Note: all information and examples are taken directly from the provided readings.

5. Technology and Warfare

Context

The passage discusses how military technology has evolved over the years, theories of military
innovation, national styles, and scenario-specific warfare, systems technology and the
“ecological system,” the military revolution and the technological edge, the rise of cyberspace
and media in warfare, and the future of warfare.

Theories of Military Innovation

The passage starts by listing theories of how military innovation occurs or fails to occur. This
includes:
● Fruits of civilian industry theory: adaptations of civilian technologies for military purposes.
● Form follows function: technology evolved to meet a specific function.
● Form follows failure: technology evolves to address weaknesses in current systems or to
target the weaknesses of superior enemy systems instead of trying to match enemy
systems.
● Non-rational explanations: aesthetics, convenience.

The National Style

It’s noted that each country has its own national style of military technology. This is affected by
factors such as:
● Political assumptions: e.g., the USA’s fuel-driven military makes the assumption they will
have clear access to fuel in conflict
● Trade-offs: the slower Israeli tanks prioritize safety over speed
● Invisible technology: planes that can avoid radar, but can only operate at night due to
their irregular shape being easy to spot in the daylight sky.
● Systems technology: complex systems of different technologies that evolved to work
together e.g. the functioning of a battleship
● Technological edge: one of the most powerful aspects in gaining an advantage over
adversaries.

The Design Process and Trade-Off

The design process often refers to which trade-offs designers of military technology are willing
to accept. E.g. protection traded for speed, mobility traded for firepower, etc. Military technology
is analogous to an organism that adapts to its environment through evolutionary processes and
has its own distinct ecological niche. For example, tanks developed armor to protect their crews,
in consequence, “predators” developed different methods of penetrating tank armor, leading to
tank armor again evolving to counter new methods of attacks. Similar changes can be seen in
stealth aircraft and other technologies.

The culmination of the trade-off design process and the national style, leads to many military
technologies only being suitable for a specific battlefield and not the next. For example, the
Israeli tanks are well suited for mountain warfare but may have trouble succeeding in a
fast-paced desert warfare environment.

The Significance of the Technological Edge

The passage notes the significance of the technological edge in warfare. Examples of the
technological edge include the Americans being able to crush Saddam Hussein in Iraq in a
mere 3 weeks due to their overpowering technological edge. Another example is that
Napoleon’s highly successful army would have been supposedly no match for the British simply
due to his force using smoothbore muskets while the British had army rifles.

Other examples include the South African howitzers' ability to outrange the American Paladin
system (30km vs. 24km) and the 130mm Russian guns' ability to outrange their 155mm
American counterparts in Vietnam.

This demonstrated that the technological edge is a powerful force but can either have subtle or
massive differences in outcomes, depending on how much of an edge one military has over
another. It also demonstrates the ability of smaller militaries to surprise larger, more advanced
militaries by developing niche technologies that may have an advantage over a larger military in
some cases.

The Military Revolution

The technological edge is also tied closely to a potential military revolution that occurred/is
occurring. The Gulf War signified this revolution, in which precision systems and stealth
significantly impacted the outcome of the war. However, the fact of unequal adversaries cast fog
on the supposed military revolution.

The passage noted that military organizations do not change uniformly. Certain aspects, such as
structure, are very durable (e.g., how an aircraft carrier is operated) while other changes occur
very rapidly (e.g., the way air attacks are conducted, technologies like night vision, precision
lasers, and ballistic computers). In some cases, such as air attacks, it's not the case that air
power can do more efficiently what it did in the past, but rather that it can do things which it
never could have before.

To circle back to the military revolution, there are 3 broad factors to consider to determine
whether one occurred or not.

This includes:
 ● The rise of quality over quantity.
● The speciation of military hardware and weapons.
● And the centrality of commercial military technology.

Quality Over Quantity

Regarding quality over quantity, the period from the French Revolution to the mid-twentieth
century is known as the period of “mass army,” where overwhelming military power was the key
factor in winning wars. This is also why conscription was a common practice.

This period of mass army seems to have ended in 1991 after the annihilation of the Iraqi army,
the 4th largest military in the world. Reasons for this include that obsolescent technology simply
became targets for more sophisticated weapons (technological edge became a much more
important factor than the scale of a military) as well as a range of disadvantages associated with
large militaries (training expenses, expenses of technology, vulnerabilities of large forces).

Each piece of technology may not make a distinct difference on its own, but the cumulative
effects across a military can be significant. Furthermore, in some cases, newer technologies
may not be much better but pave the way for significantly more advanced technologies in the
future. An example is that early muskets weren’t more lethal than a crossbow but required
significantly less training time and had a damaging psychological effect on enemies by instilling
fear. Furthermore as we now know, muskets evolved into a range of far more powerful
weapons.

It is thus clear that quality trumps quantity in regards to modern miliatries.

Speciation of Military Hardware and Weapons

The second factor is the speciation of military hardware and weapons.

For the longest time, most militaries had similar weapons with subtle differences. Speciation
began in the First World War. For example, the British invested heavily in tanks, while the
Germans did not.

As mentioned earlier, weapons often develop as an ecological system with a specific purpose
that can be useful in one scenario but useless in another. This also refers to the concept of
national style where militaries will develop technologies for the battlefields they are most likely to
encounter themselves on.

The specialization of military technology also requires troops to receive specialized training to
operate the technologies and the specialized development of tactics and use cases for specific
technologies.
Speciation also leads to certain technologies only being available to more powerful economies,
such as the USA, which can afford to purchase B2 stealth bombers while the rest of the world
cannot.

It also links into the concept of military systems and the “meta-system,” which refers to militaries
turning into extremely complex, specialized systems and the skill required to operate these
systems effectively. The meta-system refers to the widespread access to information within
militaries that can allow decision-making. It also blurs the hierarchy of authority within militaries
since lower-ranking officers have the ability to make better decisions on the go.

The Centrality of Military Technology

The last aspect to consider in the military revolution is the centrality of military technology.

The passage notes that some % of military technology has always evolved from the civilian
sector. E.g. the Higgins boats of World War 2 (beach landers).

However, the passage notes that military investment in R&D often spilled over more into the
civillian world than the other way around. An example is the transistor, which was developed as
part of a military R&D program.

From the passage, it does seem like the tables have once again turned with certain civilian
industries now contributing more towards military development than the other way around.
Some examples include software and encryption systems leading military systems; while other
civilian technologies can’t quite match their military counterparts yet, they are strongly on their
way to doing so, for example, satellites.

The centrality of military technology is to the benefit of open, democratic societies rather than
totalitarian societies since it requires:
● A sophisticated industrial base for manufacturing.
● A skilled workforce for maintenance.
● And flexible organization for intelligent use of technologies.

Asymmetric Counterbalance to the Technological Edge

The passage notes that superior conventional technology (the technological edge) can be
counterbalanced, to some extent, by asymmetric responses such as irregular (guerilla) warfare.

However, technology still plays an important role in this regard, as guerilla groups often require
advanced technologies like sophisticated radio communications or anti-tank weapons to
organize their attacks.
In this regard, weakness is the mother of innovation, with smaller groups taking advantage of
the weaknesses in the systems, technologies, and processes of larger and more powerful
opponents.

Another example of counterbalance is the threat of mass destruction.

Influence of the Civilian Sector on the Modern Military

The passage further highlighted other topics, such as the civilian sector's major challenge to
retaining military expertise due to better pay, less responsibility, and more autonomy.

Information Technology, the System of Systems, and Surveillance

Information technology has also come to play a large role by offering greater centralization of
military control. Military leaders can more effectively communicate instructions, tying into a
concept of “systems of systems” surrounding intelligence, surveillance, and reconnaissance,
which can have large effects on the outcomes a military can achieve.

It also refers to the challenge modern military leaders may face to impose surveillance on
lower-ranking personnel and control their decisions, since abundant media coverage of modern
conflicts can lead to criticism if wrong decisions are made.

Media Coverage and Cyber Warfare

Tying into this, the passage notes that media coverage of modern conflicts poses significant
challenges for military and political leaders as it extends to “online” warfare, fear of criticism, and
propaganda, e.g., Palestinian adults positioning children throwing rocks for optimal camera
shots. Other examples include beheadings by extremist groups broadcasted online and on TV
used for recruitment.

Conclusion and the Future of Warfare and Technology

The passage concludes by noting the potential future of warfare and how technology will play a
role in it. Some examples include extending the frontiers of war to space, cyber warfare
becoming more prevalent, and using biological science in warfare (for example, to create a
super soldier loyal to death that can be cloned).

6. HIV

Context

The passage focuses largely on an organization known as the Treatment Action Campaign
(TAC), the organization’s evolutions, its struggles with government, its leaders, and its issues.
TAC: Goals and Evolution

The main focus of TAC is education. It provides information about medications allowing users of
medications to be empowered. The example given was how the organization provided
information such as the name of the pill, the manufacturer, how it works, and so on to a young
woman and how it made her feel empowered.

The organization also trained its volunteers and members to pass on information.

It seems that everyone in the organization knew what was going on and what they were fighting
for, evident in the well organized rallies of TAC.

The organization also provided support to its members.

The passage states that the goal of TAC was to make treatment available and easily accessible
and provide education around HIV. In the early days of the disease, this posed a significant
challenge as there was a lot of stigma around the disease.

The first salvo of the organization was the prevention of mother to child HIV transmission
(MPTCT) through the use of AZT. AZT is a pill preganant women take to prevent transmission of
the disease. The organization also aimed to bring down AZT costs, stating that babies’ lives
were not a morally justified reason for profits by big pharma.

Later the organization advocated for Nevirapine use. A single dose that can drastically reduce
mother to child transmission.

The organization also took on other issues like sexual violence and gender-based violence.
Sexual violence is said to contribute to HIV transmission. Between March 2004 and 2005, there
were 55 000 reported rape cases, despite it being believed that only 1/9 cases are reported.

It’s said that the organization’s greatest strength was its solid core of South African members,
and its greatest challenge was keeping members involved and unified. Over time, the
organization partnered with different companies and firms to become formidable, with a political
voice, moral high ground, and legal know-how. In February 2004, TAC had 150 branches and
8,000 members, doubling to 16000 members by 2006. Today, TAC has around 250 branches.

TAC: Struggles

Initially, TAC had to fight back against international pushback from pharmaceutical companies
that wanted to keep prices high for profits and sanctions from the USA aimed at protecting the
companies' patents. It did this by effectively using the media to its advantage and framing the
pharmaceutical companies and sanctions as a “lawsuit against Nelson Mandela and dying
babies.”
Later, TAC had to force the government's hand to provide inexpensive access to HIV
medications by allowing off-brand manufacturing of the medications directly in South Africa or
the import of them from nations where it was being sold inexpensively, such as Vietnam.

Initially, it was said that TAC had a good relationship with the government but later had to fight
them and use courts to force their hand. The Government framed AIDS as an “imaginary
epidemic” invented by pharma companies and neo-colonialists to make a profit and dent Africa’s
view of itself. There were also concerns about toxic ARVs by the health minister.

TAC forced the government to create the national treatment plan, announced on 8 August 2003,
and put into action the Operational Plan for Comprehensive Treatment and Care for HIV and
AIDS on 19 November 2003. It achieved this through protests such as the Civil Disobedience
campaign, etc.

TAC: Organizational Issues

The passage highlights women’s equality as one of the organization's main challenges. The
organization supposedly always had issues with gender tensions.

It’s said that the TAC was made up of 70% women, that AIDS affected more women than men,
and yet more leadership positions in TAC were held by men. One example given is where one
of the leaders, Zackie Achmat, shouted down a woman for proposing women should speak at
conferences since the organization was 70% women.

TAC implemented equality measures by having a 50% women’s leader quota and programs to
educate men about women’s rights.

Despite this, there were still many struggles around gender issues in the organization. The
media didn’t want to speak to the new leaders since they knew and were more comfortable with
the old male leaders. The women leaders were also not taken seriously. And certain women
groups in the organization created separation.

Other than the gender issue, it's noted that TAC also had a toxic culture. Examples include: who
shouted the loudest got heard, the need to “win” arguments, a culture that lacked care and
respect, “hustle” culture, time was not taken to reflect and strategize; it was an organization of
doing, external aggression towards the government developed into internal aggression towards
each other, a lack of acknowledgment for staff that did well, and the fact that internal conflicts
weren’t handled well.

TAC: Leaders and Zackie Achmat

The passage talked about the different leaders in the organization, including the mention of the
newly appointed women’s leaders, as pointed to earlier.
The most prominent leader of the organization that the passage mentions is Zackie Achmat, an
activist who put TAC on the map. Zackie is said to be charismatic and radical. He was the public
face of the organization, but not the person on the ground recruiting members (this was done by
other activists).

Zackie is said to have had a confrontational and aggressive leaders ship style.

He became famous for refusing to take HIV medications until all the members of the
organization had access to them first. This gave him the moral high ground and put TAC on the
stage internationally.

Conclusion

The Treatment Action Campaign, TAC, did a lot to make access to HIV medications and
education widely available in South Africa. Despite the organizations many issues, it did a lot of
good for the citizens of SA by fighting big pharmaceutical companies and forcing the
governments hand to implement programs such as the Operational Plan for Comprehensive
Treatment and Care for HIV and AIDS.

7. Pharmaceuticals

Context

The passage discusses the evolution of the regulation of pharmaceuticals by looking at 3

pharmaceutical interventions, namely opium, thalidomide, and contraception. It discusses the
role of pharmaceutical companies, the state, and the law.

The Chinese, the SA opium crisis, and regulation failures

After the Anglo-Boer war, there was a shortage of mine workers, supposedly due to the many
people who were killed in the war. In an attempt to save the Gold market in SA, the now
British-controlled government brought in many Chinese mine workers.

The passage notes that this led to widespread opium use, noting that there were
“entrepreneurs” ready to take advantage of the opportunity to supply opium to the Chinese
workers. The passage didn’t clearly state why the use of opium was prevalent among Chinese
workers.

Opium is a drug made from the poppy flower. It can be extremely addictive and is very harmful
to the body.

This situation of the opium crisis introduces us to the first case where regulation was needed to
regulate pharmaceutical use and how it largely failed at the start. Perhaps because it was such
a new concept (this was around 1899 to the early 1900s). It’s also important to note that opium
was considered a medicine back then, rather than a “drug” as we know it today, due to its
addictive properties. It was even coined “mining medicine”. Many Boer families supposedly also
used opium as part of their traditional medicines.

After noticing the disastrous effects of widespread opium use among Chinese workers, there
were calls for regulation. Disastrous effects included opium casualties, crime, desertion, worker
unrest, and draconian methods of labor control by mine management.

At first, regulation attempted to significantly regulate legal opium use by limiting it with laws.
However, usage was later increased to 2 pounds per worker per month (an absurd amount).
Nevertheless, even when limited by law, there was a large amount of opium in illegal circulation.
The limiting of opium also faced backlash by Boer communities, which considered it part of their
traditional medicines, as alluded to earlier.

Another aspect to consider is the pseudoscience surrounding opium use and Chinese workers,
with some medical authorities considering Chinese bodies to be prone to opioid use or very
resilient against its use. This was despite the development of the knowledge of universal
physiology at the time.

This demonstrates the failure to effectively regulate the drug despite knowing that opium was
damaging and not in the best interest of the health of its users. There may have also been a
profit motive behind keeping opium in circulation since it was sold by many regular merchants,
as well as licensed pharmacists.

When was opium properly banned, how did the crisis come to an end?

Thalidomide, How Africa Averted It, Pharma, the Profit Motive

The second compound the passage discusses is Thalidomide. Unlike opium, this was a
synthetic chemical compound similar to many of the medicines we use and know today.
Thalidomide was manufactured by Chemie-Grünenthal Gmbh. Two of its most common forms
included Contergan and Softenen. The compound was used in a variety of different medicines,
for example, to treat nausea, headaches, diarrhea, etc.

As the passage demonstrates– when dealing with synthetic compounds, a clear and thorough
regulation and testing process is required.

Thalidomide was largely sold and consumed across Europe and the USA. Due to economic
factors, which will be discussed, Africa largely avoided the thalidomide disaster.

Thalidomide has many side effects that are harmful to the body. The most significant being
babies that are born with severe physical defects if the mother consumed the compound.
The case of Thalidomide demonstrates the lack of thorough testing and regulation in the early
days of pharmaceuticals and why it is so essential. A compound as damaging should never
have been allowed to cause widespread defects among children and could have been avoided
had testing and regulation been in place.

However, not any testing and regulation would suffice. Pharmaceutical companies are
companies. And that means (despite their questionable good intentions) they want to make as
much revenue and profit as possible. It’s not unreasonable to believe that they’d sell a drug they
know to be harmful in order to make a profit. (Or fluke tests to put it out on the market as fast as
possible).

Hence, it’s essential for testing and regulation not to be in control of the pharmaceutical industry
but by an outside body, such as the state, which is supposed to have the best interest of its
citizens in mind.

Once the disastrous effects became known, Chemie-Grunenthal swiftly removed the compound
from its medicines, and alternatives soon followed that didn’t contain the compound.

Regarding Africa, the Thalidomide disaster was mainly avoided due to economic factors. A
similar drug, Miltown, from the USA, already largely dominated the market; hence, it would have
been difficult to sell Thalidomide in Africa. Secondly, the drug that was sold across Africa by
Chemie0Grunenthal was Entero-Sediv, used to treat intestinal infections and diarrhea.

While this drug did contain thalidomide, it did so in much smaller quantities hence the damaging
effects never really took foot in Africa.

The passage notes that the disaster in Africa was avoided not by luck, superior regulation, or
testing but by the economic factors stated above.

Contraceptives, UIDs, Implanon

The last pharmaceutical intervention the passage discussed is contraceptives. This included a
variety of forms, from hormonal injections to oral pills and intra-uterine devices (IUDs).

The passage talked about how contraceptives were widely available during the Apartheid era
due to the government’s family planning program and attempt to control black population
growth. It also discussed the opposite side of the spectrum and how the newly elected
government eliminated a lot of contraceptives due to it being used for population control under
the apartheid government, but in doing so also failed to give citizens access to the
contraceptives they needed due to reduced availability.

The passage didn’t discuss oral pills or hormonal injections much but mainly focused on IUDs,
showcasing it as another case for government regulation of pharmaceuticals. There was a quick
mention of the inconvenience of hormonal injections since they required quarterly appointments.
This is where UIDs came in (Variations included the Lippes Loop, Margulis Spiral, Copper T, and
Dalkon Shield). These are devices that are implanted as a permanent type of contraceptive. The
device that was focused on was the Dalkon Shield manufactured and distributed by Dalkon
Corporation. IUDs were widely favored at the start due to the convenience of not having to go
back to the clinic every quarter. However, after a while, it became clear that these devices, too,
were detrimental to women with many of the side effects, including increased risk of pelvic
inflammatory disease, septicemia, and spontaneous abortion.

In the USA 200, 000 women called for action against the device. Dalkon Corporation soon
removed the Dalkon Shield from the US market, but despite the knowledge of its harmful
effects, continued to sell it across other international markets.

This once again demonstrates the profit motive of pharmaceutical companies and the need for
government regulation.

In a similar case, another IUD-style device, implanon, was later developed to address the
shortage of contraceptives in the South African market. Unlike IUDs, this device was, however,
implanted into the arm and released hormones that regulated birth control. It’s said to be the
most effective contraceptive device ever created, being even more effective than sterilization.

Once again, this was sold by a private company, Merck. As with the IUDs, as time went on, it
became apparent that implanon had toxic effects on the body, and many of the women who had
the device implanted soon returned to clinics and hospitals to have it removed.

The removal was so common that the device was known as “outplanon” among medical staff.
Medical staff could not handle the amount of requests to have the device removed. They
referred patients to other clinics/hospitals, required month-long waiting periods, and outrightly
refused removal. This led to some patients removing the device themselves, which is a health
hazard to the patient.

Conclusion: The Need for Pharmaceutical Regulation by the State

Pharmapolitcs refers to the relationship between the pharmaceutical industry, the medical
profession, patients, and governments.

As the passage repeatedly demonstrated, Pharmaceutical companies seem to be completely

incapable of proper regulation and testing of pharmaceuticals. Even in cases where companies
knew the product to be damaging, such as the Dalkon shield, they continued to sell it in different
markets where they were not being scrutinized.

This makes an irrefutable case for pharmaceutical regulation by the state through regulated
bodies, open discussions, and thorough scientific testing.
As noted in the reading passage of week 11, the registration of new drugs in South Africa is
currently overseen by the Medicines Control Council (MCC) and the South African Health
Products Regulatory Authority (SAHPRA), with a significant backlog of applications. Alarmingly,
after everything discussed in the current passage (Pharmaceuticals, week 7), many
pharmaceutical retailers today ignore the need for state approval before stocking and selling
preparations (due to the backlog).

8. Pharmatrash

Context

The passage discusses a number of issues related to the failure of the post-apartheid
government to provide basic waste removal services to its citizens, directly disregarding their
human rights. It talks about the histories of garbage and the popularity of pharmaceutical
commodities. The study analyzes pharmaceutical trash artifacts in the Easter Cape and
discusses illicit codeine use, a type of opioid.

Democracy and Pharmatrash

The passage starts off by discussing the post-apartheid government and its complete failure to
provide basic waste removal and sanitation services to citizens.

The passage notes the irony that widespread access to healthcare has improved, but basic
sanitation and waste removal services have not, leading to the public's concerns over
pharmaceutical trash posing potential health hazards.

Pharmatrash is defined as ‘expired, unused, spilt or contaminated drugs, medicines and

vaccines, and includes their packaging materials.’

Garbage histories

The passage describes the importance of garbage histories in analyzing past societies and their
usefulness in revealing information about current societies, as this study does. Terms like
“garbology” are used.

The passage notes that when the abundance of trash in areas where it does not belong
becomes clear, it arouses public interest (negatively).

It also notes garbage history as something that has evolved over time with different technologies
and sciences. The example given is pathogenesis (the study of germs) and how waste may
have been treated differently before its discovery in the 19th century. However, since we now
know waste to be unsanitary due to pathogens, we also know that it's important to get rid of it
through effective means for sanitary reasons.
Popularity of Pharmaceutical Commodities and the Abundance of Pharmatrash in the Domestic
Waste Stream

The passage mentions IQVIA, a healthcare data mining company based in the USA with
branches worldwide, including in Pretoria. The company's data seems to suggest a thriving
pharmaceutical market in South Africa, with the opening of 400 new retail pharmaceutical
outlets over the past decade.

It also mentions the Medicines Control Council (MCC) and the South African Health Products
Regulatory Authority (SAPHRA), which is known for having a significant backlog of drugs that
need to be approved or not. As a consequence, pharmacies often don’t wait for approval and
sell drugs before they are approved.

The passage also mentions a growing healthcare system, which has launched 1345 new clinics
and 263 upgrades since 2009.

This growth in healthcare and access to pharmaceutical products, combined with the
government's downright incompetence regarding waste removal, has led to an abundance of
pharmaceutical trash in the domestic waste stream. The passage later mentioned how it was
easy to collect pharmaceutical trash from public spaces such as illegal dump sites next to roads,
sidewalks, parks, etc.

Archiving and analyzing pharmatrash in the Eastern Cape

In this section of the passage, the author analyzes pharmatrash from various municipalities in
the Eastern Cape and examines other studies regarding pharmatrash surrounding the Eastern
Cape Buffalo Metropolitan Municipality and East London.

In addition, the author collected data herself by visiting different areas and gathering
pharmatrash from public areas. Furthermore, she conducted interviews with healthcare workers
such as pharmacists, pharmacy assistants, and young people in schools who reported cases of
codeine abuse.

The results of this data analysis are tabulated in the passage in Table 1 on page 17.

The author notes how the type of pharmatrash differed between neighborhoods of different
income levels. Poorer and middle-class neighborhoods had a higher abundance of energy
boosters and painkillers, presumably to help them work productively. They also contained
medications for more common diseases such as TB and diabetes. Richer neighborhoods had
more pharmatrash from privately purchased sources, including expensive branded medicines
like anti-depressants and anti-psychotics.

There was also mention of the Health Care Interest Group, founded by the Institue of Waste
Management South Africa, that cast attention on issues like legislation governing medical
waste, lack of awareness surrounding the disposal of safe sharps, and the lack of adequate
waste incarceration sites.

The Ubiquity of Codeine Discards: Illicit Use

The passage notes that codeine products, such as various cough syrups (Phensedyl, Lenazine
Forte, and Benylin C. ), were the most commonly discarded items at sites. Codeine is derived
from the opium poppy.

The passage notes the rise of concerns over codeine abuse in South Africa, noting how
journalistic accounts have claimed it as one of the most widely abused over-the-counter drugs in
South Africa.

The passage discusses attempts to control it by recording IDs, names, and other credentials,
which have largely failed since there is no national database to record this information. Hence,
abusers can take advantage of something called “pharmacy hopping” to fuel their addiction.

The passage also notes how the codeine product Phensedyl, which also contained ephedrine
(supposedly responsible for alertness), was widely used among students in the 1970s at the
University of Natal to study through the night and promote concentration.

The author also included an account from a pharmacist on the widespread use of codeine
among common citizens and even his accounts of how he caught some of his customers
abusing the product.

Conclusion

The passage highlights the problems with Pharmatrash in South Africa and how it can pose a
risk to public health. The expansion of the healthcare system and the failure of the
post-apartheid goverment to provide effective waste removal has led to this.

It also notes how the analysis of waste can reveal interesting information, such as the
abundance of codeine discards signaling its illicit use in South Africa.