Vigilance is the best medicine
September 08, 2006

IF YOU find yourself tempted to stock up on Tamiflu or Cialis from overseas through an online deal, read this.

Murder by medicine - or, more specifically, fake medication - is an insidious and growing problem, with an estimated million deaths a year of unsuspecting victims who took counterfeit drugs that did not treat their ailments.

More are losing their money and health to producers and traders, who reap as much as $8 billion from this counterfeit industry ("Fake pills that kill, not cure", Sept 1).

The trade in fake drugs is growing in the developing regions of Asia, Africa and Latin America, where about 60 per cent of known cases have been reported. But developed countries are clearly not spared.

Here in Singapore, in January 2004, the Health Sciences Authority (HSA) issued a warning about counterfeit Cialis tablets (for treatment of male erectile dysfunction) being sold illegally. Counterfeit Viagra tablets also found their way into Singapore and were duly seized by the HSA.

While the HSA has not detected any counterfeit Tamiflu locally, the public has been warned not to buy this drug from the Internet. Apparently, due to a worldwide shortage, counterfeiters have been working overtime to "ease" the demand.

As to the full extent of the problem, the World Health Organization (WHO) estimates that between 6 and 10 per cent of the medicines that reach the market are counterfeit. Dr Harvey Bale, director-general of the International Federation of Pharmaceutical Manufacturers & Associations, estimates more conservatively that up to 2 per cent of the world's pharmaceuticals are fake.

The reasons for the spread of this man-made epidemic of fake drugs are numerous. Developing countries often lack effective registration of medicines, have inadequate regulations where most drugs can be bought without prescriptions, and suffer an erratic or short supply of medicine because of war, corruption, poverty and illiteracy. So, the ordinary people get their medicines where they can, through channels legal and illegal.

Even developed countries are no match for the enterprising greed of the counterfeit "drug barons" (some of them actual narcotic drug barons cashing in on this new cow).

The worst perpetrators are reportedly India, which produces much of the "basic" counterfeits such as anti-malarial drugs and antibiotics, and China, which churns out the "high-class" ones such as anti-cholesterol medication.

The main buyers, be it in rich or poor countries, are usually the poor, particularly in rural areas.

The fact is, counterfeits are cheaper than the real McCoy and are sold at small stores and obscure dispensaries, most without the need for prescriptions.

The poor fakes are easy to spot, with misspelling or the wrong logo on the packaging. But it is often difficult to tell the difference with a good fake, as counterfeiters have gotten sophisticated at imitating the original - and that includes cleverly-faked holograms on the packaging et al.

Can this trade be wiped out? It would be rather difficult, when there exists a chasm of living standards.

Unless the poor have access to genuine medicines by way of subsidies, the illegal trade will continue to thrive. Also, for many years, the pharmaceutical companies have been accused of silence and acquiescence because of fear of the effects on their own business.

The other solutions are easy to prescribe - constant surveillance, vigilant investigation, effective law enforcement, exchange of information among countries, public education to buy medicines at licensed outlets and not from street vendors - but not always simple to implement.

In Singapore, thankfully, stringent laws are in place to prevent the illegal import and sale of counterfeit and unregistered medicines. The HSA acts as a watchdog and works closely with other law enforcement agencies including the Immigration & Checkpoints Authority and the Police.

But as the HSA has always reiterated, the public's cooperation is vital and it has encouraged people to come forward if they suspect counterfeits are being sold. It has also advised the public not to buy medicinal products from "dubious sources" and over the Internet.

The WHO, through its Rapid Alert System - the world's first Web-based system for tracking the activities of fake drug cheats - alerts member countries by transmitting reports on the distribution of counterfeit medicine, for their immediate action.

Dr Budiono Santoso, the WHO's regional adviser in pharmaceuticals for the Western Pacific Region, hopes this "will considerably strengthen our hand against the counterfeiters".

But as Singapore's situation shows, however stringent a system is in place, there are always chinks in the armour.

Vigilance against this counterfeit invader would save lives.

Source: http://www.todayonline.com/articles/141202.asp