BY ALICE CANNON
With relatively low risks and high rewards—for those on the manufacturing side, anyway—the trade in fake and counterfeit pharmaceuticals is on the rise. Those of us in wealthier countries are relatively well protected, though fake medicines can be easily purchased online. People in poorer countries without strong regulatory and enforcement systems are particularly vulnerable. Fakes are especially attractive where the real drugs are in high demand, in short supply, or exorbitantly expensive. It’s estimated that in areas of Asia, Africa and South America up to 30% of the market can be counterfeit. 
Counterfeit drugs have included anti-malarials, vaccines, antibiotics, HIV treatments, and cancer treatments. The fakes may contain too little of the necessary active ingredients, or none at all. Or, they contain the wrong active ingredients, out-of-date active ingredients, unlabeled ingredients (e.g. potential allergens), contaminants from non-sterile production, or straight-out toxic substances. They can cause death directly, or by failing to treat the illness for which it was prescribed. Additionally, malarial drugs or antibiotics with low levels of the active ingredient will fail to cure people and make the parasite or bacteria more resistant to future treatments.
Interpol has developed special taskforces to combat the trade of illicit drugs, and the World Health Organisation works to monitor and raise awareness of ‘substandard, spurious, falsely labeled, falsified and counterfeit’ (SSFFC) medical products.  But the international nature of the industry makes it hard to combat. Success requires extensive cooperation between countries and businesses. So for the time being, be on your guard—and examine that box of pills you bought online very carefully.
United States, 2012: hundreds of cancer patients took fake Avastin, which lacked the necessary active ingredients. 
India, 2013: 8,000 patients died over five years in a remote Himalayan hospital because the antibiotic used to prevent infection after surgery had no active ingredient. 
West Africa, 2015: expired meningitis vaccines sold affected their ability to slow the outbreak of the disease in the region. 
- Ossola, Alexandra, 17 September 2015. The fake drug industry is exploding, and we can’t do anything about it. Newsweek.
- See this WHO factsheet on SSFFCs.
- Weaver, Christopher and Jeanne Whalen, 2012. How fake cancer drugs entered U.S. The Wall Street Journal.
- Wani, Riyaz, 20 April 2013. Valley falls prey to deadly spurious drugs. Tehelka.
- World Health Organisation, 2015. Medical Product Alert No. 3/2015: Falsified Meningitis Vaccines ciruclating in West Africa. See .
Alice Cannon (@pinknantucket) is a conservator of paper and photographs and editor/publisher of pinknantucket press.
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