Fake drugs pose health dangers

Bogus drugs are causing misery in many parts of the world, including industrialized countries. Urgent action is needed to stem the growing tide of bogus medications that are either useless or actually cause harm, say doctors. The international community must act to stop the "murderous" trade.

There are several alarming examples of fake drugs in circulation. They include a meningitis vaccine made of tap water, contraceptive pills made of wheat flour, a paracetamol syrup made of industrial solvent and other fake drugs that include ingredients that can actually damage health.

This was disclosed by Dr. Paul Newton of the Nuffield Department of Clinical Medicine at Oxford University, in his article in the British Medical Journal. He said, "The accumulated evidence, such as it is, suggests that mortality and morbidity arising from this murderous trade are considerable, especially in developing countries."

The following is an excerpt from Newton’s article:

"Until recently the most infamous internationally known example of fake drug dealing was Graham Greene’s fictional account of a fake British penicillin peddler who was eliminated in the sewers of postwar-Vienna in The Third Man. Unfortunately, malevolent dealings in counterfeit drugs are very much of a contemporary reality. Notorious recent real examples include neomycin eyedrops and meningococcal vaccine made of tap water, paracetamol syrup made of industrial solvent, ampicillin consisting of turmeric, contraceptive pills made of wheat flour, and anti-malarials, antibiotics, and snake anti-venom containing no active ingredients."

In a recent survey of pharmacies in the Philippines, eight percent of drugs bought were fake. A countrywide survey in Cambodia in 1999 showed that 60 percent of 133 drug vendors sampled sold anti-malarial mefloquine tablets that contained the ineffective but much cheaper sulphadoxine-pyrimethamine, obtained from stocks that should have been destroyed, or fakes that contained no drugs at all.

In another recent survey, 38 percent of tablets sold in five countries in mainland Southeast Asia as the new anti-malarial artesunate were fake. Artesunate is an extremely important anti-malarial drug, and its rapid action and lack of side-effects have created significant demand in endemic areas. These characteristics, along with a relatively high cost, make artesunate particularly attractive to counterfeiters, who have gone to great lengths to deceive patients, using small amounts of ineffectual bitter chloroquine, copying the blister pack design, and even providing fake holograms on the package.

Some counterfeit drugs contain actively harmful ingredients, not just bogus placebos. For example, aspirin, thought to be an important contributor to acidosis in children with malaria and a cause of Reye’s syndrome, has been used in the manufacture of fake chloroquine in Africa.

These pernicious deceptions have been reported mostly in local newspapers. There is little published medical research assessing their prevalence, public health impact, or possible counter-measures. The accumulated evidence, such as it is, suggests that mortality and morbidity arising from this murderous trade are considerable, especially in developing countries.

They have also given rise to misconceptions about drug resistance as patients "fail" their ineffectual treatments. For example, artesunate resistance reported in Cambodia turned out to be due to unwitting use of fake drugs. The World Health Organization estimates that 10 percent of global pharmaceutical commerce involves fakes.

In the past, drug companies have tended to avoid publicizing the problem for fear of "damaging public confidence in medicines." Some countries, well aware of the scale of their problem, have preferred to ignore it.

In the face of this substantial criminal mortality and morbidity, there has been little international action. The appearance of fake anti-cancer drugs in the United States led to local action by the pharmaceutical industry. Much more needs to be done in the developing world. Guidelines have been produced, but most developing countries do not have the infrastructure and financial resources to implement them.

Paradoxically, the most accessible testing service for fake drugs is the free, anonymous service allowing people to check the authenticity of their illegal Ecstasy tablets. The global forum on pharmaceutical anti-counterfeiting organized by Reconnaissance International and the World Health Organization to be held in September will address these issues. — PLG News & Views