Innovations to address global drug counterfeiting: Implications for urbanization and health

Abstract

The recent rise in counterfeits has now extended from basic consumer goods and electronics to pharmaceuticals, jeopardizing the health of millions across the globe. Estimates suggest that the counterfeit industry is now $75 billion and will grow by 20 % per year, making it one of the fastest growing public health risks [Poison pills. The Economist. 2012]. Counterfeit medications, comprising more than 30 % of medications in parts of Asia, Africa, and Latin America, have only recently gained recognition by the general public and mainstream media. Although the burden of disease lies largely with the world’s most vulnerable populations, Western countries are not insulated from this problem [The deadly world of fake drugs, Washington, DC]. With the rapid growth of online pharmacies, the currently quoted 1 % prevalence of counterfeit medications in the United States will quickly rise [World Health Organization, IMPACT. Counterfeit drugs kill! 2008]. The Internet, which boasts up to 50 % prevalence of counterfeit pharmaceuticals, has introduced medications such as blood pressure control, lifestyle medications, and pain modulators to the list of counterfeited medications. The traditional definition of counterfeit medications, including both generic and brand name, is medications deliberately and fraudulently mislabeled with respect to identity and/or source [Counterfeit medical products: report by the secretariat. Geneva]. In some instances, counterfeiting involves manufacturing a drug without its active ingredient-with chalk, starch, flour, or talcum powder in place of any active compound. Although less harmful than some of the more menacing manufacturing techniques, this approach puts patients at risk of morbidity and mortality from otherwise treatable diseases. In a more sinister approach, these formulations can be made with substitute medications providing relief of symptoms but not treatment of disease, for example, filling an antimalarial with acetaminophen, which will lower the fever of malaria but will not treat the underlying parasite. Other medications may have active ingredients but at nontherapeutic doses. This “up marketing” of medications runs the risk of creating resistance in the partially treated host. These substandard medications subject patients to treatment failures and create drug-resistant organisms. Lastly, and perhaps the most publicized aspect of this issue, is the inclusion of noxious chemicals in medications marketed as therapeutic pharmaceuticals. Most notoriously, in place of the glycerin normally used in cough syrup, the toxic substance diethylene glycol has been used because of its similar taste, color, consistency, and lower cost. Counterfeit pharmaceuticals thus have significant public health consequences beyond their individual-level effects. These falsified medications jeopardize the primary care environment by undermining people’s faith in their physicians and making them question the integrity of the pharmaceutical supply chain. This chapter will provide an overview of drug counterfeiting globally, describe its potential impact for urbanization and health, and discuss various mechanisms to address this problem.