystery illness near 50 percent, Dr. Sosa alerted the hospital management, which asked him to set up and run a task force to handle the situation. The assignment, a daunting around-the-clock dash to catch a killer, was one he eagerly embraced. Several years earlier, Dr. Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents.“I took care of patients but I somehow felt I did not do enough,” he said. The next time, he vowed, would be different. Dr. Sosa set up a 24-hour “war room” in the hospital, where doctors could compare notes and theories as they scoured medical records for clues.After a while, Mr. Wang set out to find an even cheaper substitute syrup so he could increase his profit even more, according to a Chinese investigator. In a chemical book he found what he was looking for: another odorless syrup — diethylene glycol. At the time, it sold for 6,000 to 7,000 yuan a ton, or about $725 to $845, while pharmaceutical-grade syrup cost 15,000 yuan, or about $1,815, according to the investigator. In Panama Cold medicine containing diethylene glycol killed at least 100 people. Mr. Wang did not taste-test this second batch of syrup before shipping it to Qiqihar Pharmaceutical, the government investigator said, adding, “He knew it was dangerous, but he didn’t know that it could kill.” The manufacturer used the toxic syrup in five drug products: ampules of Amillarisin A for gall bladder problems; a special enema fluid for children; an injection for blood vessel diseases; an intravenous pain reliever; and an arthritis treatment. In April 2006, one of southern China’s finest hospitals, in Guangzhou, Guangdong Province, began administering Amillarisin A. Within a month or so, at least 18 people had died after taking the medicine, though some had already been quite sick. Zhou Jianhong, 33, said his father took his first dose of Amillarisin A on April 19. A week later he was in critical condition. “If you are going to die, you want to die at home,” Mr. Zhou said. “So we checked him out of the hospital.” He died the next day.“Everybody wants to invest in the pharmaceutical industry and it is growing, but the regulators can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”The final death count is unclear, since some people who took the medicine may have died in less populated areas. In a small town in Sichuan Province, a man named Zhou Lianghui said the authorities would not acknowledge that his wife had died from taking tainted Amillarisin A. But Mr. Zhou, 38, said he matched the identification number on the batch of medicine his wife received with a warning circular distributed by drug officials.“You probably cannot understand a small town if you are in Beijing,” Zhou Lianghui said in a telephone interview. “The sky is high, and the emperor is far away. There are a lot of problems here that the law cannot speak to.” The failure of the government to stop poison from contaminating the drug supply caused one of the bigger domestic scandals of the year. Last May, China’s premier, Wen Jiabao, ordered an investigation of the deaths, declaring, “The pharmaceutical market is in disorder.” At about the same time, 9,000 miles away in Panama, the long rainy season had begun. Anticipating colds and coughs, the government health program began manufacturing cough and antihistamine syrup. The cough medicine was sugarless so that even diabetics could use it.The medicine was mixed with a pale yellow, almost translucent syrup that had arrived in 46 barrels from Barcelona on the container ship Tobias Maersk. Shipping records showed the contents to be 99.5 percent pure glycerin.It would be months and many deaths later before that certification was discovered to be pure fiction.A Mysterious IllnessEarly last September, doctors at Panama City’s big public hospital began to notice patients exhibiting unusual symptoms. They initially appeared to have Guillain-Barré syndrome, a relatively rare neurological disorder that first shows up as a weakness or tingling sensation in the legs. That weakness often intensifies, spreading upward to the arms and chest, sometimes causing total paralysis and an inability to breathe.The new patients had paralysis, but it did not spread upward. They also quickly lost their ability to urinate, a condition not associated with Guillain-Barré. Even more unusual was the number of cases. In a full year, doctors might see eight cases of Guillain-Barré, yet they saw that many in just two weeks. Doctors sought help from an infectious disease specialist, Néstor Sosa, an intense, driven doctor who competes in triathlons and high-level chess. Dr. Sosa’s medical specialty had a long, rich history in Panama, once known as one of the world’s unhealthiest places. In one year in the late 1800s, a lethal mix of yellow fever and malaria killed nearly 1 in every 10 residents of Panama City. Only after the United States managed to overcome those mosquito-borne diseases was it able to build the Panama Canal without the devastation that undermined an earlier attempt by the French.The suspected Guillain-Barré cases worried Dr. Sosa. “It was something really extraordinary, something that was obviously reaching epidemic dimensions in our hospital,” he said.With the death rate from the mystery illness near 50 percent, Dr. Sosa alerted the hospital management, which asked him to set up and run a task force to handle the situation. The assignment, a daunting around-the-clock dash to catch a killer, was one he eagerly embraced. Several years earlier, Dr. Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents.“I took care of patients but I somehow felt I did not do enough,” he said. The next time, he vowed, would be different. Dr. Sosa set up a 24-hour “war room” in the hospital, where doctors could compare notes and theories as they scoured medical records for clues.Another problem is that finding traces of diethylene glycol in decomposing bodies is difficult at best, medical experts say. Nonetheless, an Argentine pathologist who has studied diethylene glycol poisonings helped develop a test for the poison in exhumed bodies. Seven of the first nine bodies tested showed traces of the poison, Panamanian authorities said. A Poison’s Path With the rainy season returning, though, the exhumations are about to end. Dr. José Vicente Pachar, director of Panama’s Institute of Legal Medicine and Forensic Sciences, said that as a scientist he would like a final count of the dead. But he added, “I should accept the reality that in the case of Panama we are not going to know the exact number.” Local prosecutors have made some arrests and are investigating others connected to the case, including officials of the import company and the government agency that mixed and distributed the cold medicine. “Our responsibilities are to establish or discover the truth,” said Dimas Guevara, the homicide investigator guiding the inquiry. But prosecutors have yet to charge anyone with actually making the counterfeit glycerin. And if the Panama investigation unfolds as other inquiries have, it is highly unlikely that they ever will.A Suspect FactoryPanamanians wanting to see where their toxic nightmare began could look up the Web site of the company in Hengxiang, China, that investigators in four countries have identified as having made the syrup — the Taixing Glycerine Factory. There, under the words “About Us,” they would see a picture of a modern white building nearly a dozen stories tall, adorned by three arches at the entrance. The factory, the Web site boasts, “can strictly obey the contract and keep its word.” But like the factory’s syrup, all is not as it seems. There are no tall buildings in Hengxiang, a country town with one main road. The factory is not certified to sell any medical ingredients, Chinese officials say. And it looks nothing like the picture on the Internet. In reality, its chemicals are mixed in a plain, one-story brick building. The factory is in a walled compound, surrounded by small shops and farms. In the spring, nearby fields of rape paint the countryside yellow. Near the front gate, a sign over the road warns, “Beware of counterfeits.” But it was posted by a nearby noodle machine factory that appears to be worried about competition.The Taixing Glycerine Factory bought its diethylene glycol from the same manufacturer as Mr. Wang, the former tailor, the government investigator said. From this spot in China’s chemical country, the 46 barrels of toxic syrup began their journey, passing from company to company, port to port and country to country, apparently without anyone testing their contents. Traders should be thoroughly familiar with their suppliers, United States health officials say. “One simply does not assume that what is labeled is indeed what it is,” said Dr. Murray Lumpkin, deputy commissioner for international and special programs for the Food and Drug Administration.In the Panama case, names of suppliers were removed from shipping documents as they passed from one entity to the next, according to records and investigators. That is a practice some traders use to prevent customers from bypassing them on future purchases, but it also hides the provenance of the product. The first distributor was the Beijing trading company, CNSC Fortune Way, a unit of a state-owned business that began by supplying goods and services to Chinese personnel and business officials overseas.As China’s market reach expanded, Fortune Way focused its business on pharmaceutical ingredients, and in 2003, it brokered the sale of the suspect syrup made by the Taixing Glycerine Factory. The manufacturer’s certificate of analysis showed the batch to be 99.5 percent pure.Whether the Taixing Glycerine Factory actually performed the test has not been publicly disclosed. Original certificates of analysis should be passed on to each new buyer, said Kevin J. McGlue, a board member of the International Pharmaceutical Excipients Council. In this case, that was not done.Fortune Way translated the certificate into English, putting its name ?not the Taixing Glycerine Factory ?at the top of the document, before shipping the barrels to a second trading company, this one in Barcelona.A Poison’s Path Li Can, managing director at Fortune Way, said he did not remember the transaction and could not comment, adding, here is a high volume of trade.?Upon receiving the barrels in September 2003, the Spanish company, Rasfer International, did not test the contents, either. It copied the chemical analysis provided by Fortune Way, then put its logo on it. Ascensi鏮 Criado, Rasfer manager, said in an e-mail response to written questions that when Fortune Way shipped the syrup, it did not say who made it. Several weeks later, Rasfer shipped the drums to a Panamanian broker, the Medicom Business Group. edicom never asked us for the name of the manufacturer,?Ms. Criado said.A lawyer for Medicom, Valent璯 Ja幯, said his client was a victim, too. hey were tricked by somebody,?Mr. Ja幯 said. hey operated in good faith.?/p>In Panama, the barrels sat unused for more than two years, and officials said Medicom improperly changed the expiration date on the syrup. During that time, the company never tested the product. And the Panamanian government, which bought the 46 barrels and used them to make cold medicine, also failed to detect the poison, officials said. The toxic pipeline ultimately emptied into the bloodstream of people like Ernesto Osorio, a former high school teacher in Panama City. He spent two months in the hospital after ingesting poison cough syrup last September.Just before Christmas, after a kidney dialysis treatment, Mr. Osorio stood outside the city big public hospital in a tear-splattered shirt, describing what his life had become.  not an eighth of what I used to be,?Mr. Osorio said, his partly paralyzed face hanging like a slab of meat.  have trouble walking. Look at my face, look at my tears.?The tears, he said apologetically, were not from emotion, but from nerve damage.And yet, Mr. Osorio knows he is one of the lucky victims. hey didn know how to keep the killer out of the medicine,?he said simply.While the suffering in Panama was great, the potential profit ?at least for the Spanish trading company, Rasfer ?was surprisingly small. For the 46 barrels of glycerin, Rasfer paid Fortune Way $9,900, then sold them to Medicom for $11,322, according to records.Chinese authorities have not disclosed how much Fortune Way and the Taixing Glycerine Factory made on their end, or how much they knew about what was in the barrels.he fault has to be traced back to areas of production,?said Dr. Motta, the cardiologist in Panama who helped uncover the source of the epidemic. his was my plea ?please, this thing is happening to us, make sure whoever did this down the line is not doing it to Peru or Sierra Leone or some other place.?/p>A Counterfeiter ConfessionThe power to prosecute the counterfeiters is now in the hands of the Chinese.Last spring, the government moved quickly against Mr. Wang, the former tailor who poisoned Chinese residents. The authorities caught up with him at a roadblock in Taizhou, a city just north of Taixing, in chemical country. He was weak and sick, and he had not eaten in two days. Inside his white sedan was a bankbook and cash. He had fled without his wife and teenage son.Chinese patients were dead, a political scandal was brewing and the authorities wanted answers. Mr. Wang was taken to a hospital. Then, in long sessions with investigators, he gave them what they wanted, explaining his scheme, how he tested industrial syrup by drinking it, how he decided to use diethylene glycol and how he conned pharmaceutical companies into buying his syrup, according to a government official who was present for his interrogation. e made a fortune, but none of it went to his family,?said Wang Xiaodong, a former village official who knows Mr. Wang and his siblings. e liked to gamble.?/p>Mr. Wang remains in custody as the authorities decide whether he should be put to death. The Qiqihar drug plant that made the poisonous medicine has been closed, and five employees are now being prosecuted for causing “a serious accident.”A Poison’s Path In contrast to the Wang Guiping investigation, Chinese authorities have been tentative in acknowledging China’s link to the Panama tragedy, which involved a state-owned trading company. No one in China has been charged with committing the fraud that ended up killing so many in Panama. Sun Jing, the pharmaceutical program officer for the World Health Organization in Beijing, said the health agency sent a fax “to remind the Chinese government that China should not be selling poisonous products overseas.” Ms. Sun said the agency did not receive an official reply. Last fall, at the request of the United States — Panama has no diplomatic relations with China — the State Food and Drug Administration of China investigated the Taixing Glycerine Factory and Fortune Way. The agency tested one batch of glycerin from the factory, and found no glycerin, only diethylene glycol and two other substances, a drug official said.Since then, the Chinese drug administration has concluded that it has no jurisdiction in the case because the factory is not certified to make medicine.The agency reached a similar conclusion about Fortune Way, saying that as an exporter it was not engaged in the pharmaceutical business.“We did not find any evidence that either of these companies had broken the law,” said Yan Jiangying, a spokeswoman for the drug administration. “So a criminal investigation was never opened.” A drug official said the investigation was subsequently handed off to an agency that tests and certifies commercial products — the General Administration of Quality Supervision, Inspection and Quarantine. But the agency acted surprised to learn that it was now in charge. “What investigation?” asked Wang Jian, director of its Taixing branch. “I’m not aware of any investigation involving a glycerin factory.”Besides, Huang Tong, an investigator in that office, said, “We rarely get involved in products that are sold for export.”Wan Qigang, the legal representative for the Taixing Glycerine Factory, said in an interview late last year that the authorities had not questioned him about the Panama poisoning, and that his company made only industrial-grade glycerin. “I can tell you for certain that we have no connection with Panama or Spain,” Mr. Wan said.But in recent months, the Glycerine Factory has advertised 99.5 percent pure glycerin on the Internet.Mr. Wan recently declined to answer any more questions. “If you come here as a guest, I will welcome you,” Mr. Wan said. “But if you come again wanting to talk about this matter, I will make a telephone call.” A local government official said Mr. Wan was told not to grant interviews.A five-minute walk away, another manufacturer, the Taixing White Oil Factory, also advertises medical glycerin on the Internet, yet it, too, has no authorization to make it. The company’s Web site says its products “have been exported to America, Australia and Italy.”Ding Xiang, who represents the White Oil Factory, denied that his company made pharmaceutical-grade glycerin, but he said chemical trading companies in Beijing often called, asking for it.“They want us to mark the barrels glycerin,” Mr. Ding said in late December. “I tell them we cannot do that.”Mr. Ding said he stopped answering calls from Beijing. “If this stuff is taken overseas and improperly used. ...” He did not complete the thought. In chemical country, product names are not always what they seem. “The only two factories in Taixing that make glycerin don’t even make glycerin,” said Jiang Peng, who oversees inspections and investigations in the Taixing branch of the State Food and Drug Administration. “It is a different product.”All in a NameOne lingering mystery involves the name of the product made by the Taixing Glycerine Factory. The factory had called its syrup “TD” glycerin. The letters TD were in virtually all the shipping documents. What did TD mean? Spanish medical authorities concluded that it stood for a manufacturing process. Chinese inspectors thought it was the manufacturer’s secret formula. But Yuan Kailin, a former salesman for the factory , said he knew what the TD meant because a friend and former manager of the factory, Ding Yuming, had once told him. TD stood for the Chinese word “tidai” (pronounced tee-die), said Mr. Yuan, who left his job in 1998 and still lives about a mile from the factory. In Chinese, tidai means substitute. A clue that might have revealed the poison, the counterfeit product, was hiding in plain sight. It was in the product name.原文见:>太长了,我将之分为七部分,感兴趣的共同翻译吧.From China to Panama, a Trail of Poisoned Medicine第一部分:The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die. Many of them are children, poisoned at the hands of their unsuspecting parents. The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. It is also a killer. And the deaths, if not intentional, are often no accident. Over the years, the poison has been loaded into all varieties of medicine — cough syrup, fever medication, injectable drugs — a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin, commonly used in drugs, food, toothpaste and other products.Toxic syrup has figured in at least eight mass poisonings around the world in the past two decades. Researchers estimate that thousands have died. In many cases, the precise origin of the poison has never been determined. But records and interviews show that in three of the last four cases it was made in China, a major source of counterfeit drugs. Panama is the most recent victim. Last year, government officials there unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine — with devastating results. Families have reported 365 deaths from the poison, 100 of which have been confirmed so far. With the onset of the rainy season, investigators are racing to exhume as many potential victims as possible before bodies decompose even more. Panama’s death toll leads directly to Chinese companies that made and exported the poison as 99.5 percent pure glycerin.Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching halfway around the world. Through shipping records and interviews with government officials, The New York Times traced this pipeline from the Panamanian port of Colón, back through trading companies in Barcelona, Spain, and Beijing, to its beginning near the Yangtze Delta in a place local people call “chemical country.”The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered — as The Times did — that the manufacturer was not certified to make pharmaceutical ingredients.An examination of the two poisoning cases last year — in Panama and earlier in China — shows how China’s safety regulations have lagged behind its growing role as low-cost supplier to the world. It also demonstrates how a poorly policed chain of traders in country after country allows counterfeit medicine to contaminate the global market.Last week, the United States Food and Drug Administration warned drug makers and suppliers in the United States “to be especially vigilant” in watching for diethylene glycol. The warning did not specifically mention China, and it said there was “no reason to believe” that glycerin in this country was tainted. Even so, the agency asked that all glycerin shipments be tested for diethylene glycol, and said it was “exploring how supplies of glycerin become contaminated.”China is already being accused by United States authorities of exporting wheat gluten containing an industrial chemical, melamine, that ended up in pet food and livestock feed. The F.D.A. recently banned imports of Chinese-made wheat gluten after it was linked to pet deaths in the United States.Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, Bangladesh, Argentina, Nigeria and twice in India. In Bangladesh, investigators found poison in seven brands of fever medication in 1992, but only after countless children died. A Massachusetts laboratory detected the contamination after Dr. Michael L. Bennish, a pediatrician who works in developing countries, smuggled samples of the tainted syrup out of the country in a suitcase. Dr. Bennish, who investigated the Bangladesh epidemic and helped write a 1995 article about it for BMJ, formerly known as the British Medical Journal, said that given the amount of medication distributed, deaths “must be in the thousands or tens of thousands.”第二部分:“It’s vastly underreported,” Dr. Bennish said of diethylene glycol poisoning. Doctors might not suspect toxic medicine, particularly in poor countries with limited resources and a generally unhealthy population, he said, adding, “Most people who die don’t come to a medical facility.”The makers of counterfeit glycerin, which superficially looks and acts like the real thing but generally costs considerably less, are rarely identified, much less prosecuted, given the difficulty of tracing shipments across borders. “This is really a global problem, and it needs to be handled in a global way,” said Dr. Henk Bekedam, the World Health Organization’s top representative in Beijing. Seventy years ago, medicine laced with diethylene glycol killed more than 100 people in the United States, leading to the passage of the toughest drug regulations of that era and the creation of the modern Food and Drug Administration.The F.D.A. has tried to help in poisoning cases around the world, but there is only so much it can do.When at least 88 children died in Haiti a decade ago, F.D.A. investigators traced the poison to the Manchurian city of Dalian, but their attempts to visit the suspected manufacturer were repeatedly blocked by Chinese officials, according to internal State Department records. Permission was granted more than a year later, but by then the plant had moved and its records had been destroyed.“Chinese officials we contacted on this matter were all reluctant to become involved,” the American Embassy in Beijing wrote in a confidential cable. “We cannot be optimistic about our chances for success in tracking down the other possible glycerine shipments.” In fact, The Times found records showing that the same Chinese company implicated in the Haiti poisoning also shipped about 50 tons of counterfeit glycerin to the United States in 1995. Some of it was later resold to another American customer, Avatar Corporation, before the deception was discovered. “Thank God we caught it when we did,” said Phil Ternes, chief operating officer of Avatar, a Chicago-area supplier of bulk pharmaceuticals and nonmedicinal products. The F.D.A. said it was unaware of the shipment.In China, the government is vowing to clean up its pharmaceutical industry, in part because of criticism over counterfeit drugs flooding the world markets. In December, two top drug regulators were arrested on charges of taking bribes to approve drugs. In addition, 440 counterfeiting operations were closed down last year, the World Health Organization said.But when Chinese officials investigated the role of Chinese companies in the Panama deaths, they found that no laws had been broken, according to an official of the nation’s drug enforcement agency. China’s drug regulation is “a black hole,” said one trader who has done business through CNSC Fortune Way, the Beijing-based broker that investigators say was a crucial conduit for the Panama poison. In this environment, Wang Guiping, a tailor with a ninth-grade education and access to a chemistry book, found it easy to enter the pharmaceutical supply business as a middleman. He quickly discovered what others had before him: that counterfeiting was a simple way to increase profits. And then people in China began to die.Cheating the SystemMr. Wang spent years as a tailor in the manufacturing towns of the Yangtze Delta, in eastern China. But he did not want to remain a common craftsman, villagers say. He set his sights on trading chemicals, a business rooted in the many small chemical plants that have sprouted in the region.“He didn’t know what he was doing,” Mr. Wang’s older brother, Wang Guoping, said in an interview. “He didn’t understand chemicals.”But he did understand how to cheat the system.Wang Guiping, 41, realized he could earn extra money by substituting cheaper, industrial-grade syrup — not approved for human consumption — for pharmaceutical grade syrup. To trick pharmaceutical buyers, he forged his licenses and laboratory analysis reports, records show.Mr. Wang later told investigators that he figured no harm would come from the substitution, because he initially tested a small quantity. He did it with the expertise of a former tailor.He swallowed some of it. When nothing happened, he shipped it.One company that used the syrup beginning in early 2005 was Qiqihar No. 2 Pharmaceutical, about 1,000 miles away in Heilongjiang Province in the northeast. A buyer for the factory had seen a posting for Mr. Wang’s syrup on an industry Web site.第三部分:After a while, Mr. Wang set out to find an even cheaper substitute syrup so he could increase his profit even more, according to a Chinese investigator. In a chemical book he found what he was looking for: another odorless syrup — diethylene glycol. At the time, it sold for 6,000 to 7,000 yuan a ton, or about $725 to $845, while pharmaceutical-grade syrup cost 15,000 yuan, or about $1,815, according to the investigator. Mr. Wang did not taste-test this second batch of syrup before shipping it to Qiqihar Pharmaceutical, the government investigator said, adding, “He knew it was dangerous, but he didn’t know that it could kill.” The manufacturer used the toxic syrup in five drug products: ampules of Amillarisin A for gall bladder problems; a special enema fluid for children; an injection for blood vessel diseases; an intravenous pain reliever; and an arthritis treatment. In April 2006, one of southern China’s finest hospitals, in Guangzhou, Guangdong Province, began administering Amillarisin A. Within a month or so, at least 18 people had died after taking the medicine, though some had already been quite sick. Zhou Jianhong, 33, said his father took his first dose of Amillarisin A on April 19. A week later he was in critical condition. “If you are going to die, you want to die at home,” Mr. Zhou said. “So we checked him out of the hospital.” He died the next day.“Everybody wants to invest in the pharmaceutical industry and it is growing, but the regulators can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”The final death count is unclear, since some people who took the medicine may have died in less populated areas. In a small town in Sichuan Province, a man named Zhou Lianghui said the authorities would not acknowledge that his wife had died from taking tainted Amillarisin A. But Mr. Zhou, 38, said he matched the identification number on the batch of medicine his wife received with a warning circular distributed by drug officials.“You probably cannot understand a small town if you are in Beijing,” Zhou Lianghui said in a telephone interview. “The sky is high, and the emperor is far away. There are a lot of problems here that the law cannot speak to.” The failure of the government to stop poison from contaminating the drug supply caused one of the bigger domestic scandals of the year. Last May, China’s premier, Wen Jiabao, ordered an investigation of the deaths, declaring, “The pharmaceutical market is in disorder.” At about the same time, 9,000 miles away in Panama, the long rainy season had begun. Anticipating colds and coughs, the government health program began manufacturing cough and antihistamine syrup. The cough medicine was sugarless so that even diabetics could use it.The medicine was mixed with a pale yellow, almost translucent syrup that had arrived in 46 barrels from Barcelona on the container ship Tobias Maersk. Shipping records showed the contents to be 99.5 percent pure glycerin.It would be months and many deaths later before that certification was discovered to be pure fiction.A Mysterious IllnessEarly last September, doctors at Panama City’s big public hospital began to notice patients exhibiting unusual symptoms. They initially appeared to have Guillain-Barré syndrome, a relatively rare neurological disorder that first shows up as a weakness or tingling sensation in the legs. That weakness often intensifies, spreading upward to the arms and chest, sometimes causing total paralysis and an inability to breathe.The new patients had paralysis, but it did not spread upward. They also quickly lost their ability to urinate, a condition not associated with Guillain-Barré. Even more unusual was the number of cases. In a full year, doctors might see eight cases of Guillain-Barré, yet they saw that many in just two weeks. Doctors sought help from an infectious disease specialist, Néstor Sosa, an intense, driven doctor who competes in triathlons and high-level chess. Dr. Sosa’s medical specialty had a long, rich history in Panama, once known as one of the world’s unhealthiest places. In one year in the late 1800s, a lethal mix of yellow fever and malaria killed nearly 1 in every 10 residents of Panama City. Only after the United States managed to overcome those mosquito-borne diseases was it able to build the Panama Canal without the devastation that undermined an earlier attempt by the French.The suspected Guillain-Barré cases worried Dr. Sosa. “It was something really extraordinary, something that was obviously reaching epidemic dimensions in our hospital,” he said.With the death rate from the mystery illness near 50 percent, Dr. Sosa alerted the hospital management, which asked him to set up and run a task force to handle the situation. The assignment, a daunting around-the-clock dash to catch a killer, was one he eagerly embraced. Several years earlier, Dr. Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents.“I took care of patients but I somehow felt I did not do enough,” he said. The next time, he vowed, would be different. Dr. Sosa set up a 24-hour “war room” in the hospital, where doctors could compare notes and theories as they scoured medical records for clues.第四部分:As a precaution, the patients with the mystery illness were segregated and placed in a large empty room awaiting renovation. Health care workers wore masks, heightening fears in the hospital and the community.“That spread a lot of panic,” said Dr. Jorge Motta, a cardiologist who runs the Gorgas Memorial Institute, a widely respected medical research center in Panama. “That is always a terrifying thought, that you will be the epicenter of a new infectious disease, and especially a new infectious disease that kills with a high rate of death, like this.”Meanwhile, patients kept coming, and hospital personnel could barely keep up. “I ended up giving C.P.R.,” Dr. Sosa said. “I haven’t given C.P.R. since I was a resident, but there were so many crises going on.” Frightened hospital patients had to watch others around them die for reasons no one understood, fearing that they might be next.As reports of strange Guillain-Barré symptoms started coming in from other parts of the country, doctors realized they were not just dealing with a localized outbreak.Pascuala Pérez de González, 67, sought treatment for a cold at a clinic in Coclé Province, about a three-hour drive from Panama City. In late September she was treated and sent home. Within days, she could no longer eat; she stopped urinating and went into convulsions. A decision was made to take her to the public hospital in Panama City, but on the way she stopped breathing and had to be resuscitated. She arrived at the hospital in a deep coma and later died.Medical records contained clues but also plenty of false leads. Early victims tended to be males older than 60 and diabetic with high blood pressure. About half had been given Lisinopril, a blood pressure medicine distributed by the public health system.But many who did not receive Lisinopril still got sick. On the chance that those patients might have forgotten that they had taken the drug, doctors pulled Lisinopril from pharmacy shelves — only to return it after tests found nothing wrong. Investigators would later discover that Lisinopril did play an important, if indirect role in the epidemic, but not in the way they had imagined.A Major ClueOne patient of particular interest to Dr. Sosa came into the hospital with a heart attack, but no Guillain-Barré-type symptoms. While undergoing treatment, the patient received several drugs, including Lisinopril. After a while, he began to exhibit the same neurological distress that was the hallmark of the mystery illness.“This patient is a major clue,” Dr. Sosa recalled saying. “This is not something environmental, this is not a folk medicine that’s been taken by the patients at home. This patient developed the disease in the hospital, in front of us.”Soon after, another patient told Dr. Sosa that he, too, developed symptoms after taking Lisinopril, but because the medicine made him cough, he also took cough syrup — the same syrup, it turned out, that had been given to the heart patient.“I said this has got to be it,” Dr. Sosa recalled. “We need to investigate this cough syrup.”The cough medicine had not initially aroused much suspicion because many victims did not remember taking it. “Twenty-five percent of those people affected denied that they had taken cough syrup, because it’s a nonevent in their lives,” Dr. Motta said. Investigators from the United States Centers for Disease Control and Prevention, who were in Panama helping out, quickly put the bottles on a government jet and flew them to the United States for testing. The next day, Oct. 11, as Panamanian health officials were attending a news conference, a Blackberry in the room went off. The tests, the C.D.C. was reporting, had turned up diethylene glycol in the cough syrup.The mystery had been solved. The barrels labeled glycerin turned out to contain poison. Dr. Sosa’s exhilaration at learning the cause did not last long. “It’s our medication that is killing these people,” he said he thought. “It’s not a virus, it’s not something that they got outside, but it was something we actually manufactured.”A nationwide campaign was quickly begun to stop people from using the cough syrup. Neighborhoods were searched, but thousands of bottles either had been discarded or could not be found. As the search wound down, two major tasks remained: count the dead and assign blame. Neither has been easy. A precise accounting is all but impossible because, medical authorities say, victims were buried before the cause was known, and poor patients might not have seen doctors.第五部分:Another problem is that finding traces of diethylene glycol in decomposing bodies is difficult at best, medical experts say. Nonetheless, an Argentine pathologist who has studied diethylene glycol poisonings helped develop a test for the poison in exhumed bodies. Seven of the first nine bodies tested showed traces of the poison, Panamanian authorities said. With the rainy season returning, though, the exhumations are about to end. Dr. José Vicente Pachar, director of Panama’s Institute of Legal Medicine and Forensic Sciences, said that as a scientist he would like a final count of the dead. But he added, “I should accept the reality that in the case of Panama we are not going to know the exact number.” Local prosecutors have made some arrests and are investigating others connected to the case, including officials of the import company and the government agency that mixed and distributed the cold medicine. “Our responsibilities are to establish or discover the truth,” said Dimas Guevara, the homicide investigator guiding the inquiry. But prosecutors have yet to charge anyone with actually making the counterfeit glycerin. And if the Panama investigation unfolds as other inquiries have, it is highly unlikely that they ever will.A Suspect FactoryPanamanians wanting to see where their toxic nightmare began could look up the Web site of the company in Hengxiang, China, that investigators in four countries have identified as having made the syrup — the Taixing Glycerine Factory. There, under the words “About Us,” they would see a picture of a modern white building nearly a dozen stories tall, adorned by three arches at the entrance. The factory, the Web site boasts, “can strictly obey the contract and keep its word.” But like the factory’s syrup, all is not as it seems. There are no tall buildings in Hengxiang, a country town with one main road. The factory is not certified to sell any medical ingredients, Chinese officials say. And it looks nothing like the picture on the Internet. In reality, its chemicals are mixed in a plain, one-story brick building. The factory is in a walled compound, surrounded by small shops and farms. In the spring, nearby fields of rape paint the countryside yellow. Near the front gate, a sign over the road warns, “Beware of counterfeits.” But it was posted by a nearby noodle machine factory that appears to be worried about competition.The Taixing Glycerine Factory bought its diethylene glycol from the same manufacturer as Mr. Wang, the former tailor, the government investigator said. From this spot in China’s chemical country, the 46 barrels of toxic syrup began their journey, passing from company to company, port to port and country to country, apparently without anyone testing their contents. Traders should be thoroughly familiar with their suppliers, United States health officials say. “One simply does not assume that what is labeled is indeed what it is,” said Dr. Murray Lumpkin, deputy commissioner for international and special programs for the Food and Drug Administration.In the Panama case, names of suppliers were removed from shipping documents as they passed from one entity to the next, according to records and investigators. That is a practice some traders use to prevent customers from bypassing them on future purchases, but it also hides the provenance of the product. The first distributor was the Beijing trading company, CNSC Fortune Way, a unit of a state-owned business that began by supplying goods and services to Chinese personnel and business officials overseas.As China’s market reach expanded, Fortune Way focused its business on pharmaceutical ingredients, and in 2003, it brokered the sale of the suspect syrup made by the Taixing Glycerine Factory. The manufacturer’s certificate of analysis showed the batch to be 99.5 percent pure.Whether the Taixing Glycerine Factory actually performed the test has not been publicly disclosed. Original certificates of analysis should be passed on to each new buyer, said Kevin J. McGlue, a board member of the International Pharmaceutical Excipients Council. In this case, that was not done.第六部分:Fortune Way translated the certificate into English, putting its name — not the Taixing Glycerine Factory’s — at the top of the document, before shipping the barrels to a second trading company, this one in Barcelona.Li Can, managing director at Fortune Way, said he did not remember the transaction and could not comment, adding, “There is a high volume of trade.” Upon receiving the barrels in September 2003, the Spanish company, Rasfer International, did not test the contents, either. It copied the chemical analysis provided by Fortune Way, then put its logo on it. Ascensión Criado, Rasfer’s manager, said in an e-mail response to written questions that when Fortune Way shipped the syrup, it did not say who made it. Several weeks later, Rasfer shipped the drums to a Panamanian broker, the Medicom Business Group. “Medicom never asked us for the name of the manufacturer,” Ms. Criado said.A lawyer for Medicom, Valentín Jaén, said his client was a victim, too. “They were tricked by somebody,” Mr. Jaén said. “They operated in good faith.”In Panama, the barrels sat unused for more than two years, and officials said Medicom improperly changed the expiration date on the syrup. During that time, the company never tested the product. And the Panamanian government, which bought the 46 barrels and used them to make cold medicine, also failed to detect the poison, officials said. The toxic pipeline ultimately emptied into the bloodstream of people like Ernesto Osorio, a former high school teacher in Panama City. He spent two months in the hospital after ingesting poison cough syrup last September.Just before Christmas, after a kidney dialysis treatment, Mr. Osorio stood outside the city’s big public hospital in a tear-splattered shirt, describing what his life had become. “I’m not an eighth of what I used to be,” Mr. Osorio said, his partly paralyzed face hanging like a slab of meat. “I have trouble walking. Look at my face, look at my tears.” The tears, he said apologetically, were not from emotion, but from nerve damage.And yet, Mr. Osorio knows he is one of the lucky victims. “They didn’t know how to keep the killer out of the medicine,” he said simply.While the suffering in Panama was great, the potential profit — at least for the Spanish trading company, Rasfer — was surprisingly small. For the 46 barrels of glycerin, Rasfer paid Fortune Way $9,900, then sold them to Medicom for $11,322, according to records.Chinese authorities have not disclosed how much Fortune Way and the Taixing Glycerine Factory made on their end, or how much they knew about what was in the barrels.“The fault has to be traced back to areas of production,” said Dr. Motta, the cardiologist in Panama who helped uncover the source of the epidemic. “This was my plea — please, this thing is happening to us, make sure whoever did this down the line is not doing it to Peru or Sierra Leone or some other place.”A Counterfeiter’s ConfessionThe power to prosecute the counterfeiters is now in the hands of the Chinese.Last spring, the government moved quickly against Mr. Wang, the former tailor who poisoned Chinese residents. The authorities caught up with him at a roadblock in Taizhou, a city just north of Taixing, in chemical country. He was weak and sick, and he had not eaten in two days. Inside his white sedan was a bankbook and cash. He had fled without his wife and teenage son.Chinese patients were dead, a political scandal was brewing and the authorities wanted answers. Mr. Wang was taken to a hospital. Then, in long sessions with investigators, he gave them what they wanted, explaining his scheme, how he tested industrial syrup by drinking it, how he decided to use diethylene glycol and how he conned pharmaceutical companies into buying his syrup, according to a government official who was present for his interrogation. “He made a fortune, but none of it went to his family,” said Wang Xiaodong, a former village official who knows Mr. Wang and his siblings. “He liked to gamble.”第七部分:Mr. Wang remains in custody as the authorities decide whether he should be put to death. The Qiqihar drug plant that made the poisonous medicine has been closed, and five employees are now being prosecuted for causing “a serious accident.”In contrast to the Wang Guiping investigation, Chinese authorities have been tentative in acknowledging China’s link to the Panama tragedy, which involved a state-owned trading company. No one in China has been charged with committing the fraud that ended up killing so many in Panama. Sun Jing, the pharmaceutical program officer for the World Health Organization in Beijing, said the health agency sent a fax “to remind the Chinese government that China should not be selling poisonous products overseas.” Ms. Sun said the agency did not receive an official reply. Last fall, at the request of the United States — Panama has no diplomatic relations with China — the State Food and Drug Administration of China investigated the Taixing Glycerine Factory and Fortune Way. The agency tested one batch of glycerin from the factory, and found no glycerin, only diethylene glycol and two other substances, a drug official said.Since then, the Chinese drug administration has concluded that it has no jurisdiction in the case because the factory is not certified to make medicine.The agency reached a similar conclusion about Fortune Way, saying that as an exporter it was not engaged in the pharmaceutical business.“We did not find any evidence that either of these companies had broken the law,” said Yan Jiangying, a spokeswoman for the drug administration. “So a criminal investigation was never opened.” A drug official said the investigation was subsequently handed off to an agency that tests and certifies commercial products — the General Administration of Quality Supervision, Inspection and Quarantine. But the agency acted surprised to learn that it was now in charge. “What investigation?” asked Wang Jian, director of its Taixing branch. “I’m not aware of any investigation involving a glycerin factory.”Besides, Huang Tong, an investigator in that office, said, “We rarely get involved in products that are sold for export.”Wan Qigang, the legal representative for the Taixing Glycerine Factory, said in an interview late last year that the authorities had not questioned him about the Panama poisoning, and that his company made only industrial-grade glycerin. “I can tell you for certain that we have no connection with Panama or Spain,” Mr. Wan said.But in recent months, the Glycerine Factory has advertised 99.5 percent pure glycerin on the Internet.Mr. Wan recently declined to answer any more questions. “If you come here as a guest, I will welcome you,” Mr. Wan said. “But if you come again wanting to talk about this matter, I will make a telephone call.” A local government official said Mr. Wan was told not to grant interviews.A five-minute walk away, another manufacturer, the Taixing White Oil Factory, also advertises medical glycerin on the Internet, yet it, too, has no authorization to make it. The company’s Web site says its products “have been exported to America, Australia and Italy.”Ding Xiang, who represents the White Oil Factory, denied that his company made pharmaceutical-grade glycerin, but he said chemical trading companies in Beijing often called, asking for it.“They want us to mark the barrels glycerin,” Mr. Ding said in late December. “I tell them we cannot do that.”Mr. Ding said he stopped answering calls from Beijing. “If this stuff is taken overseas and improperly used. ...” He did not complete the thought. In chemical country, product names are not always what they seem. “The only two factories in Taixing that make glycerin don’t even make glycerin,” said Jiang Peng, who oversees inspections and investigations in the Taixing branch of the State Food and Drug Administration. “It is a different product.”All in a NameOne lingering mystery involves the name of the product made by the Taixing Glycerine Factory. The factory had called its syrup “TD” glycerin. The letters TD were in virtually all the shipping documents. What did TD mean? Spanish medical authorities concluded that it stood for a manufacturing process. Chinese inspectors thought it was the manufacturer’s secret formula. But Yuan Kailin, a former salesman for the factory , said he knew what the TD meant because a friend and former manager of the factory, Ding Yuming, had once told him. TD stood for the Chinese word “tidai” (pronounced tee-die), said Mr. Yuan, who left his job in 1998 and still lives about a mile from the factory. In Chinese, tidai means substitute. A clue that might have revealed the poison, the counterfeit product, was hiding in plain sight. It was in the product name.文章太长了,先认领第一部分,会尽快翻译.第二、三部分本人也认领，48小时未能提交，请再认领“It’s vastly underreported,” Dr. Bennish said of diethylene glycol poisoning. Doctors might not suspect toxic medicine, particularly in poor countries with limited resources and a generally unhealthy population, he said, adding, “Most people who die don’t come to a medical facility.”Dr. Bennish 说：“二甘醇中毒很少见报导”。 医生或许不会怀疑药品有毒，通常在那些资源有限和人口健康状况很差的贫穷国家尤其如此。他补充说道，很多死去的人根本就没有想到是医疗设施。The makers of counterfeit glycerin, which superficially looks and acts like the real thing but generally costs considerably less, are rarely identified, much less prosecuted, given the difficulty of tracing shipments across borders. “This is really a global problem, and it needs to be handled in a global way,” said Dr. Henk Bekedam, the World Health Organization’s top representative in Beijing. 丙三醇的伪劣制造者们通常浅薄地认为花较低成本就可制得作用与外貌一样的药物，极少对药物鉴定更少遭到起诉，由于很难追踪他们发货出境。Henk Bekedam，在北京召开的高级世界卫生组织大会上说：“这是一个全球性问题，必须用全球方化式处理”。Seventy years ago, medicine laced with diethylene glycol killed more than 100 people in the United States, leading to the passage of the toughest drug regulations of that era and the creation of the modern Food and Drug Administration.70年代前，在美国因为加酒的二甘醇药物致100多人死亡，自那时起致使人们加强药物法规的形成及现代药物食品管理局建立。The F.D.A. has tried to help in poisoning cases around the world, but there is only so much it can do. 药物食品管理局设法帮助世界范围内的药物中毒事件，但实际上不仅仅只是这些。When at least 88 children died in Haiti a decade ago, F.D.A. investigators traced the poison to the Manchurian city of Dalian, but their attempts to visit the suspected manufacturer were repeatedly blocked by Chinese officials, according to internal State Department records. Permission was granted more than a year later, but by then the plant had moved and its records had been destroyed. 10多年前在海地至少有88位儿童因药物致死，F.A.D调查追踪其来源于中国大连，但当他们试图进一步查明其怀疑的制造商时被当地政府官员再三阻止，依据国内的记录。允许在一年过后，但是，工厂搬迁其记录也就被毁。“Chinese officials we contacted on this matter were all reluctant to become involved,” the American Embassy in Beijing wrote in a confidential cable. “We cannot be optimistic about our chances for success in tracking down the other possible glycerine shipments.” “我们所接触的政府官员都不愿参与此事”，一位驻北京的美国大使在一封密电中写到，“在追踪其他可能的二甘醇发货方式时，形势不容乐观。”In fact, The Times found records showing that the same Chinese company implicated in the Haiti poisoning also shipped about 50 tons of counterfeit glycerin to the United States in 1995. Some of it was later resold to another American customer, Avatar Corporation, before the deception was discovered. 事实上，英国泰晤士报找到1995年在海地毒药事件中，也有约50吨带有中国船运标记的伪劣二甘醇进入美国市场。“Thank God we caught it when we did,” said Phil Ternes, chief operating officer of Avatar, a Chicago-area supplier of bulk pharmaceuticals and nonmedicinal products. The F.D.A. said it was unaware of the shipment.芝加哥地区的大批量药物和非药物供应商，埃维塔公司主管Phil Ternes说，“感谢上帝我们发现了它”，在FDA还没意识到时。In China, the government is vowing to clean up its pharmaceutical industry, in part because of criticism over counterfeit drugs flooding the world markets. In December, two top drug regulators were arrested on charges of taking bribes to approve drugs. In addition, 440 counterfeiting operations were closed down last year, the World Health Organization said.据世界卫生组织报导，在中国，政府答应整理规范制药工业，某种程度上是因为大量的伪劣药物流入国外市场而招致批判，去年12月份，两位高级药物法规执行者因受贿而被捕。此外，440多加非法药物公司被停产。But when Chinese officials investigated the role of Chinese companies in the Panama deaths, they found that no laws had been broken, according to an official of the nation’s drug enforcement agency. China’s drug regulation is “a black hole,” said one trader who has done business through CNSC Fortune Way, the Beijing-based broker that investigators say was a crucial conduit for the Panama poison. 但是，当中国政府通过一个国家药物代理机构调查中国公司在巴拿马死亡事件中所扮演的角色时发现没有违法行为，一位通过CNSC致富的商人说，“中国药物管理存在漏洞”，北京的一位经济人士说，巴拿马事件就像一个十字形管道。In this environment, Wang Guiping, a tailor with a ninth-grade education and access to a chemistry book, found it easy to enter the pharmaceutical supply business as a middleman. He quickly discovered what others had before him: that counterfeiting was a simple way to increase profits.在这种环境下，王平贵，一位只具初中文化的商人，发现作为药品供应的中间人是一件很容易的事。他也很快就发现在他之前的那些人：增加利润的一个简单方式就是造假。 And then people in China began to die.在中国有人开始死于造假药物。Cheating the System欺骗方法体系Mr. Wang spent years as a tailor in the manufacturing towns of the Yangtze Delta, in eastern China. But he did not want to remain a common craftsman, villagers say. He set his sights on trading chemicals, a business rooted in the many small chemical plants that have sprouted in the region. 王先生作为一位商人很快就在中国东部的长江三角洲制造了许多伪劣产品。他根本就没想到他是一位普通的制造商。村民们说，他竖起了一个化学药物制造的榜样，在这个地区许多小化工厂如雨后春笋般涌出。“He didn’t know what he was doing,” Mr. Wang’s older brother, Wang Guoping, said in an interview. “He didn’t understand chemicals.”“他不知道他在干什么，”王贵平的哥哥说，“他不懂化学药物制作”。But he did understand how to cheat the system.但他，理解明白怎样去欺骗的规则。Wang Guiping, 41, realized he could earn extra money by substituting cheaper, industrial-grade syrup — not approved for human consumption — for pharmaceutical grade syrup. To trick pharmaceutical buyers, he forged his licenses and laboratory analysis reports, records show.在王平贵41岁时，意识到可以利用廉价的代替物赚更多的收入，工业糖浆不允许用于制造供人使用的药用糖浆。为了欺骗购药买主，他伪造了执照和实验室的分析，并把它公示出来。Mr. Wang later told investigators that he figured no harm would come from the substitution, because he initially tested a small quantity. He did it with the expertise of a former tailor.王后来告诉调查人员说他的替代品数据没有造成损害，因为他的最初测试数量较小。并进行专业包装。He swallowed some of it. When nothing happened, he shipped it.他自己吞食了一些这种糖浆。什么也没发生，然后他装船并贴了质检条。One company that used the syrup beginning in early 2005 was Qiqihar No. 2 Pharmaceutical, about 1,000 miles away in Heilongjiang Province in the northeast. A buyer for the factory had seen a posting for Mr. Wang’s syrup on an industry Web site.早在2005年远在东北黑龙江省1000公里的齐齐哈尔No. 2制药公司开始使用这种糖浆。这个公司的采购员在一个工业网站上看到了王的这种糖浆的邮购品。该文编译字数1200Dr. Bennish 说：“二甘醇中毒很少见报导”。 医生或许不会怀疑药品有毒，通常在那些资源有限和人口健康状况很差的贫穷国家尤其如此。他补充说道，很多死去的人根本就没有想到是医疗设施。丙三醇的伪劣制造者们通常浅薄地认为花较低成本就可制得作用与外貌一样的药物，极少对药物鉴定更少遭到起诉，由于很难追踪他们发货出境。Henk Bekedam，在北京召开的高级世界卫生组织大会上说：“这是一个全球性问题，必须用全球方化式处理”。 70年代前，在美国因为加酒的二甘醇药物致100多人死亡，自那时起致使人们加强药物法规的形成及现代药物食品管理局建立。药物食品管理局设法帮助世界范围内的药物中毒事件，但实际上不仅仅只是这些。 10多年前在海地至少有88位儿童因药物致死，F.A.D调查追踪其来源于中国大连，但当他们试图进一步查明其怀疑的制造商时被当地政府官员再三阻止，依据国内的记录。允许在一年过后，但是，工厂搬迁其记录也就被毁。“我们所接触的政府官员都不愿参与此事”，一位驻北京的美国大使在一封密电中写到，“在追踪其他可能的二甘醇发货方式时，形势不容乐观。” 事实上，英国泰晤士报找到1995年在海地毒药事件中，也有约50吨带有中国船运标记的伪劣二甘醇进入美国市场。芝加哥地区的大批量药物和非药物供应商，埃维塔公司主管Phil Ternes说，“感谢上帝我们发现了它”，在FDA还没意识到时。 据世界卫生组织报导，在中国，政府答应整理规范制药工业，某种程度上是因为大量的伪劣药物流入国外市场而招致批判，去年12月份，两位高级药物法规执行者因受贿而被捕。此外，440多加非法药物公司被停产。 但是，当中国政府通过一个国家药物代理机构调查中国公司在巴拿马死亡事件中所扮演的角色时发现没有违法行为，一位通过CNSC致富的商人说，“中国药物管理存在漏洞”，北京的一位经济人士说，巴拿马事件就像一个十字形管道错综复杂。在这种环境下，王平贵，一位只具初中文化的商人，发现作为药品供应的中间人是一件很容易的事。他也很快就发现在他之前的那些人：增加利润的一个简单方式就是造假。 在中国有人开始死于造假药物。 欺骗方法体系王先生作为一位商人很快就在中国东部的长江三角洲制造了许多伪劣产品。他根本就没想到他是一位普通的制造商。村民们说，他竖起了一个化学药物制造的榜样，在这个地区许多小化工厂如雨后春笋般涌出。“他不知道他在干什么，”王贵平的哥哥说，“他不懂化学药物制作”。 但他，理解明白怎样去欺骗的规则。在王平贵41岁时，意识到可以利用廉价的代替物赚更多的收入，工业糖浆不允许用于制造供人使用的药用糖浆。为了欺骗购药买主，他伪造了执照和实验室的分析，并把它公示出来。王后来告诉调查人员说他的替代品数据没有造成损害，因为他的最初测试数量较小。并进行专业包装。 他自己吞食了一些这种糖浆。什么也没发生，然后他装船并贴了质检条。 早在2005年远在东北黑龙江省1000公里的齐齐哈尔No. 2制药公司开始使用这种糖浆。这个公司的采购员在一个工业网站上看到了王的这种糖浆的邮购品。After a while, Mr. Wang set out to find an even cheaper substitute syrup so he could increase his profit even more, according to a Chinese investigator. In a chemical book he found what he was looking for: another odorless syrup — diethylene glycol. At the time, it sold for 6,000 to 7,000 yuan a ton, or about $725 to $845, while pharmaceutical-grade syrup cost 15,000 yuan, or about $1,815, according to the investigator. 依照中国的调查显示，不久，王先生开始着手寻找更廉价的糖浆替代品以赚取更大的利润。在一本化学药物书中他找到了他要寻找的另一种无色无味的糖浆－二甘醇。同时，根据调查显示，这种物质一吨售价6,000到7，000元人民币，约725到845美元，然而制药糖浆价值15,000人民币，约1,815美元。Mr. Wang did not taste-test this second batch of syrup before shipping it to Qiqihar Pharmaceutical, the government investigator said, adding, “He knew it was dangerous, but he didn’t know that it could kill.” 王先生在装运到齐齐哈尔之前没有再次品尝作感官测试，政府调查官员补充说，“他知道这种物品危险，但他不知道能置人于死地”。The manufacturer used the toxic syrup in five drug products: ampules of Amillarisin A for gall bladder problems; a special enema fluid for children; an injection for blood vessel diseases; an intravenous pain reliever; and an arthritis treatment. 制造商用这种有毒的糖浆生产了5种药物：胆囊疾病的Amillarisin安瓿；专用于小儿的灌肠液；血管疾病注射液；静脉用解热镇痛药；关节炎治疗药。In April 2006, one of southern China’s finest hospitals, in Guangzhou, Guangdong Province, began administering Amillarisin A. Within a month or so, at least 18 people had died after taking the medicine, though some had already been quite sick. 2006年4月，在中国南方广东省的广州市的一家很好的医院开始试用Amillarisin 甲，虽然有的曾经病得很严重，但至少有18人在服药大约一个月左右后死亡。Zhou Jianhong, 33, said his father took his first dose of Amillarisin A on April 19. A week later he was in critical condition. “If you are going to die, you want to die at home,” Mr. Zhou said. “So we checked him out of the hospital.” He died the next day.周建红，33岁，说他父亲第一次服用Amillarisin 甲是4月19日。一周后病情加剧。“假如你要死，你会想死在家”周说，“我们办了出院把他接回家。”回家后第二天他就去世了。“Everybody wants to invest in the pharmaceutical industry and it is growing, but the regulators can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”“ 因为它的发展，大家都想在制药业投资。但我们的制度跟不上。”周先生说，“我们需要一个能确保我们安全的系统。”The final death count is unclear, since some people who took the medicine may have died in less populated areas. 最后的死亡人数不清楚，因为有些服药者来自于人口稀少的地区。In a small town in Sichuan Province, a man named Zhou Lianghui said the authorities would not acknowledge that his wife had died from taking tainted Amillarisin A. But Mr. Zhou, 38, said he matched the identification number on the batch of medicine his wife received with a warning circular distributed by drug officials.在四川省的一个偏远小镇，一位叫周良辉的男子说，当局不承认他的妻子死于服用污染的Amillarisin 甲。周先生，38岁，说他用他的配偶身份证号码对给妻子发这批医药的官员警示通告。 “You probably cannot understand a small town if you are in Beijing,” Zhou Lianghui said in a telephone interview. “The sky is high, and the emperor is far away. There are a lot of problems here that the law cannot speak to.” "你也许无法理解一个小镇,如果你是在北京，"周良辉在电话采访中说，“山高皇帝远。有很多问题是没有法律可言的。”The failure of the government to stop poison from contaminating the drug supply caused one of the bigger domestic scandals of the year. Last May, China’s premier, Wen Jiabao, ordered an investigation of the deaths, declaring, “The pharmaceutical market is in disorder.” 政府未能阻止毒物污染 ，毒品供应造成一个更大的国内丑闻的一年。去年5月,中国国务院总理***,下令进行调查的死亡报告，宣告：药品市场是一片混乱。At about the same time, 9,000 miles away in Panama, the long rainy season had begun. Anticipating colds and coughs, the government health program began manufacturing cough and antihistamine syrup. The cough medicine was sugarless so that even diabetics could use it. 与此同时，9，000英里以外的巴拿马，长长的雨季已经开始。预防感冒和咳嗽,政府的医疗保健开始制造咳嗽糖浆抗组胺药。咳嗽药是无糖的以便于糖尿病人可以服用。 The medicine was mixed with a pale yellow, almost translucent syrup that had arrived in 46 barrels from Barcelona on the container ship Tobias Maersk. Shipping records showed the contents to be 99.5 percent pure glycerin.来自巴塞罗那的46万桶几乎是半透明杂着浅黄，糖浆药集装箱船运抵托比马士基。航运记录显示的成分应为99.5%纯甘油。It would be months and many deaths later before that certification was discovered to be pure fiction. 这是个多人死亡后,在那之前认证发现纯属子虚乌有。A Mysterious Illness神秘的疾病Early last September, doctors at Panama City’s big public hospital began to notice patients exhibiting unusual symptoms. 早在去年9月，在巴拿马大型公立医院的医生就开始注意到患者出现异常的症状。They initially appeared to have Guillain-Barré syndrome, a relatively rare neurological disorder that first shows up as a weakness or tingling sensation in the legs. That weakness often intensifies, spreading upward to the arms and chest, sometimes causing total paralysis and an inability to breathe.起初，患者表现为格林巴利综合征，相对罕见的神经紊乱，首先表现为腿部无力与刺痛感。这种无力常加剧，并向上传导到手臂和胸部，有时引起全身无力与呼吸困难。The new patients had paralysis, but it did not spread upward. They also quickly lost their ability to urinate, a condition not associated with Guillain-Barré. Even more unusual was the number of cases. In a full year, doctors might see eight cases of Guillain-Barré, yet they saw that many in just two weeks. 新病人麻痹后，但它不向上传递。他们也很快失去排尿能力，这与格林巴利综合征不相关。即使是罕见的个案。一全年医生可能会见到8例格林巴利综合征，然而现在短短两周他们就看到许多类似患者。Doctors sought help from an infectious disease specialist, Néstor Sosa, an intense, driven doctor who competes in triathlons and high-level chess. 医生们向传染病专家Néstor Sosa求助，并驱使医生们之间向在进行三项全能运动和高水平的象棋比赛竞争探求病因。Dr. Sosa’s medical specialty had a long, rich history in Panama, once known as one of the world’s unhealthiest places. In one year in the late 1800s, a lethal mix of yellow fever and malaria killed nearly 1 in every 10 residents of Panama City. Only after the United States managed to overcome those mosquito-borne diseases was it able to build the Panama Canal without the devastation that undermined an earlier attempt by the French. Sosa博士在健康贫乏地区巴拿马医专业学领域久负盛名。1800年底，一种致命的组合黄热病和疟疾使巴拿马居民每10人就有1人死亡。仅居美国之后设法克复这些蚊传播疾病，在早期法国试图暗中破坏的情况下而没有放弃修建巴拿马运河。 The suspected Guillain-Barré cases worried Dr. Sosa. “It was something really extraordinary, something that was obviously reaching epidemic dimensions in our hospital,” he said.这个可疑的格林巴利综合征使Sosa’s博士烦恼不堪。他说到“在我们医院有时候真的令人惊讶，有时候它达到流行病的尺度”。With the death rate from the mystery illness near 50 percent, Dr. Sosa alerted the hospital management, which asked him to set up and run a task force to handle the situation. The assignment, a daunting around-the-clock dash to catch a killer, was one he eagerly embraced. 随着神秘疾病死亡率接近50%，Sosa’s博士警告医院的管理处，让他建立一个专门的情况处理小组。被指定捕捉无休止恐吓人的放毒者是要对生活有积极态度的人。Several years earlier, Dr. Sosa had watched as other doctors identified the cause of another epidemic, later identified as hantavirus, a pathogen spread by infected rodents.早在几年前，Sosa博士观察了经其他医生证实了得另外的流行病因，后来被证实是由啮齿类动物传播的汉坦病毒。“I took care of patients but I somehow felt I did not do enough,” he said. The next time, he vowed, would be different. “我精心照料患者，但我有时仍感觉我做得还不够，”他说到。他发誓说下一次将又会有所不同。Dr. Sosa set up a 24-hour “war room” in the hospital, where doctors could compare notes and theories as they scoured medical records for clues. Sosa博士成立了24小时治疗病室，在这里医生可以比较对照他们搜索到的医疗档案与文献记录。该文编译字数1433依照中国的调查显示，不久，王先生开始着手寻找更廉价的糖浆替代品以赚取更大的利润。在一本化学药物书中他找到了他要寻找的另一种无色无味的糖浆－二甘醇。同时，根据调查显示，这种物质一吨售价6,000到7，000元人民币，约725到845美元，然而制药糖浆价值15,000人民币，约1,815美元。王先生在装运到齐齐哈尔之前没有再次品尝作感官测试，政府调查官员补充说，“他知道这种物品危险，但他不知道能置人于死地”。制造商用这种有毒的糖浆生产了5种药物：胆囊疾病的Amillarisin安瓿；专用于小儿的灌肠液；血管疾病注射液；静脉用解热镇痛药；关节炎治疗药。2006年4月，在中国南方广东省的广州市的一家很好的医院开始试用Amillarisin 甲，虽然有的曾经病得很严重，但至少有18人在服药大约一个月左右后死亡。周建红，33岁，说他父亲第一次服用Amillarisin 甲是4月19日。一周后病情加剧。“假如你要死，你会想死在家”周说，“我们办了出院把他接回家。”回家后第二天他就去世了。“ 因为它的发展，大家都想在制药业投资。但我们的制度跟不上。”周先生说，“我们需要一个能确保我们安全的系统。”最后的死亡人数不清楚，因为有些服药者来自于人口稀少的地区。在四川省的一个偏远小镇，一位叫周良辉的男子说，当局不承认他的妻子死于服用污染的Amillarisin 甲。周先生，38岁，说他用他的配偶身份证号码对给妻子发这批医药的官员警示通告。"你也许无法理解一个小镇,如果你是在北京，"周良辉在电话采访中说，“山高皇帝远。有很多问题是没有法律可言的。政府未能阻止毒物污染 ，毒品供应造成一个更大的国内丑闻的一年。去年5月,中国国务院总理***,下令进行调查的死亡报告，宣告：药品市场是一片混乱。与此同时，9，000英里以外的巴拿马，长长的雨季已经开始。预防感冒和咳嗽,政府的医疗保健开始制造咳嗽糖浆抗组胺药。咳嗽药是无糖的以便于糖尿病人可以服用。来自巴塞罗那的46万桶几乎是半透明杂着浅黄，糖浆药集装箱船运抵托比马士基。航运记录显示的成分应为99.5%纯甘油。这是个多人死亡后,在那之前认证发现纯属子虚乌有。神秘的疾病早在去年9月，在巴拿马大型公立医院的医生就开始注意到患者出现异常的症状。起初，患者表现为格林巴利综合征，相对罕见的神经紊乱，首先表现为腿部无力与刺痛感。这种无力常加剧，并向上传导到手臂和胸部，有时引起全身无力与呼吸困难。新病人麻痹后，但它不向上传递。他们也很快失去排尿能力，这与格林巴利综合征不相关。即使是罕见的个案。一全年医生可能会见到8例格林巴利综合征，然而现在短短两周他们就看到许多类似患者。医生们向传染病专家Néstor Sosa求助，并驱使医生们之间向在进行三项全能运动和高水平的象棋比赛竞争探求病因。Sosa博士在健康贫乏地区巴拿马医专业学领域久负盛名。1800年底，一种致命的组合黄热病和疟疾使巴拿马居民每10人就有1人死亡。仅居美国之后设法克复这些蚊传播疾病，在早期法国试图暗中破坏的情况下而没有放弃修建巴拿马运河。 这个可疑的格林巴利综合征使Sosa’s博士烦恼不堪。他说到“在我们医院有时候真的令人惊讶，有时候它达到流行病的尺度”。随着神秘疾病死亡率接近50%，Sosa’s博士警告医院的管理处，让他建立一个专门的情况处理小组。被指定捕捉无休止恐吓人的放毒者是要对生活有积极态度的人。早在几年前，Sosa博士观察了经其他医生证实了得另外的流行病因，后来被证实是由啮齿类动物传播的汉坦病毒。“我精心照料患者，但我有时仍感觉我做得还不够，”他说到。他发誓说下一次将又会有所不同。Sosa博士成立了24小时治疗病室，在这里医生可以比较对照他们搜索到的医疗档案与文献记录。The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die. 首先是肾衰，其次中枢神经系统开始失控。麻痹差，造成呼吸困难，然后往往无医疗救助变得无法呼吸，最后大多数受害者死亡。Many of them are children, poisoned at the hands of their unsuspecting parents. 他们中的很多人是孩子，成为他们父母缺乏戒心的受害者。The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. 这种糖浆状有毒液体，二甘醇，作为一种工业溶剂和一些防冻液的主要成分是现代世界不可或缺的部分。It is also a killer. And the deaths, if not intentional, are often no accident. 它还是一个杀手，而死亡事例即使不是有意而为，也常常不是事故。Over the years, the poison has been loaded into all varieties of medicine — cough syrup, fever medication, injectable drugs — a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin, commonly used in drugs, food, toothpaste and other products.多年来,这种毒物在各种药品中应用--止咳糖浆，退烧药，注射剂--牟利的制造商用它代替了另一种安全但更贵的甜味溶剂（通常为甘油），它在药品、食品、牙膏和其它产品中有广泛应用。Toxic syrup has figured in at least eight mass poisonings around the world in the past two decades. Researchers estimate that thousands have died. In many cases, the precise origin of the poison has never been determined. But records and interviews show that in three of the last four cases it was made in China, a major source of counterfeit drugs. 在过去二十年中，世界各地以这种有毒糖浆进行大规模投毒已达了至少八次，研究者估计已有数千人死亡。 在许多情况下，这种毒药的确切来源从来没有确定过。但记录和访谈显示最近四例中的三个都是来自中国--假药的一个主要来源地。Panama is the most recent victim. Last year, government officials there unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine — with devastating results. Families have reported 365 deaths from the poison, 100 of which have been confirmed so far. With the onset of the rainy season, investigators are racing to exhume as many potential victims as possible before bodies decompose even more. 巴拿马是最近的受害者. 去年,政府官员出于无意将二甘醇混入260,000瓶感冒药中，结果造成了灾难性后果。他们收到了365人死亡的家庭报告，目前已有100人得到确认。 随着雨季的到来，调查人员要在其腐烂之前尽可能多地挖出许多潜在受害者的遗体。Panama’s death toll leads directly to Chinese companies that made and exported the poison as 99.5 percent pure glycerin.巴拿马的死亡人数与中国公司将二甘醇作为99.5%的甘油出口直接相关。Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching halfway around the world. Through shipping records and interviews with government officials, The New York Times traced this pipeline from the Panamanian port of Colón, back through trading companies in Barcelona, Spain, and Beijing, to its beginning near the Yangtze Delta in a place local people call “chemical country.” 四十六桶毒糖浆经过一条“毒物管道”抵达了半个地球。通过航运记录和对政府官员的采访，纽约时报从巴拿马的科隆港口追踪这条管道，通过回溯到巴塞罗那、西班牙和北京的贸易公司，最后到其长江三角洲地区附近的的始发点，这个地点被当地人称为“化学之乡（chemical country）”。The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered — as The Times did — that the manufacturer was not certified to make pharmaceutical ingredients. 这些假丙三醇经过三大洲的三家贸易公司，然而它们都没有测试这些糖浆进行检测。在航运过程中，证明货物纯度的证书被一改再改，删去了制造商和早前所有者的名字。结果，购买这些糖浆的贸易商不知道它来自何方，谁是制造者。而有了这些信息，贸易商本可能和纽约时报一样发现该糖浆的制造商没有制造药用辅料的资格。An examination of the two poisoning cases last year — in Panama and earlier in China — shows how China’s safety regulations have lagged behind its growing role as low-cost supplier to the world. It also demonstrates how a poorly policed chain of traders in country after country allows counterfeit medicine to contaminate the global market. 对去年的两起毒药案（在巴拿马和中国）的考察显示，中国的安全管理是如何的落后于它作为世界不断成长的低成本供应商的角色。它同时证明了自从该国允许其“假劣药品”进入全球市场后对药品贸易链的监管是如此疏松。Last week, the United States Food and Drug Administration warned drug makers and suppliers in the United States “to be especially vigilant” in watching for diethylene glycol. The warning did not specifically mention China, and it said there was “no reason to believe” that glycerin in this country was tainted. Even so, the agency asked that all glycerin shipments be tested for diethylene glycol, and said it was “exploring how supplies of glycerin become contaminated.”上周，美国食品与药品管理局警告美国的药品制造商和供应商，要对二甘醇”保持特别的警惕“。这个警告并没有特别提到中国，而且它表示”没有理由认为“美国的丙三醇也受到了污染。即使如此，该机构还是要求所有甘油输送商要对甘油进行二甘醇测试，并说这是为了”探究甘油是如何被污染的。“China is already being accused by United States authorities of exporting wheat gluten containing an industrial chemical, melamine, that ended up in pet food and livestock feed. The F.D.A. recently banned imports of Chinese-made wheat gluten after it was linked to pet deaths in the United States. 一家中国公司已经遭到美国当局的起诉，它出口的麦麸中含有工业化学品三聚氰胺，这些麦麸被用于制造宠物食品和家畜饲料。确认这些麦麸跟美国的宠物死亡有联系后，FDA最近对从中国进口麦麸发出禁令。Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, Bangladesh, Argentina, Nigeria and twice in India. 除了巴拿马和中国之外，毒糖浆在海地、孟加拉国、阿根廷、尼日利亚和印度（两次）造成群众中毒事件。In Bangladesh, investigators found poison in seven brands of fever medication in 1992, but only after countless children died. A Massachusetts laboratory detected the contamination after Dr. Michael L. Bennish, a pediatrician who works in developing countries, smuggled samples of the tainted syrup out of the country in a suitcase. Dr. Bennish, who investigated the Bangladesh epidemic and helped write a 1995 article about it for BMJ, formerly known as the British Medical Journal, said that given the amount of medication distributed, deaths “must be in the thousands or tens of thousands.”在孟加拉国不计其数的孩子死亡之后，调查员才于1992 年在七种退烧药中发现了毒物。自从在发展中国家工作的儿科医师Michael L. Bennish博士用手提箱查偷运出了被污染的糖浆样品后马萨诸塞实验室对之进行了检测，Bennish博士主要研究孟加拉国的流行病并于1995 年为《英国医学期刊》（BMJ）写了一篇相关文章， 声称，”考虑到已经使用的药品数量， 死亡人数必须以千计或以万计。"第四、五部分本人已认领，48小时未提交，请再认领第六部分:Fortune Way贸易公司在把这些有毒产品运送到位于巴塞罗那的第二家贸易公司之前把证明文件翻译为英文，并且去掉了文档中的泰兴甘油厂（the Taixing Glycerine Factory）的名字，代之以自己公司的名字。李灿（音），Fortune Way贸易公司的主管说他不知道那次的交易所以无法发表评论，但他补充说他们公司的交易量很大。 位于西班牙的Rasfer International公司在接收到这些装满货物的桶时，同样没有检验货物的成分。他们也复制了Fortune Way公司提供的化学成分分析的文件，并且把自己公司的标志放到了文件中。Rasfer International公司的经理Ascensión Criado在一份回答Fortune Way公司什么时候发出了该批货物的书面提问的电子邮件中这样说到，但也没有提到是谁制造了这些产品。 几个星期以后，他们把这批货物发送给了巴拿马的一家贸易公司the Medicom Business Group，Criado说： Medicom公司从未问过制造厂商的名字”。　　 Medicom公司的一名律师Valentín Jaén说：“我的雇主也是受害者，他们是被某些人欺骗了，我雇主的公司一向信誉良好”。　　 在巴拿马，这些装满毒药的桶被放置了两年多，巴拿马的调查官员说Medicom公司擅自更改了糖浆的过期日期。　　 在此期间，该公司从未检验过这些产品。巴拿马官方称，巴拿马政府购买了这46桶糖浆并将其用于生产感冒药，却同样没有检验这些产品。　　 毒药的管道最后进入了如Ernesto Osorio一样的患者的血液中，他曾是巴拿马的一位高中老师。去年9月，他服用了有毒的止咳糖浆后在医院度过了整整两个月。　　 就在圣诞节前，在刚刚进行了一次血液透析治疗之后，Ernesto Osorio站在巴拿马公立医院外面，身着一件溅满了眼泪的衬衫，（对我们）描述他的生活如今成了何种状况。　　 Ernesto Osorio已部分瘫痪的面部像一块肉一样挂在脸上，他说：“我和此前的我已经完全不一样了（我连过去的八分之一都不如了），我走路都有困难，看看我的脸、我的眼泪”。他辩解道，他的眼泪并非由于情绪，而是由于神经损失（不由自主的流泪）。　　 尽管如此，Ernesto Osorio也知道，他是幸运的受害者之一。　　 他简单的说：“他们（政府）不知道如何把杀手排除在药物之外”。　　 巴拿马所承受的痛苦是巨大的，但这其中潜在的利润却惊人的少，至少对于西班牙的贸易公司而言如此。根据交易记录，西班牙的Rasfer公司为购买那46桶甘油支付了9，900美金，并以11，322美金的价格卖给了巴拿马的Medicom公司。　　 中国官方到目前为止没有发现泰兴甘油厂（the Taixing Glycerine Factory）和Fortune Way贸易公司最终在这笔交易上获得了多少利润，或者他们对于桶里的产品了解多少。　　协助发现这起事件原因的巴拿马心脏病专家Motta医生说：“一定要追查到这些产品的生产地，这是我个人的请求。这件事发生在我们身上，我们一定不要这些造孽的人再在秘鲁、塞拉利昂或其他地方再干同样的勾当”。　　造假者的供词：　　目前，起诉制假者的权力在中国政府手中。　　 去年春天，中国政府迅速对毒死了中国居民的王（音）－这位曾经的裁缝采取了行动。　　 中国政府在化工村附近泰兴北部的城市-泰州的公路设置路障拘捕了王。他当时重病缠身身体虚弱，且已2天没有吃饭了。在他的白色轿车里是一本存折和一些现金，他是抛下妻子与十几岁的孩子独自外逃的。　　 中国的患者已死，一场政治丑闻正在酝酿，官方需要一个答案。王被送到了医院。随后在调查人员漫长的审查中，他说出了事情的真相，说明了自己的计划，他是如何亲自喝下工业用糖浆的，他是如何决定使用二甘醇乙二醇代替工业甘油的，他是如何操纵制药公司购买他的糖浆的。这些资料均来自一位参加对王审问的政府官员。　　 王小东（音），一位认识王及其亲属的原村干部说：“他发了财，但他家并未从中受益，因为王喜欢赌博”。　　 　　第七部分:王仍在拘留中，当局正决定是否对他处以死刑。制造有毒药物的齐齐哈尔第二制药厂已被关闭了，该厂的5名管理人员因引起了这场造成严重后果的事故而被指控。　　 与对王的果断逮捕形成鲜明对比的是，中国官方对于承认中国与巴拿马毒药悲剧事件之间是否存在联系非常谨慎，因为其中涉及一家中国国有贸易公司。到目前为止，在中国没有人因造假事件导致这么多巴拿马人死亡而被起诉。　　世界卫生组织的驻北京的药品项目主管孙静（音）说，该组织曾发了一份传真提醒中国政府不要再向海外销售有毒产品，但没未得到中国政府的任何官方回应。　　 去年秋天，在美国政府的要求下（巴拿马与中国并未建立外交关系），中国国家食品药品监督管理局调查了泰兴甘油厂与Fortune Way贸易公司。　　 中国的一位药品官员说，药品管理部门检查了该公司生产的一批甘油产品，结果发现其中根本没有甘油，只有二甘醇乙二醇和另外两种物质。　　 到此为止，国家食品药品监督管理局得出的结论是他们在这起事件中没有管辖权，因为这家工厂没有药品生产许可证。　　 他们对Fortune Way贸易公司得出了同样的结论，因为该公司作为一个出口商并未参与药品贸易，因而他们对这家公司同样没有管辖权。　　 中国国家食品药品监督管理局的发言人袁江英（音）说：“我们没有发现这些公司违反了相关法律的证据。因此针对这些公司的刑事调查从未展开过。”　　 一位药品官员说这项调查随后转交到了进行商品检验与认证的中国质量监督检验检疫总局。　　 但是该局对于这件案子归他们管辖非常吃惊，该局泰兴分局的主任王建（音）说：“什么调查，我不知道有什么针对甘油厂的调查”。　　 此外，该局的一位叫黄童（音）的调查员说：“我们很少参与对出口商品的调查”。　　泰兴甘油厂的法律代理人万其刚（音）在去年年底的一次采访中说，当局没有因为巴拿马中毒事件对他进行过任何询问，并且他的公司只生产工业等级的甘油。　　 万其刚说：“我可以肯定的告诉你，我们与巴拿马或者西班牙没有任何联系”。　　 但在最近几个月，这家甘油工厂又在互联网上做百分之九十九点五纯度的甘油的广告。　　 最近万其刚拒绝回答更多的问题，他说：“如果你们作为客人到这里来，我欢迎你们。如果你们再来谈论这件事，我要打个电话”。　　 一位地方官员说，万其刚被告知禁止接受采访。　　 距离王的工厂5分钟路程处的另一家工厂-泰兴白油厂，也在互联网上做医用甘油的广告，这家工厂也没有生产医药原料的资质。这家公司的网站说他们的产品曾经出口到美国、澳大利亚和意大利。　　 丁翔（音），白油工厂的代表否认他的公司生产医用等级的甘油，但是他说北京的化学贸易公司经常打电话来要求提供医用甘油。　　丁翔说：“他们要求我们在桶上表明是甘油，我告诉他们我们不能那样做”。　　丁翔说他已停止和北京的电话联系，“如果这些东西被运到国外滥用的话……”，他没有继续说下去。　　 在化工村，产品名称经常并不是它们原来看起来那样。　　 视察了泰兴药品食品监督管理局的调查员蒋鹏（音）说：“在泰兴唯一生产甘油的两家工厂甚至根本不生产甘油，他们生产的完全是另外一种产品”。　　全部在一个名字之中一个谜团始终围绕着泰兴甘油公司生产的产品名称。这家工厂曾经把生产的糖浆叫做“TD”甘油，TD这两个字母出现在所有的货运文件中，但是它们到底代表什么意思呢？　　 西班牙的药品官员得出结论说，这两个字母代表一种生产工艺，中国调查官员认为这代表生产厂家的一种独特生产配方。　　 但是，曾经在泰兴甘油厂工作的一位销售员袁开林（音）说他知道这两个字母所代表的含义。因为他的一位朋友曾经是该厂的经理，叫做丁玉明（音）。他曾经告诉过他，TD代表中文里的“替代”（用这两个字母是汉语拼音的简写）。袁开林于1998年离开了这家工厂，现在仍住在距离这家工厂1英里远的地方。　　 在中文里，替代的含义是代替品。这是一条曾经可能成为发现有毒物质的线索，假冒产品本来是一眼就可以看穿的！　　 可惜，这两个字母出现的位置是在产品名称之中！抱歉！突然出差，耽误了翻译。编译：二甘醇是一种糖浆状有毒液体，作为一种工业溶剂和一些防冻液的主要成分是现代世界不可或缺的部分。它还是一个杀手，而死亡事例即使不是有意而为，也常常不是事故。首先是肾衰，其次中枢神经系统开始失控。麻痹差，造成呼吸困难，然后往往无医疗救助变得无法呼吸，最后大多数受害者死亡。其中很多人是孩子，是他们父母缺乏戒心的受害者。多年来,这种毒物在各种药品中应用--止咳糖浆、退烧药、注射剂--牟利的制造商用它代替了另一种安全但更贵的甜味溶剂（通常为甘油），它在药品、食品、牙膏和其它产品中有广泛应用。在过去二十年中，世界各地以这种有毒糖浆进行大规模投毒已达了至少八次，研究者估计已有数千人死亡。 在许多情况下，这种毒药的确切来源从来没有确定过。但记录和访谈显示最近四例中的三个都是来自中国这个假药的主要来源地。巴拿马是最近的受害者。去年，政府官员出于无意将二甘醇混入260,000瓶感冒药中，结果造成了灾难性后果。他们收到了365人死亡的家庭报告，目前已有100人得到确认。 随着雨季的到来，调查人员要在其腐烂之前尽可能多地挖出许多潜在受害者的遗体。巴拿马的死亡人数与中国公司将二甘醇作为99.5%的甘油出口直接相关。四十六桶毒糖浆经过一条“毒物管道”抵达了半个地球。通过航运记录和对政府官员的采访，纽约时报从巴拿马的科隆港口追踪这条管道，通过回溯到巴塞罗那、西班牙和北京的贸易公司，最后到其长江三角洲地区附近的的始发点，这个地点被当地人称为“化学之乡（chemical country）”。这些假丙三醇经过三大洲的三家贸易公司，然而它们都没有测试这些糖浆进行检测。在航运过程中，证明货物纯度的证书被一改再改，删去了制造商和早前所有者的名字。结果，购买这些糖浆的贸易商不知道它来自何方，谁是制造者。而有了这些信息，贸易商本可能和纽约时报一样发现该糖浆的制造商没有制造药用辅料的资格。对去年的两起毒药案（在巴拿马和中国）的考察显示，中国的安全管理是如何的落后于它作为世界不断成长的低成本供应商的角色。它同时证明了自从该国允许其“假劣药品”进入全球市场后对药品贸易链的监管是如此疏松。上周，美国食品与药品管理局警告美国的药品制造商和供应商，要对二甘醇”保持特别的警惕“。这个警告并没有特别提到中国，而且它表示”没有理由认为“美国的丙三醇也受到了污染。即使如此，该机构还是要求所有甘油输送商要对甘油进行二甘醇测试，并说这是为了”探究甘油是如何被污染的。“一家中国公司已经遭到美国当局的起诉，它出口的麦麸中含有工业化学品三聚氰胺，这些麦麸被用于制造宠物食品和家畜饲料。确认这些麦麸跟美国的宠物死亡有联系后，FDA最近对从中国进口麦麸发出禁令。除了巴拿马和中国之外，毒糖浆在海地、孟加拉国、阿根廷、尼日利亚和印度（两次）造成群众中毒事件。在孟加拉国不计其数的孩子死亡之后，调查员才于1992 年在七种退烧药中发现了毒物。自从在发展中国家工作的儿科医师Michael L. Bennish博士用手提箱查偷运出了被污染的糖浆样品后马萨诸塞实验室对之进行了检测，Bennish博士主要研究孟加拉国的流行病并于1995 年为《英国医学期刊》（BMJ）写了一篇相关文章， 声称，”考虑到已经使用的药品数量， 死亡人数必须以千计或以万计。"第四部分As a precaution, the patients with the mystery illness were segregated and placed in a large empty room awaiting renovation. Health care workers wore masks, heightening fears in the hospital and the community.作为一项预防措施，患有神秘疾病的患者被隔离并安置在一个空旷的大房间等待康复治疗。在医院和社区的卫生保健工作者他们都戴着口罩，而且内心满怀恐惧。“That spread a lot of panic,” said Dr. Jorge Motta, a cardiologist who runs the Gorgas Memorial Institute, a widely respected medical research center in Panama. “That is always a terrifying thought, that you will be the epicenter of a new infectious disease, and especially a new infectious disease that kills with a high rate of death, like this.”“极大的恐慌在人群中蔓延” 来自于巴拿马的世界闻名的医疗研究中心的Jorge医疗所的心脏病学专家Motta博士说。“人们将处于一个新的未知的具有较高的传染性与致死性的传染疾病的氛围里，就像这种疾病一样，这种想法令人极度震骇”。Meanwhile, patients kept coming, and hospital personnel could barely keep up. 与此同时，患者在不断地增加，以致医院的医护工作都快跟不上了。“I ended up giving C.P.R.,” Dr. Sosa said. “I haven’t given C.P.R. since I was a resident, but there were so many crises going on.” “我曾被迫放弃C.R.P” Sosa博士说，“但我最终没有放弃C.P.R，尽管在这里有很多危险因素再继续发展，因为我是这里的一员。”Frightened hospital patients had to watch others around them die for reasons no one understood, fearing that they might be next.在医院里的患者看着自己身边的病人不明病因的死去，感到十分的恐慌，因为他们担心下一个死去的可能就是自己。As reports of strange Guillain-Barré symptoms started coming in from other parts of the country, doctors realized they were not just dealing with a localized outbreak.关于这种奇特的格林巴利综合征症状的报导相继在世界其他的地方也有报道，医务工作者们开始意识到不应只是把它作为局部的疾病爆发来对待。Pascuala Pérez de González, 67, sought treatment for a cold at a clinic in Coclé Province, about a three-hour drive from Panama City. In late September she was treated and sent home. Within days, she could no longer eat; she stopped urinating and went into convulsions. 67岁的老年女性患者pascuala佩雷斯德 .冈萨雷斯，居住在到巴拿马城约三个小时车程的克莱省，因为感冒在当地一个诊所寻求治疗，在9月下旬，她接受治疗后被送回家。几天之后，她开始不进饮食，并出现无尿和抽搐症状。A decision was made to take her to the public hospital in Panama City, but on the way she stopped breathing and had to be resuscitated. She arrived at the hospital in a deep coma and later died.于是其家人决定把她送到巴拿马的公立医院，但在转运途中她的呼吸停止了，不得不对其进行心肺复苏抢救。在她被送到医院时，已处于深昏迷状态，随后不久就死亡。Medical records contained clues but also plenty of false leads. Early victims tended to be males older than 60 and diabetic with high blood pressure. About half had been given Lisinopril, a blood pressure medicine distributed by the public health system.医学文献含有相关信息但常易误导。早期关注受害对象大多趋于大于60岁老年男性和有高血压的糖尿病患者。他们当中的近半人数通过公共医疗系统被给予口服调剂血压药物赖诺普利。But many who did not receive Lisinopril still got sick. On the chance that those patients might have forgotten that they had taken the drug, doctors pulled Lisinopril from pharmacy shelves — only to return it after tests found nothing wrong. 但是，许多患病者未接收该药物（赖诺普利）的治疗仍旧患有类似疾病。那些患者或许忘记了他们曾经偶尔服用过该药，医务人员把该药从药架上取下进行测试，但意想不到的是，测试结果没有任何问题。Investigators would later discover that Lisinopril did play an important, if indirect role in the epidemic, but not in the way they had imagined.调查者后来发现赖诺普利在流行病学中的疫情方面，间接作用中扮演了一个重要的角色，而不是他们想像中的那样直接导致发病的因素。A Major Clue主要线索One patient of particular interest to Dr. Sosa came into the hospital with a heart attack, but no Guillain-Barré-type symptoms. While undergoing treatment, the patient received several drugs, including Lisinopril. After a while, he began to exhibit the same neurological distress that was the hallmark of the mystery illness.一位心脏疾病患者来到医院引起Sosa博士的特别兴趣，但他没有格林巴利综合征症状。但当该患者接收了包括莱诺普利等几种极少量药物的治疗后，病人开始出现相同的由该神秘疾病引起的典型的神经失调的症状。“This patient is a major clue,” Dr. Sosa recalled saying. “This is not something environmental, this is not a folk medicine that’s been taken by the patients at home. This patient developed the disease in the hospital, in front of us.”“这位患者是个重大的突破线索”，Sosa博士说，“这没有环境的影响，不是患者在家自服药物的民俗疗法引起。该患者的发病是在医院，是活生生的就发现在我们眼前的事实”。Soon after, another patient told Dr. Sosa that he, too, developed symptoms after taking Lisinopril, but because the medicine made him cough, he also took cough syrup — the same syrup, it turned out, that had been given to the heart patient.在这不久后，另一位患者告诉Sosa博士，在服用莱诺普利后，他也有同样症状，而是因为这种药物引起他咳嗽，他同时服用了同一种糖浆制造的咳嗽药，结果他出现了心脏病。“I said this has got to be it,” Dr. Sosa recalled. “We need to investigate this cough syrup.”“我必须要找到该药物”Sosa博士说，“我们必须调查这种咳嗽糖浆药物。”The cough medicine had not initially aroused much suspicion because many victims did not remember taking it. “Twenty-five percent of those people affected denied that they had taken cough syrup, because it’s a nonevent in their lives,” Dr. Motta said. 这种咳嗽药最初没有引起大多数人的怀疑，是因为许多受害者没有记起他们曾经服用过该咳嗽糖浆。Sosa博士说，“这些人中约25%的患者否认曾经服用过该咳嗽糖浆，是因为他们认为它是大肆宣扬的广告药”。Investigators from the United States Centers for Disease Control and Prevention, who were in Panama helping out, quickly put the bottles on a government jet and flew them to the United States for testing. The next day, Oct. 11, as Panamanian health officials were attending a news conference, a Blackberry in the room went off. 来自于美国疾病预防与控制中心的调查者们，在巴拿马当局的帮助下，很快地收集到该糖浆的药瓶，并乘飞机迅速送到美国进行检测。随后的第二天，即10月12日,巴拿马卫生官员出席的新闻发布会上的发布消息，在会议室就像投下了一枚黑色的重磅炸弹爆炸了一样。The tests, the C.D.C. was reporting, had turned up diethylene glycol in the cough syrup.疾控中心这个检测证实在这种咳嗽糖浆中含有甘油。The mystery had been solved. The barrels labeled glycerin turned out to contain poison. 咳嗽糖浆之谜得以解决。桶装标记甘油药物内含有有毒物质。Dr. Sosa’s exhilaration at learning the cause did not last long. “It’s our medication that is killing these people,” he said he thought. “It’s not a virus, it’s not something that they got outside, but it was something we actually manufactured.”Sosa博士了解了致病原因后并未极度兴奋。“是我们的药物杀死了那些患者，”他若有所思的说，“不是病毒，也不是他们周围的事物导致他们死亡，实际上是我们人为制造的”。A nationwide campaign was quickly begun to stop people from using the cough syrup. Neighborhoods were searched, but thousands of bottles either had been discarded or could not be found. 随后，停止使用咳嗽糖浆的全国性运动开始了。在追寻药品来源时，由于成千上万的药瓶要么被抛弃或者找不到，而变得十分困难。As the search wound down, two major tasks remained: count the dead and assign blame. Neither has been easy. 作为搜索调查结的两个主要任务是：统计死亡率和责任过失都不是容易的事。A precise accounting is all but impossible because, medical authorities say, victims were buried before the cause was known, and poor patients might not have seen doctors.药物官员说，进行精确的统计根不可能，因为，受害者在致死原因被了解前就已被埋葬了，还有就是家境贫困的患者未到医院就医，而不被医生记录。该文共编译1，555字作为一项预防措施，患有神秘疾病的患者被隔离并安置在一个空旷的大房间等待康复治疗。在医院和社区的卫生保健工作者他们都戴着口罩，而且内心满怀恐惧。 “极大的恐慌在人群中蔓延” 来自于巴拿马的世界闻名的医疗研究中心的Jorge医疗所的心脏病学专家Motta博士说。“人们将处于一个新的未知的具有较高的传染性与致死性的传染疾病的氛围里，就像这种疾病一样，这种想法令人极度震骇”。与此同时，患者在不断地增加，以致医院的医护工作都快跟不上了。“我曾被迫放弃C.R.P” Sosa博士说，“但我最终没有放弃C.P.R，尽管在这里有很多危险因素再继续发展，因为我是这里的一员。” 在医院里的患者看着自己身边的病人不明病因的死去，感到十分的恐慌，因为他们担心下一个死去的可能就是自己。关于这种奇特的格林巴利综合征症状的报导相继在世界其他的地方也有报道，医务工作者们开始意识到不应只是把它作为局部的疾病爆发来对待。 67岁的老年女性患者pascuala佩雷斯德 .冈萨雷斯，居住在到巴拿马城约三个小时车程的克莱省，因为感冒在当地一个诊所寻求治疗，在9月下旬，她接受治疗后被送回家。几天之后，她开始不进饮食，并出现无尿和抽搐症状。于是其家人决定把她送到巴拿马的公立医院，但在转运途中她的呼吸停止了，不得不对其进行心肺复苏抢救。在她被送到医院时，已处于深昏迷状态，随后不久就死亡。医学文献含有相关信息但常易误导。早期关注受害对象大多趋于大于60岁老年男性和有高血压的糖尿病患者。他们当中的近半人数通过公共医疗系统被给予口服调剂血压药物赖诺普利。但是，许多患病者未接收该药物（赖诺普利）的治疗仍旧患有类似疾病。那些患者或许忘记了他们曾经偶尔服用过该药，医务人员把该药从药架上取下进行测试，但意想不到的是，测试结果没有任何问题。调查者后来发现赖诺普利在流行病学中的疫情方面，间接作用中扮演了一个重要的角色，而不是他们想像中的那样直接导致发病的因素。主要线索一位心脏疾病患者来到医院引起Sosa博士的特别兴趣，但他没有格林巴利综合征症状。但当该患者接收了包括莱诺普利等几种极少量药物的治疗后，病人开始出现相同的由该神秘疾病引起的典型的神经失调的症状。“这位患者是个重大的突破线索”，Sosa博士说，“这没有环境的影响，不是患者在家自服药物的民俗疗法引起。该患者的发病是在医院，是活生生的就发现在我们眼前的事实”。在这不久后，另一位患者告诉Sosa博士，在服用莱诺普利后，他也有同样症状，而是因为这种药物引起他咳嗽，他同时服用了同一种糖浆制造的咳嗽药，结果他出现了心脏病。“我必须要找到该药物”Sosa博士说，“我们必须调查这种咳嗽糖浆药物。” 这种咳嗽药最初没有引起大多数人的怀疑，是因为许多受害者没有记起他们曾经服用过该咳嗽糖浆。Sosa博士说，“这些人中约25%的患者否认曾经服用过该咳嗽糖浆，是因为他们认为它是大肆宣扬的广告药”。 来自于美国疾病预防与控制中心的调查者们，在巴拿马当局的帮助下，很快地收集到该糖浆的药瓶，并乘飞机迅速送到美国进行检测。随后的第二天，即10月12日,巴拿马卫生官员出席的新闻发布会上的发布消息，在会议室就像投下了一枚黑色的重磅炸弹爆炸了一样。 疾控中心这个检测证实在这种咳嗽糖浆中含有甘油。咳嗽糖浆之谜得以解决。桶装标记甘油药物内含有有毒物质。Sosa博士了解了致病原因后并未极度兴奋。“是我们的药物杀死了那些患者，”他若有所思的说，“不是病毒，也不是他们周围的事物导致他们死亡，实际上是我们人为制造的”。随后，停止使用咳嗽糖浆的全国性运动开始了。在追寻药品来源时，由于成千上万的药瓶要么被抛弃或者找不到，而变得十分困难。作为搜索调查结的两个主要任务是：统计死亡率和责任过失都不是容易的事。药物官员说，进行精确的统计根不可能，因为，受害者在致死原因被了解前就已被埋葬了，还有就是家境贫困的患者未到医院就医，而不被医生记录。第五部分:[/color]Another problem is that finding traces of diethylene glycol in decomposing bodies is difficult at best, medical experts say. Nonetheless, an Argentine pathologist who has studied diethylene glycol poisonings helped develop a test for the poison in exhumed bodies. Seven of the first nine bodies tested showed traces of the poison, Panamanian authorities said. 还有一个问题就是在已经腐烂的尸体找到甘油的踪迹宜非常困难，权威的医学专家说道。尽管如此，来自于阿根廷的病原学家仍然在掘出的尸体中检测出有毒的甘油。巴拿马的发言人说，首批掘出的9具尸体就由7具被检测出这种有毒物质的踪迹存在。With the rainy season returning, though, the exhumations are about to end. Dr. José Vicente Pachar, director of Panama’s Institute of Legal Medicine and Forensic Sciences, said that as a scientist he would like a final count of the dead. But he added, “I should accept the reality that in the case of Panama we are not going to know the exact number.” 随着雨季的来临，发掘工作行也将结束。巴拿马国家药物和立法机构主管José Vicente Pachar博士说，作为科学我很想知道最终的死亡数。但他又补充说，“我要面对的事实就是在巴拿马事间中，我们是不可能知道精确的死亡人数的。”Local prosecutors have made some arrests and are investigating others connected to the case, including officials of the import company and the government agency that mixed and distributed the cold medicine. “Our responsibilities are to establish or discover the truth,” said Dimas Guevara, the homicide investigator guiding the inquiry. 当地检查机关逮捕了一些罪犯并着手调查与在此事件中与之有关联的人员，包括正式的药物进口公司和政府代理机构混合了分发感冒药的相关人员。“我们的责任是建立或发现事实真相” 凶杀案调查者Dimas Guevara说。But prosecutors have yet to charge anyone with actually making the counterfeit glycerin. And if the Panama investigation unfolds as other inquiries have, it is highly unlikely that they ever will.而且检查人员还必须对仍在进行伪劣产品制造者提起诉讼。如果巴拿马调查人员向调查价格那样公开查询的话，那么他们永远也不可能的到他们想象中的结果。A Suspect Factory可疑的工厂Panamanians wanting to see where their toxic nightmare began could look up the Web site of the company in Hengxiang, China, that investigators in four countries have identified as having made the syrup — the Taixing Glycerine Factory. There, under the words “About Us,” they would see a picture of a modern white building nearly a dozen stories tall, adorned by three arches at the entrance. The factory, the Web site boasts, “can strictly obey the contract and keep its word.” 巴拿马人想了解毒药恶梦事件的根源，在因特网上他们查到了在中国的衡祥公司的网址，在四个国家均有生产同一糖浆的叫太祥的公司网页。在网页的关于我们一栏，他们看到几乎差不多近十二层楼高的一幢现代化的白色建筑物，可循三个圆拱形的入口进入该建筑物。该公司在网站上鼓吹“我们严格遵守和约和信守我们的誓言。”But like the factory’s syrup, all is not as it seems. 但是，瞧一瞧此工厂制造的糖浆，一切似乎都不是那么回事。There are no tall buildings in Hengxiang, a country town with one main road. The factory is not certified to sell any medical ingredients, Chinese officials say. And it looks nothing like the picture on the Internet. In reality, its chemicals are mixed in a plain, one-story brick building. 中国政府官员说，在衡祥，这里没有高大的建筑，唯一有的就是一条乡镇的主干道公路。该工厂没有销售任何药物的执照。也没有现在因特网上说的那样的建筑物。实际情况是，他们的药物加工是在一个只有一层楼房的砖房里进行。The factory is in a walled compound, surrounded by small shops and farms. In the spring, nearby fields of rape paint the countryside yellow. Near the front gate, a sign over the road warns, “Beware of counterfeits.” But it was posted by a nearby noodle machine factory that appears to be worried about competition.该工厂只是一个四合大院，周围是小商店店与农舍。在春天里，附近田野里的油菜花盛开使这里的乡村景色呈现出一片金黄色。在门口前的路边有一个标牌上写着“当心假冒伪劣商品”的警示语。但是是附近面条制造机器工厂张贴的，似乎是担心竞争。The Taixing Glycerine Factory bought its diethylene glycol from the same manufacturer as Mr. Wang, the former tailor, the government investigator said. From this spot in China’s chemical country, the 46 barrels of toxic syrup began their journey, passing from company to company, port to port and country to country, apparently without anyone testing their contents. 中国政府调查人员说，在太兴甘油制造厂从同一家工厂收购二甘醇也即是王先生制造工厂的前身。46桶有毒糖浆从中国的这个地区的化学药工厂开始了它们的征途，一路畅通无阻的从一个公司到另一个公司，一个港口到另一个港口，一个国家到另一个国家，很显然他们没有经过任何的成分检测。Traders should be thoroughly familiar with their suppliers, United States health officials say. “One simply does not assume that what is labeled is indeed what it is,” said Dr. Murray Lumpkin, deputy commissioner for international and special programs for the Food and Drug Administration.美国卫生官员说，贸易商应该全面从分的了解自己的供货商。“人们不能简单的认为出厂商提供的标记是真实的就认为它是真实的”国际理事代表委员会及药品食品特别项目管理委员Murray Lumpkin说。In the Panama case, names of suppliers were removed from shipping documents as they passed from one entity to the next, according to records and investigators. That is a practice some traders use to prevent customers from bypassing them on future purchases, but it also hides the provenance of the product. 在巴拿马事件中，通过调查文档发现，从一个企业实体到另一个实体，在运输记录上供应商的名字被消除。这是销售商用于阻止购买者在将来绕过他们直接到供应商处购买而采取的一个措施，但这种做法与此同时也隐藏了产品的原产地。The first distributor was the Beijing trading company, CNSC Fortune Way, a unit of a state-owned business that began by supplying goods and services to Chinese personnel and business officials overseas.第一个发货者是北京贸易公司，通过CNSC财富方式，一个州立的商业组织，它通过在海外的中国职员与政府的商业组织机构提供货物供应。As China’s market reach expanded, Fortune Way focused its business on pharmaceutical ingredients, and in 2003, it brokered the sale of the suspect syrup made by the Taixing Glycerine Factory. The manufacturer’s certificate of analysis showed the batch to be 99.5 percent pure.随着中国市场范围的扩展，财富方式聚焦于原料成分的商业业务，2003年开始，它的经纪人开始销售泰兴制造厂生产的可疑糖浆。制造者的分析报告显示原料纯度为99.5%。Whether the Taixing Glycerine Factory actually performed the test has not been publicly disclosed. 泰兴制造厂是否真正完成测试，未见公开报导。Original certificates of analysis should be passed on to each new buyer, said Kevin J. McGlue, a board member of the International Pharmaceutical Excipients Council. In this case, that was not done.国际药物辅料理事会成员Kevin J. McGlue说，原始的分析测试证明应该在每一位新买主之间传阅。但在此次事件过程中，很显然大家根本就未这样按程序办事。[color=red]该文译文共1,300字还有一个问题就是在已经腐烂的尸体找到甘油的踪迹宜非常困难，权威的医学专家说道。尽管如此，来自于阿根廷的病原学家仍然在掘出的尸体中检测出有毒的甘油。巴拿马的发言人说，首批掘出的9具尸体就由7具被检测出这种有毒物质的踪迹存在。 随着雨季的来临，发掘工作行也将结束。巴拿马国家药物和立法机构主管José Vicente Pachar博士说，作为科学我很想知道最终的死亡数。但他又补充说，“我要面对的事实就是在巴拿马事间中，我们是不可能知道精确的死亡人数的。” 当地检查机关逮捕了一些罪犯并着手调查与在此事件中与之有关联的人员，包括正式的药物进口公司和政府代理机构混合了分发感冒药的相关人员。“我们的责任是建立或发现事实真相” 凶杀案调查者Dimas Guevara说。 而且检查人员还必须对仍在进行伪劣产品制造者提起诉讼。如果巴拿马调查人员向调查价格那样公开查询的话，那么他们永远也不可能的到他们想象中的结果。可疑的工厂巴拿马人想了解毒药恶梦事件的根源，在因特网上他们查到了在中国的衡祥公司的网址，在四个国家均有生产同一糖浆的叫太祥的公司网页。在网页的关于我们一栏，他们看到几乎差不多近十二层楼高的一幢现代化的白色建筑物，可循三个圆拱形的入口进入该建筑物。该公司在网站上鼓吹“我们严格遵守和约和信守我们的誓言。”但是，瞧一瞧此工厂制造的糖浆，一切似乎都不是那么回事。中国政府官员说，在衡祥，这里没有高大的建筑，唯一有的就是一条乡镇的主干道公路。该工厂没有销售任何药物的执照。也没有现在因特网上说的那样的建筑物。实际情况是，他们的药物加工是在一个只有一层楼房的砖房里进行。该工厂只是一个四合大院，周围是小商店店与农舍。在春天里，附近田野里的油菜花盛开使这里的乡村景色呈现出一片金黄色。在门口前的路边有一个标牌上写着“当心假冒伪劣商品”的警示语。但是是附近面条制造机器工厂张贴的，似乎是担心竞争。 中国政府调查人员说，在太兴甘油制造厂从同一家工厂收购二甘醇也即是王先生制造工厂的前身。46桶有毒糖浆从中国的这个地区的化学药工厂开始了它们的征途，一路畅通无阻的从一个公司到另一个公司，一个港口到另一个港口，一个国家到另一个国家，很显然他们没有经过任何的成分检测。美国卫生官员说，贸易商应该全面从分的了解自己的供货商。“人们不能简单的认为出厂商提供的标记是真实的就认为它是真实的”国际理事代表委员会及药品食品特别项目管理委员Murray Lumpkin说。在巴拿马事件中，通过调查文档发现，从一个企业实体到另一个实体，在运输记录上供应商的名字被消除。这是销售商用于阻止购买者在将来绕过他们直接到供应商处购买而采取的一个措施，但这种做法与此同时也隐藏了产品的原产地。 第一个发货者是北京贸易公司，通过CNSC财富方式，一个州立的商业组织，它通过在海外的中国职员与政府的商业组织机构提供货物供应。 随着中国市场范围的扩展，财富方式聚焦于原料成分的商业业务，2003年开始，它的经纪人开始销售泰兴制造厂生产的可疑糖浆。制造者的分析报告显示原料纯度为99.5%。 泰兴制造厂是否真正完成测试，未见公开报导。 国际药物辅料理事会成员Kevin J. McGlue说，原始的分析测试证明应该在每一位新买主之间传阅。但在此次事件过程中，很显然大家根本就未这样按程序办事。二甘醇是一种糖浆状有毒液体，作为一种工业溶剂和一些防冻液的主要成分是现代世界不可或缺的部分。它还是一个杀手，而死亡事例即使不是有意而为，也常常不是事故。首先是肾衰，其次中枢神经系统开始失控。麻痹差，造成呼吸困难，然后往往无医疗救助变得无法呼吸，最后大多数受害者死亡。其中很多人是孩子，是他们父母缺乏戒心的受害者。多年来,这种毒物在各种药品中应用--止咳糖浆、退烧药、注射剂--牟利的制造商用它代替了另一种安全但更贵的甜味溶剂（通常为甘油），它在药品、食品、牙膏和其它产品中有广泛应用。在过去二十年中，世界各地以这种有毒糖浆进行大规模投毒已达了至少八次，研究者估计已有数千人死亡。 在许多情况下，这种毒药的确切来源从来没有确定过。但记录和访谈显示最近四例中的三个都是来自中国这个假药的主要来源地。巴拿马是最近的受害者。去年，政府官员出于无意将二甘醇混入260,000瓶感冒药中，结果造成了灾难性后果。他们收到了365人死亡的家庭报告，目前已有100人得到确认。 随着雨季的到来，调查人员要在其腐烂之前尽可能多地挖出许多潜在受害者的遗体。巴拿马的死亡人数与中国公司将二甘醇作为99.5%的甘油出口直接相关。四十六桶毒糖浆经过一条“毒物管道”抵达了半个地球。通过航运记录和对政府官员的采访，纽约时报从巴拿马的科隆港口追踪这条管道，通过回溯到巴塞罗那、西班牙和北京的贸易公司，最后到其长江三角洲地区附近的的始发点，这个地点被当地人称为“化学之乡（chemical country）”。这些假丙三醇经过三大洲的三家贸易公司，然而它们都没有测试这些糖浆进行检测。在航运过程中，证明货物纯度的证书被一改再改，删去了制造商和早前所有者的名字。结果，购买这些糖浆的贸易商不知道它来自何方，谁是制造者。而有了这些信息，贸易商本可能和纽约时报一样发现该糖浆的制造商没有制造药用辅料的资格。对去年的两起毒药案（在巴拿马和中国）的考察显示，中国的安全管理是如何的落后于它作为世界不断成长的低成本供应商的角色。它同时证明了自从该国允许其“假劣药品”进入全球市场后对药品贸易链的监管是如此疏松。上周，美国食品与药品管理局警告美国的药品制造商和供应商，要对二甘醇”保持特别的警惕“。这个警告并没有特别提到中国，而且它表示”没有理由认为“美国的丙三醇也受到了污染。即使如此，该机构还是要求所有甘油输送商要对甘油进行二甘醇测试，并说这是为了”探究甘油是如何被污染的。“一家中国公司已经遭到美国当局的起诉，它出口的麦麸中含有工业化学品三聚氰胺，这些麦麸被用于制造宠物食品和家畜饲料。确认这些麦麸跟美国的宠物死亡有联系后，FDA最近对从中国进口麦麸发出禁令。除了巴拿马和中国之外，毒糖浆在海地、孟加拉国、阿根廷、尼日利亚和印度（两次）造成群众中毒事件。在孟加拉国不计其数的孩子死亡之后，调查员才于1992 年在七种退烧药中发现了毒物。自从在发展中国家工作的儿科医师Michael L. Bennish博士用手提箱查偷运出了被污染的糖浆样品后马萨诸塞实验室对之进行了检测，Bennish博士主要研究孟加拉国的流行病并于1995 年为《英国医学期刊》（BMJ）写了一篇相关文章， 声称，”考虑到已经使用的药品数量， 死亡人数必须以千计或以万计。" Dr. Bennish 说：“二甘醇中毒很少见报导”。 医生或许不会怀疑药品有毒，通常在那些资源有限和人口健康状况很差的贫穷国家尤其如此。他补充说道，很多死去的人根本就没有想到是医疗设施。丙三醇的伪劣制造者们通常浅薄地认为花较低成本就可制得作用与外貌一样的药物，极少对药物鉴定更少遭到起诉，由于很难追踪他们发货出境。Henk Bekedam，在北京召开的高级世界卫生组织大会上说：“这是一个全球性问题，必须用全球方化式处理”。70年代前，在美国因为加酒的二甘醇药物致100多人死亡，自那时起致使人们加强药物法规的形成及现代药物食品管理局建立。药物食品管理局设法帮助世界范围内的药物中毒事件，但实际上不仅仅只是这些。10多年前在海地至少有88位儿童因药物致死，F.A.D调查追踪其来源于中国大连，但当他们试图进一步查明其怀疑的制造商时被当地政府官员再三阻止，依据国内的记录。允许在一年过后，但是，工厂搬迁其记录也就被毁。“我们所接触的政府官员都不愿参与此事”，一位驻北京的美国大使在一封密电中写到，“在追踪其他可能的二甘醇发货方式时，形势不容乐观。”事实上，英国泰晤士报找到1995年在海地毒药事件中，也有约50吨带有中国船运标记的伪劣二甘醇进入美国市场。芝加哥地区的大批量药物和非药物供应商，埃维塔公司主管Phil Ternes说，“感谢上帝我们发现了它”，在FDA还没意识到时。 据世界卫生组织报导，在中国，政府答应整理规范制药工业，某种程度上是因为大量的伪劣药物流入国外市场而招致批判，去年12月份，两位高级药物法规执行者因受贿而被捕。此外，440多加非法药物公司被停产。 但是，当中国政府通过一个国家药物代理机构调查中国公司在巴拿马死亡事件中所扮演的角色时发现没有违法行为，一位通过CNSC致富的商人说，“中国药物管理存在漏洞”，北京的一位经济人士说，巴拿马事件就像一个十字形管道错综复杂。在这种环境下，王平贵，一位只具初中文化的商人，发现作为药品供应的中间人是一件很容易的事。他也很快就发现在他之前的那些人：增加利润的一个简单方式就是造假。 在中国有人开始死于造假药物。欺骗方法体系王先生作为一位商人很快就在中国东部的长江三角洲制造了许多伪劣产品。他根本就没想到他是一位普通的制造商。村民们说，他竖起了一个化学药物制造的榜样，在这个地区许多小化工厂如雨后春笋般涌出。“他不知道他在干什么，”王贵平的哥哥说，“他不懂化学药物制作”。但他，理解明白怎样去欺骗的规则。在王平贵41岁时，意识到可以利用廉价的代替物赚更多的收入，工业糖浆不允许用于制造供人使用的药用糖浆。为了欺骗购药买主，他伪造了执照和实验室的分析，并把它公示出来。王后来告诉调查人员说他的替代品数据没有造成损害，因为他的最初测试数量较小。并进行专业包装。他自己吞食了一些这种糖浆。什么也没发生，然后他装船并贴了质检条。早在2005年远在东北黑龙江省1000公里的齐齐哈尔No. 2制药公司开始使用这种糖浆。这个公司的采购员在一个工业网站上看到了王的这种糖浆的邮购品。依照中国的调查显示，不久，王先生开始着手寻找更廉价的糖浆替代品以赚取更大的利润。在一本化学药物书中他找到了他要寻找的另一种无色无味的糖浆－二甘醇。同时，根据调查显示，这种物质一吨售价6,000到7，000元人民币，约725到845美元，然而制药糖浆价值15,000人民币，约1,815美元。王先生在装运到齐齐哈尔之前没有再次品尝作感官测试，政府调查官员补充说，“他知道这种物品危险，但他不知道能置人于死地”。制造商用这种有毒的糖浆生产了5种药物：胆囊疾病的Amillarisin安瓿；专用于小儿的灌肠液；血管疾病注射液；静脉用解热镇痛药；关节炎治疗药。2006年4月，在中国南方广东省的广州市的一家很好的医院开始试用Amillarisin 甲，虽然有的曾经病得很严重，但至少有18人在服药大约一个月左右后死亡。周建红，33岁，说他父亲第一次服用Amillarisin 甲是4月19日。一周后病情加剧。“假如你要死，你会想死在家”周说，“我们办了出院把他接回家。”回家后第二天他就去世了。“ 因为它的发展，大家都想在制药业投资。但我们的制度跟不上。”周先生说，“我们需要一个能确保我们安全的系统。”最后的死亡人数不清楚，因为有些服药者来自于人口稀少的地区。在四川省的一个偏远小镇，一位叫周良辉的男子说，当局不承认他的妻子死于服用污染的Amillarisin 甲。周先生，38岁，说他用他的配偶身份证号码对给妻子发这批医药的官员警示通告。"你也许无法理解一个小镇,如果你是在北京，"周良辉在电话采访中说，“山高皇帝远。有很多问题是没有法律可言的。政府未能阻止毒物污染 ，毒品供应造成一个更大的国内丑闻的一年。去年5月,中国国务院总理***,下令进行调查的死亡报告，宣告：药品市场是一片混乱。与此同时，9，000英里以外的巴拿马，长长的雨季已经开始。预防感冒和咳嗽,政府的医疗保健开始制造咳嗽糖浆抗组胺药。咳嗽药是无糖的以便于糖尿病人可以服用。来自巴塞罗那的46万桶几乎是半透明杂着浅黄，糖浆药集装箱船运抵托比马士基。航运记录显示的成分应为99.5%纯甘油。这是个多人死亡后,在那之前认证发现纯属子虚乌有。神秘的疾病早在去年9月，在巴拿马大型公立医院的医生就开始注意到患者出现异常的症状。起初，患者表现为格林巴利综合征，相对罕见的神经紊乱，首先表现为腿部无力与刺痛感。这种无力常加剧，并向上传导到手臂和胸部，有时引起全身无力与呼吸困难。新病人麻痹后，但它不向上传递。他们也很快失去排尿能力，这与格林巴利综合征不相关。即使是罕见的个案。一全年医生可能会见到8例格林巴利综合征，然而现在短短两周他们就看到许多类似患者。医生们向传染病专家Néstor Sosa求助，并驱使医生们之间向在进行三项全能运动和高水平的象棋比赛竞争探求病因。Sosa博士在健康贫乏地区巴拿马医专业学领域久负盛名。1800年底，一种致命的组合黄热病和疟疾使巴拿马居民每10人就有1人死亡。仅居美国之后设法克复这些蚊传播疾病，在早期法国试图暗中破坏的情况下而没有放弃修建巴拿马运河。 这个可疑的格林巴利综合征使Sosa’s博士烦恼不堪。他说到“在我们医院有时候真的令人惊讶，有时候它达到流行病的尺度”。随着神秘疾病死亡率接近50%，Sosa’s博士警告医院的管理处，让他建立一个专门的情况处理小组。被指定捕捉无休止恐吓人的放毒者是要对生活有积极态度的人。早在几年前，Sosa博士观察了经其他医生证实了得另外的流行病因，后来被证实是由啮齿类动物传播的汉坦病毒。“我精心照料患者，但我有时仍感觉我做得还不够，”他说到。他发誓说下一次将又会有所不同。Sosa博士成立了24小时治疗病室，在这里医生可以比较对照他们搜索到的医疗档案与文献记录。作为一项预防措施，患有神秘疾病的患者被隔离并安置在一个空旷的大房间等待康复治疗。在医院和社区的卫生保健工作者他们都戴着口罩，而且内心满怀恐惧。“极大的恐慌在人群中蔓延” 来自于巴拿马的世界闻名的医疗研究中心的Jorge医疗所的心脏病学专家Motta博士说。“人们将处于一个新的未知的具有较高的传染性与致死性的传染疾病的氛围里，就像这种疾病一样，这种想法令人极度震骇”。与此同时，患者在不断地增加，以致医院的医护工作都快跟不上了。“我曾被迫放弃C.R.P” Sosa博士说，“但我最终没有放弃C.P.R，尽管在这里有很多危险因素再继续发展，因为我是这里的一员。”在医院里的患者看着自己身边的病人不明病因的死去，感到十分的恐慌，因为他们担心下一个死去的可能就是自己。关于这种奇特的格林巴利综合征症状的报导相继在世界其他的地方也有报道，医务工作者们开始意识到不应只是把它作为局部的疾病爆发来对待。67岁的老年女性患者pascuala佩雷斯德 .冈萨雷斯，居住在到巴拿马城约三个小时车程的克莱省，因为感冒在当地一个诊所寻求治疗，在9月下旬，她接受治疗后被送回家。几天之后，她开始不进饮食，并出现无尿和抽搐症状。于是其家人决定把她送到巴拿马的公立医院，但在转运途中她的呼吸停止了，不得不对其进行心肺复苏抢救。在她被送到医院时，已处于深昏迷状态，随后不久就死亡。医学文献含有相关信息但常易误导。早期关注受害对象大多趋于大于60岁老年男性和有高血压的糖尿病患者。他们当中的近半人数通过公共医疗系统被给予口服调剂血压药物赖诺普利。但是，许多患病者未接收该药物（赖诺普利）的治疗仍旧患有类似疾病。那些患者或许忘记了他们曾经偶尔服用过该药，医务人员把该药从药架上取下进行测试，但意想不到的是，测试结果没有任何问题。调查者后来发现赖诺普利在流行病学中的疫情方面，间接作用中扮演了一个重要的角色，而不是他们想像中的那样直接导致发病的因素。主要线索一位心脏疾病患者来到医院引起Sosa博士的特别兴趣，但他没有格林巴利综合征症状。但当该患者接收了包括莱诺普利等几种极少量药物的治疗后，病人开始出现相同的由该神秘疾病引起的典型的神经失调的症状。“这位患者是个重大的突破线索”，Sosa博士说，“这没有环境的影响，不是患者在家自服药物的民俗疗法引起。该患者的发病是在医院，是活生生的就发现在我们眼前的事实”。在这不久后，另一位患者告诉Sosa博士，在服用莱诺普利后，他也有同样症状，而是因为这种药物引起他咳嗽，他同时服用了同一种糖浆制造的咳嗽药，结果他出现了心脏病。“我必须要找到该药物”Sosa博士说，“我们必须调查这种咳嗽糖浆药物。”这种咳嗽药最初没有引起大多数人的怀疑，是因为许多受害者没有记起他们曾经服用过该咳嗽糖浆。Sosa博士说，“这些人中约25%的患者否认曾经服用过该咳嗽糖浆，是因为他们认为它是大肆宣扬的广告药”。来自于美国疾病预防与控制中心的调查者们，在巴拿马当局的帮助下，很快地收集到该糖浆的药瓶，并乘飞机迅速送到美国进行检测。随后的第二天，即10月12日,巴拿马卫生官员出席的新闻发布会上的发布消息，在会议室就像投下了一枚黑色的重磅炸弹爆炸了一样。疾控中心这个检测证实在这种咳嗽糖浆中含有甘油。咳嗽糖浆之谜得以解决。桶装标记甘油药物内含有有毒物质。Sosa博士了解了致病原因后并未极度兴奋。“是我们的药物杀死了那些患者，”他若有所思的说，“不是病毒，也不是他们周围的事物导致他们死亡，实际上是我们人为制造的”。随后，停止使用咳嗽糖浆的全国性运动开始了。在追寻药品来源时，由于成千上万的药瓶要么被抛弃或者找不到，而变得十分困难。作为搜索调查结的两个主要任务是：统计死亡率和责任过失都不是容易的事。药物官员说，进行精确的统计根不可能，因为，受害者在致死原因被了解前就已被埋葬了，还有就是家境贫困的患者未到医院就医，而不被医生记录。 还有一个问题就是在已经腐烂的尸体找到甘油的踪迹宜非常困难，权威的医学专家说道。尽管如此，来自于阿根廷的病原学家仍然在掘出的尸体中检测出有毒的甘油。巴拿马的发言人说，首批掘出的9具尸体就由7具被检测出这种有毒物质的踪迹存在。随着雨季的来临，发掘工作行也将结束。巴拿马国家药物和立法机构主管José Vicente Pachar博士说，作为科学我很想知道最终的死亡数。但他又补充说，“我要面对的事实就是在巴拿马事间中，我们是不可能知道精确的死亡人数的。”当地检查机关逮捕了一些罪犯并着手调查与在此事件中与之有关联的人员，包括正式的药物进口公司和政府代理机构混合了分发感冒药的相关人员。“我们的责任是建立或发现事实真相” 凶杀案调查者Dimas Guevara说。而且检查人员还必须对仍在进行伪劣产品制造者提起诉讼。如果巴拿马调查人员向调查价格那样公开查询的话，那么他们永远也不可能的到他们想象中的结果。可疑的工厂巴拿马人想了解毒药恶梦事件的根源，在因特网上他们查到了在中国的衡祥公司的网址，在四个国家均有生产同一糖浆的叫太祥的公司网页。在网页的关于我们一栏，他们看到几乎差不多近十二层楼高的一幢现代化的白色建筑物，可循三个圆拱形的入口进入该建筑物。该公司在网站上鼓吹“我们严格遵守和约和信守我们的誓言。”但是，瞧一瞧此工厂制造的糖浆，一切似乎都不是那么回事。中国政府官员说，在衡祥，这里没有高大的建筑，唯一有的就是一条乡镇的主干道公路。该工厂没有销售任何药物的执照。也没有现在因特网上说的那样的建筑物。实际情况是，他们的药物加工是在一个只有一层楼房的砖房里进行。该工厂只是一个四合大院，周围是小商店店与农舍。在春天里，附近田野里的油菜花盛开使这里的乡村景色呈现出一片金黄色。在门口前的路边有一个标牌上写着“当心假冒伪劣商品”的警示语。但是是附近面条制造机器工厂张贴的，似乎是担心竞争。中国政府调查人员说，在太兴甘油制造厂从同一家工厂收购二甘醇也即是王先生制造工厂的前身。46桶有毒糖浆从中国的这个地区的化学药工厂开始了它们的征途，一路畅通无阻的从一个公司到另一个公司，一个港口到另一个港口，一个国家到另一个国家，很显然他们没有经过任何的成分检测。美国卫生官员说，贸易商应该全面从分的了解自己的供货商。“人们不能简单的认为出厂商提供的标记是真实的就认为它是真实的”国际理事代表委员会及药品食品特别项目管理委员Murray Lumpkin说。在巴拿马事件中，通过调查文档发现，从一个企业实体到另一个实体，在运输记录上供应商的名字被消除。这是销售商用于阻止购买者在将来绕过他们直接到供应商处购买而采取的一个措施，但这种做法与此同时也隐藏了产品的原产地。 第一个发货者是北京贸易公司，通过CNSC财富方式，一个州立的商业组织，它通过在海外的中国职员与政府的商业组织机构提供货物供应。随着中国市场范围的扩展，财富方式聚焦于原料成分的商业业务，2003年开始，它的经纪人开始销售泰兴制造厂生产的可疑糖浆。制造者的分析报告显示原料纯度为99.5%。泰兴制造厂是否真正完成测试，未见公开报导。国际药物辅料理事会成员Kevin J. McGlue说，原始的分析测试证明应该在每一位新买主之间传阅。但在此次事件过程中，很显然大家根本就未这样按程序办事。 Fortune Way贸易公司在把这些有毒产品运送到位于巴塞罗那的第二家贸易公司之前把证明文件翻译为英文，并且去掉了文档中的泰兴甘油厂（the Taixing Glycerine Factory）的名字，代之以自己公司的名字。李灿（音），Fortune Way贸易公司的主管说他不知道那次的交易所以无法发表评论，但他补充说他们公司的交易量很大。 位于西班牙的Rasfer International公司在接收到这些装满货物的桶时，同样没有检验货物的成分。他们也复制了Fortune Way公司提供的化学成分分析的文件，并且把自己公司的标志放到了文件中。Rasfer International公司的经理Ascensión Criado在一份回答Fortune Way公司什么时候发出了该批货物的书面提问的电子邮件中这样说到，但也没有提到是谁制造了这些产品。几个星期以后，他们把这批货物发送给了巴拿马的一家贸易公司the Medicom Business Group，Criado说： Medicom公司从未问过制造厂商的名字”。　　 Medicom公司的一名律师Valentín Jaén说：“我的雇主也是受害者，他们是被某些人欺骗了，我雇主的公司一向信誉良好”。　　 在巴拿马，这些装满毒药的桶被放置了两年多，巴拿马的调查官员说Medicom公司擅自更改了糖浆的过期日期。　　 在此期间，该公司从未检验过这些产品。巴拿马官方称，巴拿马政府购买了这46桶糖浆并将其用于生产感冒药，却同样没有检验这些产品。　　 毒药的管道最后进入了如Ernesto Osorio一样的患者的血液中，他曾是巴拿马的一位高中老师。去年9月，他服用了有毒的止咳糖浆后在医院度过了整整两个月。　　 就在圣诞节前，在刚刚进行了一次血液透析治疗之后，Ernesto Osorio站在巴拿马公立医院外面，身着一件溅满了眼泪的衬衫，（对我们）描述他的生活如今成了何种状况。　　 Ernesto Osorio已部分瘫痪的面部像一块肉一样挂在脸上，他说：“我和此前的我已经完全不一样了（我连过去的八分之一都不如了），我走路都有困难，看看我的脸、我的眼泪”。他辩解道，他的眼泪并非由于情绪，而是由于神经损失（不由自主的流泪）。　　 尽管如此，Ernesto Osorio也知道，他是幸运的受害者之一。　　 他简单的说：“他们（政府）不知道如何把杀手排除在药物之外”。　　 巴拿马所承受的痛苦是巨大的，但这其中潜在的利润却惊人的少，至少对于西班牙的贸易公司而言如此。根据交易记录，西班牙的Rasfer公司为购买那46桶甘油支付了9，900美金，并以11，322美金的价格卖给了巴拿马的Medicom公司。　　 中国官方到目前为止没有发现泰兴甘油厂（the Taixing Glycerine Factory）和Fortune Way贸易公司最终在这笔交易上获得了多少利润，或者他们对于桶里的产品了解多少。　　协助发现这起事件原因的巴拿马心脏病专家Motta医生说：“一定要追查到这些产品的生产地，这是我个人的请求。这件事发生在我们身上，我们一定不要这些造孽的人再在秘鲁、塞拉利昂或其他地方再干同样的勾当”。　　造假者的供词：　　目前，起诉制假者的权力在中国政府手中。　　 去年春天，中国政府迅速对毒死了中国居民的王（音）－这位曾经的裁缝采取了行动。　　 中国政府在化工村附近泰兴北部的城市-泰州的公路设置路障拘捕了王。他当时重病缠身身体虚弱，且已2天没有吃饭了。在他的白色轿车里是一本存折和一些现金，他是抛下妻子与十几岁的孩子独自外逃的。　　 中国的患者已死，一场政治丑闻正在酝酿，官方需要一个答案。王被送到了医院。随后在调查人员漫长的审查中，他说出了事情的真相，说明了自己的计划，他是如何亲自喝下工业用糖浆的，他是如何决定使用二甘醇乙二醇代替工业甘油的，他是如何操纵制药公司购买他的糖浆的。这些资料均来自一位参加对王审问的政府官员。　　 王小东（音），一位认识王及其亲属的原村干部说：“他发了财，但他家并未从中受益，因为王喜欢赌博”。　　 王仍在拘留中，当局正决定是否对他处以死刑。制造有毒药物的齐齐哈尔第二制药厂已被关闭了，该厂的5名管理人员因引起了这场造成严重后果的事故而被指控。　　 与对王的果断逮捕形成鲜明对比的是，中国官方对于承认中国与巴拿马毒药悲剧事件之间是否存在联系非常谨慎，因为其中涉及一家中国国有贸易公司。到目前为止，在中国没有人因造假事件导致这么多巴拿马人死亡而被起诉。　　世界卫生组织的驻北京的药品项目主管孙静（音）说，该组织曾发了一份传真提醒中国政府不要再向海外销售有毒产品，但没未得到中国政府的任何官方回应。　　 去年秋天，在美国政府的要求下（巴拿马与中国并未建立外交关系），中国国家食品药品监督管理局调查了泰兴甘油厂与Fortune Way贸易公司。　　 中国的一位药品官员说，药品管理部门检查了该公司生产的一批甘油产品，结果发现其中根本没有甘油，只有二甘醇乙二醇和另外两种物质。　　 到此为止，国家食品药品监督管理局得出的结论是他们在这起事件中没有管辖权，因为这家工厂没有药品生产许可证。　　 他们对Fortune Way贸易公司得出了同样的结论，因为该公司作为一个出口商并未参与药品贸易，因而他们对这家公司同样没有管辖权。　　 中国国家食品药品监督管理局的发言人袁江英（音）说：“我们没有发现这些公司违反了相关法律的证据。因此针对这些公司的刑事调查从未展开过。”　　 一位药品官员说这项调查随后转交到了进行商品检验与认证的中国质量监督检验检疫总局。　　 但是该局对于这件案子归他们管辖非常吃惊，该局泰兴分局的主任王建（音）说：“什么调查，我不知道有什么针对甘油厂的调查”。　　 此外，该局的一位叫黄童（音）的调查员说：“我们很少参与对出口商品的调查”。　　泰兴甘油厂的法律代理人万其刚（音）在去年年底的一次采访中说，当局没有因为巴拿马中毒事件对他进行过任何询问，并且他的公司只生产工业等级的甘油。　　 万其刚说：“我可以肯定的告诉你，我们与巴拿马或者西班牙没有任何联系”。　　 但在最近几个月，这家甘油工厂又在互联网上做百分之九十九点五纯度的甘油的广告。　　 最近万其刚拒绝回答更多的问题，他说：“如果你们作为客人到这里来，我欢迎你们。如果你们再来谈论这件事，我要打个电话”。　　 一位地方官员说，万其刚被告知禁止接受采访。　　 距离王的工厂5分钟路程处的另一家工厂-泰兴白油厂，也在互联网上做医用甘油的广告，这家工厂也没有生产医药原料的资质。这家公司的网站说他们的产品曾经出口到美国、澳大利亚和意大利。　　 丁翔（音），白油工厂的代表否认他的公司生产医用等级的甘油，但是他说北京的化学贸易公司经常打电话来要求提供医用甘油。　　丁翔说：“他们要求我们在桶上表明是甘油，我告诉他们我们不能那样做”。　　丁翔说他已停止和北京的电话联系，“如果这些东西被运到国外滥用的话……”，他没有继续说下去。　　 在化工村，产品名称经常并不是它们原来看起来那样。　　 视察了泰兴药品食品监督管理局的调查员蒋鹏（音）说：“在泰兴唯一生产甘油的两家工厂甚至根本不生产甘油，他们生产的完全是另外一种产品”。　　全部在一个名字之中一个谜团始终围绕着泰兴甘油公司生产的产品名称。这家工厂曾经把生产的糖浆叫做“TD”甘油，TD这两个字母出现在所有的货运文件中，但是它们到底代表什么意思呢？　　 西班牙的药品官员得出结论说，这两个字母代表一种生产工艺，中国调查官员认为这代表生产厂家的一种独特生产配方。　　 但是，曾经在泰兴甘油厂工作的一位销售员袁开林（音）说他知道这两个字母所代表的含义。因为他的一位朋友曾经是该厂的经理，叫做丁玉明（音）。他曾经告诉过他，TD代表中文里的“替代”（用这两个字母是汉语拼音的简写）。袁开林于1998年离开了这家工厂，现在仍住在距离这家工厂1英里远的地方。　　 在中文里，替代的含义是代替品。这是一条曾经可能成为发现有毒物质的线索，假冒产品本来是一眼就可以看穿的！　　 可惜，这两个字母出现的位置是在产品名称之中！