Counterfeit drugs

Every year, a million people die of malaria. Up to twenty percent of those deaths may be the result of sick individuals taking counterfeit drugs. The new issue of Smithsonian features an engaging story about the trade in fake anti-malaria drugs and efforts to squash it. Sometimes, spotting bogus pills, often sold in small village pharmacies, is easy due to mistakes on the packaging: blister packs reading "tabtle" instead of "tablet." However, the best counterfeits require high-tech forensic tests to identify. Public health officials teamed up with the World Health Organization for Project Jupiter, an effort to throw a wrench in the trade. First they have to identify the source though. From Smithsonian (click image for full photo by Jack Picone):
Bogus medicines are by no means limited to malaria or Southeast Asia; business is booming in India, Africa and Latin America. The New York City-based Center for Medicine in the Public Interest estimates that the global trade in fake pharmaceuticals--including treatments for malaria, tuberculosis and AIDS--will reach $75 billion a year in 2010. In developing countries, corruption among government officials and police officers, along with weak border controls, allow counterfeiters to ply their trade with relative impunity. Counterfeiting is "a relatively high-profit and risk-free venture," says Paul Newton, a British physician at Mahosot Hospital in Vientiane, Laos. "Very few people are sent to jail for dealing in fake anti-infectives."

When the fake artesunate pills first appeared in Southeast Asia in the late 1990s, they were relatively easy to distinguish. They had odd shapes and their packaging was crudely printed. Even so, Guilin Pharmaceutical, a company based in southern China's Guangxi autonomous region and one of the largest producers of genuine artesunate in Asia, took extra steps to authenticate its medication by adding batch numbers and holograms to the packaging. But the counterfeiters quickly caught on--new and improved fakes appeared with imitation holograms...
Dallas Mildenhall is an expert (some would say the expert) in forensic palynology. Working from his lab at GNS Science, a government-owned research institute, in Avalon, New Zealand, he is a veteran of more than 250 criminal cases, involving everything from theft to murder. In 2005, Paul Newton asked him if he could extract pollen samples from antimalarials. "I was fairly certain I could," Mildenhall says. He views the trade in fake antimalarials as his biggest case yet. "It is mass murder on a horrendous scale," he says. "And there appears to be very little--if any--government involvement in trying to stamp it out."

In the fake drugs, Mildenhall found pollen or spores from firs, pines, cypresses, sycamores, alders, wormwood, willows, elms, wattles and ferns--all of which grow along China's southern border. (The fakes also contained fragments of charcoal, presumably from vehicle tailpipes and fires, suggesting the phony drugs were manufactured in severely polluted areas.) Then Mildenhall discovered a pollen grain from the Restionaceae family of reeds, which is found from along the Vietnam coast into southernmost China. That location matched the source of the calcite identified by Jupiter Operation's geochemists. "The Fatal Consequences of Counterfeit Drugs"


  1. I guess that blows a hole in one of the arguments for legalizing schedule 1 substances. There would just be counterfeits of the medical versions. :(

  2. @kleer001: Not really; counterfeit drugs make up a mercifully small percentage of the market in developed countries that have safeguards against this kind of thing. As usual, it’s the world’s poor that are getting screwed over by these murdering crooks.

  3. @kleer01

    This doesn’t defeat that argument for legalizing illicit drugs. Rather, this supports an argument that the regulatory system should encourage high-quality production from a variety of sources, and put a system in place to increase consumer awareness and transparency.

    Instead of that, right now we have regulations written by pharmaceutical corporations that discourage competition. Thus the black market, where quality is poor and ignorance is high.

  4. Ugh. Knowingly manufacturing and distributing a placebo that can actually CAUSE THE REAL DRUGS TO STOP WORKING? Endangering tens of thousands of lives?

    There are very few crimes I think are deserving of crucifixion, but these people need to asphyxiate slowly in the sun in front of the world, so that crimes like this will be too scary to get involved in.

    And I’m against the death penalty, too- my rage is overcoming what I used to consider common decency.

  5. Don’t the counterfeiters realize that by slapping “homeopathic” or “herbal remedy” on the packaging they’d immediately legalize their trade?

  6. shouldnt the placebo effect allow some who take the fakes to get better anyway? If not, why, don’t some who take the placebo in double-blind trials before drugs are approved get better?

  7. take control of medicine from the pharmaceuticals. saturate the world with cheep, real medicine. problem solved.

    (they say they have to maintain private control to ensure profitability or no one would be interested in R/D. This is a lie. i don’t know a single oncologist, for instance, who’s in it for the money. some people are just healers. greed is not the only motive force in human existence.)

    and, oh yes, we could do it easily. cheaply. it would take nothing more than american people actually controlling their tax dollars and their country.

    1. First of all, cheap for people in developed countries would be expensive for people in developing countries, unless you meant ultra-cheap.

      Secondly, oncologists and other doctors don’t profit from drug sales unless they’re seriously breaching their code of ethics, so yeah. People shouldn’t become doctors for the money.

      Last, but most important, is government money and the big pharma business model.

      – Any drugs created as a direct, or somewhat indirect, result of research performed using government grant money should be required to be sold within regulated price controls.

      – The business model where manufacturing and R&D is performed in-house is outdated. By separating these two highly divergent activities you can maximize the efficiency of your research by the ability to sell a discovery on the open market no matter what it is, instead of having to sit on them because they don’t fall neatly inside the company’s product line. Manufacturers can then focus on recouping the cost on the purchased rights/patents, instead of having to make up for potential short-falls in the company’s R&D division, making pricing an easier task and partially deflating the big pharma argument.

      So yeah, you’re right.

  8. “You know, I never feel comfortable on these sort of things. Victims? Don’t be melodramatic. Look down there. Tell me. Would you really feel any pity if one of those dots stopped moving forever? If I offered you twenty thousand pounds for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spare? Free of income tax, old man. Free of income tax – the only way you can save money nowadays. “

  9. “First of all, cheap for people in developed countries would be expensive for people in developing countries, unless you meant ultra-cheap.”

    Then, they should be ultra-cheap.

    The price of drugs is *also* a problem in developed countries. You have the working poors, you have the homeless, you have the illegal immigrants. These people do not have that much more available money that people is some third world countries.
    All these people should have access to dirt cheap drugs and medecine. Including illegal immigrants. France had a program that covered *everyone* (CMU, Universal Medical Coverage). It included all these populations, including illegal immigrants. But the program is being dismantled piece by piece, and the illegal immigrants are too scared of being caught to use it anyway. The result? We know have more and more strains of tuberculosis that are antibiotics resistant… And middle class citizen catch tuberculosis too, healthcare is global…

    How cheap is cheap enough? I would say : free. I live in France, I have both State healthcare (sadly, in the process of being dismantled) and private healthcare (through my employer, I pay 45€ per month for the family). Well, I also have private coverage through my girlfriend (15€ per month for the family), that’s a bit overkill. This is a pretty typical situation.
    When I go to the pharmacy, I don’t even get out my credit card. I just show my electronic healthcare card and I have my drugs – the pharmacist then gets paid by the insurances. I never ever paid for antibiotics or anything.

    As a result, counterfeit drugs are virtually non-existant. Ordering drugs online is inexistant too. Why spend money to order Viagra online, when you only need to see a doctor to get a prescription and have it for free? Why order overpriced Xanax online when a doctor’s prescription will let you have it for free (and in a much safer way)? And the same applies to the more vital drugs : antibiotics, AIDS drugs, cancer drugs…
    Anyway, even without health insurance, most drugs are cheap. For instance, Xanax in generic form is typically less than 5€ per box. Most antibiotics are around that price too. Per box, not per pill.

    The only reason counterfeit drugs exist is because people cannot afford the real drugs.
    So, you can spend tons of money fighting against fraud – The War on Counterfeit Drugs. With the usual result. You will also have to spend tons of money on the side effects of the use of these drugs – at some point, the society as a whole will have to pay the cost.
    Or you can spend money on a proper healthcare system that makes counterfeit drugs unattractive. And by proper, I mean one that does more than spend money, but one that also control costs – and this includes negotiating with the drug industry to bring prices down.

  10. Well as long as you’re honest about the government being the one to pay for everything, although I wouldn’t call government cheese the most ideal of incentives.

    Also, as a Canadian, I only have access to State Healthcare, for the most part. While I appreciate that I won’t be denied healthcare, the waiting times to see a specialist can be nightmarish. I think a two-tiered system is worth experimenting with.

    And since when is Viagra considered to be a drug that the government should be paying for?

  11. Artemisia is apparently rather expensive to produce so although the drug companies are by no means poor, they do spend a lot making the Artemisia based Coartem (I believe it is the most effective drug against multi drug resistant strains).

    Though a big problem, for the developing world, is corruption. Even if the drugs are cheap, you have gov folks regulating the supply for profit.

    I currently live in Africa and my wife works in public health fighting malaria.
    From what I see, the problem is tied to bad governance and corruption. How exactly can you ‘saturate the world with real drugs’ if the powers-that-be control the distribution networks–and in many developing countries the distribution networks are badly broken or barely exist at all.

    And if I’m a big government in the developed world- and I give millions to a poorer country for drugs, I must make sure that the money is used to buy real drugs and not fakes to supply extra profits for the corrupt. Oversight of aid money is essential! Oversight, from what I see, is often lacking.

    The Global Fund (much supported by Bono and others) is a pool of money from international donors to battle AIDS, Malaria (maybe other diseases too) It is a kind of common fund that poorer governments can draw from to shore up their health systems. And to be clear, although it is not perfect– it is helping the developing world!
    The US has been criticized for pulling much of their money out of the global fund and managing it themselves through PEPFAR and PMI (now renamed I believe). But the reasons for doing this all revolve around effectively spending the aid money, better oversight–reducing loss thru corruption.

    Sorry, this is a rambling, disorganized comment but my point is that it’s not just cheaper drugs from the pharmaceuticals but anti-corruption efforts that are needed to fight the fake drug problem.


    I don’t know how it works in Canada, but in France, the government does not pay for the healthcare system (actually, it rather tends to steal money from it by distributing tax exonerations to big corporations). Nor does it manage it. We don’t really have a socialist system.

    The general idea (simplified, it’s pretty complex actually) is this : the healthcare is paid both by workers and employers, directly from the paychecks. All the money goes to a common pot that is used for coverage (it’s a bit more subtle : there is an employer only pot to cover work related costs, some professions pool their own pot…).
    This is not revenue tax : the money goes directly to healthcare and can only be used for that and is not related to the budget of the State.
    The healthcare system (“sécu”) actually deals with more than health : the system also handles retirement insurance, family care, housing aids… It’s actually not a single entity, but a myriad of them, each dealing with one aspect. Some of them are State operated, some are operation by representatives from the employers and employees, some are private…
    So, it’s not really free State money. It’s more like a global mutual insurance company.

    As for the waiting like, it seems the Canadian system is pretty different. We actually have a multi-tier system. More important, the insurance and the public health system are not related at all. This means I’m insured whether I go to the public health system or the private health system. So, I can :
    – go to a public hospital; I will have to pay close to nothing (for instance, my girlfriend paid 10€ for an exam, radio and a dozen stitches), unless I’m very poor and benefit from CMU, then I will pay nothing. There is some waiting involved, for instance, my father had to wait three weeks for a knee scanner and would have had to wait about the same time for surgery. Wait is on a need most basis, so if you have something life threatening or serious there is not much wait.
    – go to a private hospital (“clinic”); I will pay more, but I will wait less and comfort is overall better. I will be sure to have a private room, the food will be better and I will be able to pick my surgeon. Public insurance will reimburse what it would have with public hospital, private insurance will cover the rest.
    – go to a private doctor in a private practice. Usually I can have an appointment within days. There are different cases. The doctor could work within the costs established by the public insurance (I will pay close to nothing), work with the public insurance guidelines but outside its costs (my private insurance will pay part or all of the difference) or work totally outside (then it’s only private insurance or nothing, that’s most of all the case for doctors that I not officially doctors : herbalists, acupuncturist…). Normally (recent reform), I would have to validate the specialist visit through my usual non-specialized doctor. If I don’t, I will pay a little more (around 5€, not worth the trouble).
    In every case, *I* have the choice of what option I pick and of where I go for each ones. Depending on the doctor, I can have to pay and wait for the insurance to reimburse me or I can have the insurance (public and private) deduced directly. The second option is always available in public hospitals.
    This might seems pretty complex, but most people do not even think about it and just use the system…

    As for Viagra, I double-checked and it’s not covered by public insurance (but it might be covered by private insurance). Edex (Alprostadil) is though.
    I would not see problems with the government covering it within reasons. First of all, erectile dysfunction can happen because of several serious diseases : prostate cancer, diabetes… It is usual for healthcare to cover side-effects of such diseases, I don’t see why erectile dysfunction should be treated any differently than chimio burns, nerve damages or the like…
    Also, erectile dysfunction can lead to over troubles : nervous breakdown, panic attacks, divorce… All of these have a social cost. It’s cheaper to treat a married employee with Viagra than to wait and treat an unemployed divorced man with Xanax…
    Most of all, proper healthcare also deals with the mental state. It deals with panic attacks, nervous breakdowns, bipolar disordes and the like. Again, I don’t see why sexual problems should be handled differently.

  13. @ Lictor

    Thanks for the explanation of the French health system. And you’re right about the Viagra instead of Xanax ideal, which is also a little funny.

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