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http://www.bmj.com/cgi/content/full/324/7341/800>
Murder by fake drugs
Time for international action
Until recently the most infamous internationally known example of fake drug dealing was Graham Greene's fictional account of a British fake penicillin peddler who was eliminated in the sewers of postwar Vienna in The Third Man.1 Unfortunately, malevolent dealings in counterfeit drugs are very much a contemporary reality. Notorious recent real examples include neomycin eye drops and meningococcal vaccine made of tap water; paracetamol syrup made of industrial solvent; ampicillin consisting of turmeric; contraceptive pills made of wheat flour; and antimalarials, antibiotics, and snake antivenom containing no active ingredients.2
n a recent survey of pharmacies in the Philippines, 8% of drugs bought were fake (quoted by Wondemagegnehu2). A countrywide survey in Cambodia in 1999 showed that 60% of 133 drug vendors sampled sold, as the antimalarial mefloquine, tablets that contained the ineffective but much cheaper sulphadoxine-pyrimethamine, obtained from stocks that should have been destroyed, or fakes that contained no drug at all. 3 4 In another recent survey, 38% of tablets sold in five countries in mainland South East Asia as the new antimalarial artesunate were fake.5 Artesunate is an extremely important antimalarial 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.5 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 malaria10 and a cause of Reye's syndrome, has been used in the manufacture of fake chloroquine in Africa.6
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