by Marvin Ackerman, M.D.
No matter where you live – especially if it’s in a developing country – beware of unscrupulous traders in fake drugs. When it comes to making a fast fortune, anyone is fair game, even the sick or the dying. We can also go one step further. If you’re not dying already, these purveyors of malicious indifference would not hesitate in the least to provide you with the means of getting there. Children are no exception. Especially those afflicted with malaria in Africa where fake chloroquine may not just contain harmless ingredients but has actually been manufactured with aspirin in the formulation. Giving aspirin to young children with life threatening malaria is like lighting a cigarette near a tankful of gasoline. The result can be disastrous because the aspirin might help bring on dangerous acidosis, and is also considered to be completely “verboten” because of its tendency to cause Reye’s syndrome in children.
Writing in the April 6, 2002 issue of BMJ Newton, White, and Rozendaal provided some startling revelations about the subject in their editorial, aptly titled “Murder by fake drugs: Time for international action.” This is scary enough but some of their illustrations of what is actually going on around the world are literally “hair raising.” Malaria seems to be one of the major targets. When a survey was done of 133 vendors in Cambodia of mefloquine tablets for malaria back in 1999 the amazing figure of 60% of them were found to be providing fake medication. Many simply sold pills with nothing of value in them at all. Some at least gave pills, which had mefloquine in them, but the pills came from stocks that were supposed to have been destroyed. The rest put sulphadoxine-pyrimethamine in their tablets instead of mefloquine because it’s a good deal cheaper. However, it also doesn’t work. The result is that people are failing to be helped, many are dying, and physicians are deluded into thinking that drug resistance is developing. Similarly, in mainland South East Asia, a survey of five countries found that 38% of tablets that were supposed to be the new antimalarial artusenate were actually fakes. Counterfeiters love drugs like this one because it’s expensive, acts quickly, and is in great demand, so they go to a lot of trouble to prepare virtually exact copies of the package designs, even the holograms on them.
In the Philippines the World Health Organization reports, via a quote from Wondemagegnehu, that 8% of drugs that are bought are fakes, according to a survey of pharmacies. All in all, the WHO estimates that about 10% of all worldwide pharmaceuticals are actually fakes, and even worse, very little is being done about it. In the United States recently the spread of these malicious practices became apparent when it was reported that a drug dispenser was diluting anticancer medicines. Prior to that the appearance of fake drugs for cancer in the United States led to local action by the pharmaceutical industry in 2001. But most developing companies are unable to follow through due to lack of resources. Fortunately, a major effort may be in the works as the WHO and Reconnaissance International try to organize a united front against these practices. Also, various techniques for making drugs and their packaging harder to imitate, development of simple assays, policing and legal actions, education of the public, lowering the price of those drugs being copied, etc. are starting to make inroads into the trade, but we are a long way off from achieving success.
Until these horrible purveyors of misery and death can be stopped and brought to justice your best weapon for protecting your own families and yourselves is awareness. That’s why this editorial in BMJ is so important and why I chose to review it for you. Now it’s up to you to be wary. Never purchase your medications from anywhere but reliable sources, always be suspicious if a medication fails to do what it is supposed to do, be sure that the packaging is proper and intact when purchased, and report any of your suspicions or findings to your physician and the proper authorities.
Whom can you trust when you’re feeling low?
How can you tell a friend from a foe?
Who will stand by your side to the end?
Who will oppose and who will defend?You must never give in to a whim or a vibe,
You must test a beverage before you imbibe,
And be sure to question before you buy
For the truth is near, but so is the lie.