Download Drugs and internet – cheap and dangerous

D RU G S A N D I N T E R N E T – A DA N G E RO U S A F FA I R
INTRODUCTION
Every day people die after having used fake medicines. On the internet you are promised miracle pills and
life-saving remedies for all kinds of aches and pains. The scientific proofs are not as promising, i.e. if you
have a pill containing anything at all. There are two kinds of medicines you can get from the internet. One
pretending to be a well-known medicine that in fact is a forgery, the second being a miracle medicine you
have never heard of, promising a lot of advantages. Buying this kind of preparations from the internet can
be a life threatening and an expensive affair.
COUNTERFEIT MEDICINES
Why does the problem exist?
The development and production and of a new pharmaceutical product involves enormous costs and the
pharmaceutical companies have to bring the money in before they loose the patent, which means
expensive medicines to the customer. That is why making counterfeit medicines is a great source of
income. Swindlers can manufacture well-known drugs without their expensive active ingredient.
The customers might be people wanting prescription drugs without visiting a doctor. Ordering from the
internet is the easiest way to get hold of the wanted medicines without having to deal with the shame
about ones condition when visiting the doctor. In some cases, for example, to get a prescription for
Xenical you have to be motivated to loose weight, and need to show to the doctor that you are ready to
diet. If you are not, you could find it easier to get the prescription drug from the internet. Another group
of customers is bodybuilders wanting different kinds of preparations for bodybuilding.
The extent of the problem
Between five and ten percent of the medicines sold in the world can be fake (1). The developing world
suffers the worst problem, but also the industrial countries have got their share, due to an increased trade
in pharmaceuticals over the internet. “Trade with pharmaceuticals over the internet means that the risk of
fakes increasing even for us Europeans” says Sten Olsson at the Uppsala Monitoring Centre, which is the
WHO’s agency for monitoring pharmaceutical side effects (1).
In the developing world it is often more commonly used medicines that are counterfeited, such as
painkillers, antiparasitic medicines and antimalarial drugs. In the industrialised world the counterfeit tends
to be more lifestyle-oriented medicines, like oral contraceptives, virility drugs and drugs for loosing
weight.
Swedish medical products agency reported 2001 that Viagra is sold illegal and that it has been an attempt
to smuggle tablets of Viagra from Estonia to Finland (2). At a routine check 150 packages of Viagra á 50
tablets were found. The colour of the tablets resembled the
colour of Viagra but the shape was not identical. Laboratory
analyses showed that the tablets did not contain any active
substance. This was one of the first attempts to import
counterfeit drugs into the Nordic.
Another example is smuggled growth hormone from the
former Soviet Union. Analyses showed that the hormone
probably was extracted from human pituitary gland, which can
increase the risk for Creutzfeldts-Jacobs disease.
2002 the Swedish medical agency reported that a batch of fake
Xenical, used for loosing weight, was found in the customs in
South Korea on its way from China (3). Analyses showed they
Photo: CBS/AP
contained another active substance that is normally found in
CBS/AP
Reductil (another drug for loosing weight).
WHO had a project in the late 90’s in which the aim was to chart the incidence of counterfeit
pharmaceuticals (1). The result in all was 751 cases recorded, and a full eleven percent of those were
recorded in Europe. Some of the forgeries were so cleverly done that the manufacturer of the original
product could not tell which one was the fake by studying the packaging. They even found a fake
hologram.
In the developed countries taking the fake medicines often leads to non-appearance of the promised
effect. The fakes themselves are seldom dangerous. In the third world on the other hand they can be
poisonous or even lethal. In Delhi, 1998, 33 children died after haven taken contaminated cough-medicine
(5). The contaminant was dietylenglycol, which can induce renal failure. Approximately 500 people have
died from dietylenglycol poisoning. Dietylenglycol is a cheap solutant and has been used to substitute
more expensive ones
MIRACLE PILLS
There are a lot of different kinds of miracle pills on the internet, in
magazines and from mail-order companies. What they all have in
common is the fact that they are not registered medicines. If they
would have all the effects they promise, they would be a source of
great income. The medical companies, would fight to get hold of
them and sell them as registered medicines. Why, in that case, are
they only sold on the internet?
When finding a great drug on the internet you should consider a
few things before ordering:
Photo: www.tiofoto.se
 Have you ever heard about the drug in another context. For
example on the news or in the newspaper?. Newly discovered cures for diseases are getting a lot of
attention. Can you get information about the drug from trustworthy suppliers of medical information,
like medical products agencies, pharmacies, Netdoctor or Infomedica.
 Do you think the information is trustworthy, if you consider your previous knowledge about the
disease and treatment.
 Preparations that are said to have effect against diseases are by law required to undergo controlled
studies for effect and patient safety. Are there controlled studies for the miracle pill and has a
comparative study been done, comparing the effect of the miracle pill versus other medicines used to
treat the condition.
CONSEQUENCES
Health
One could say, so what if I get a preparation without active substance or a herbal drug from the internet.
At least it is not harmful. In fact, you should be afraid of what you can get. In the above example with
Xenical the active ingredient, orlistat, had been changed to sibutramin, which is the active substance in the
weightloss preparation Reductil. Reductil has other contraindications, i.e. diseases when you cannot use
the preparation, for example heart disease and mental disturbances. This means that for some people this
batch can be even fatal.
People tend to believe that herbal medicines are safe and not dangerous at all. Sellers on the internet prey
on that myth, even selling herbal remedies as antibiotics and cure for cancer. The Swedish medical
products agency have recently attracted attention to extracts from grapefruit seeds sold in herbal shops
(4). This extract is said to be working as an antibiotic and to strengthen the immundefense against
bacteria, viruses and fungus. This means according to the definition of a medicine, that this product is, in
fact, medical. The corporation has not applied for registration of such a drug. The extract can cause severe
damage to mouth and throat due to irritation.
You can get prescription medicines from the internet without seeing a doctor by just filling out a
questionnaire on the webpage, in some cases you do not even have to do that. This can delay your true
diagnosis leading to serious harm in the future. That is, if you are not harmed by the received drug itself.
Economomy
There are a lot of laws and regulations concerning import and mail deliveries of medicines. Drugs that are
sent by mail can be held in customs. Products ordered from the internet are often expensive, and you are
often required to pay in advance. If you can’t convince the medical agency to approve the import, the
mail package will be returned or destroyed and your money will be lost.
If one is in fact injured of drugs from the internet one is at risk of being denied economic compensation
for medical attention, because the common health insurance only cover damages from registered drugs in
the country you are living in.
DISCUSSION
There is very little documentation of pharmaceutical counterfeiting. The risk of getting cought is
negligible, the risk of getting punished even less and the profits are great. The swindlers can make a
greater profit producing fake medicines than producing and selling narcotics.
With fake medicines getting around in the world, the risk for a fake batch ending up on the shelves of real
pharmacies increases. In the ongoing situation of competitive pricing it would be a possibility for a less
honest company to dilute a batch of genuine product with fakes to cut costs, make more profit or win an
order.
The pharmaceutical companies have to, and are, getting together to fight forgeries. The best way to fight
fake medical products is to make the pharmaceutical product, and foremost the packaging, more difficult
to counterfeit. Holograms are already in use, another way is to include trace elements in the medicine
which makes it easier to analyse. Of course this means that the product becomes more expensive, which
economically hurts poor people, leading to extensive internet shopping for cheaper drugs.
The increasing problem with medicine counterfeit threatens the credibility of the original products. This
leading to the worst scenario that people refuses to take any medicine out of fare for poisonous medicines.
REFERENCES
1. Näsström Jan, Fight against fake medicine, Holmen business report, February 2003
2. Svart Viagra kan vara dyrbar placebo, Läkemedelsverket i Sverige, 19.02.2001.
3. Läkemedelsverket, http://www.mpa.se/observanda/obs02/020508_xenical.shtml, 08.10.2004
4. Läkemedelsverket, http://www.mpa.se/press/press98/981016.shtml, 08.10.2004
5. Hake Karl-Magnus, Förfalskade läkemedel-ett växande internationellt problem, Läkemedelsvärlden (6),
June 2001