Dangerous ‘drugs’: the war on fake malaria pills

An international collaboration between public health researchers, forensic scientists and police has led to the identification and arrest of individuals responsible for distributing fake anti-malaria pills (artesunate). Analysis of the air around fake tablets in blister packs, trace amounts of pollen found inside the blisters, and the composition of the tablets themselves provided evidence that the drugs were being made in southern China. This information was provided by Interpol to the Chinese government, which subsequently made the arrests, though the producer is yet to be tracked down.

There is a huge international trade in fake pharmaceuticals, many of which, like fake DVDs, watches or clothing are made in south-east Asia. People sometimes express ambivalence about pirate software or DVDs. However pirate pharmaceuticals have significant implications for public health.

Some fake drugs contain no active compounds. This can lead to death, when such drugs are taken for serious illnesses like tuberculosis or malaria. However potentially even more worrying is that fake anti-malaria drugs sometimes contain small amounts of the real anti-malaria medication. This is not enough to be effective, but may speed up the development of resistance to the anti-malarial agents. This concern is one of the factors that spurred the hunt for the source of the fake drugs in the published paper.

One interesting feature of the investigation into fake artesunate is that it was largely done without funding by researchers outside the pharmaceutical industry. Drug companies themselves have often led previous investigations into fake drugs and have closely guarded the results of such investigations. It has been claimed that drug companies try to prevent public knowledge about fake drugs in order to protect the image of their drug, and their sales.

The success of this investigation has led to calls for further action to stamp out the trade in fake antimalaria or anti tuberculosis drugs. However it is worthwhile noting that the reason that there is a market for such drugs is that the poor in countries most affected by tuberculosis or malaria are not able to afford even the relatively modest costs of treatment. In countries such as the UK there is no illicit trade in life-saving medications, and no fake pharmaceuticals because such drugs are available at minimal cost within a public health system.

An alternative approach to the problem of fake anti-malaria drugs would be to make such drugs available for free to those who need them in the developing world. It would be a shame if the problem of fake pharmaceuticals became a part of the global war on drugs, and large amounts of money were spent in attempts at policing. The real public health tragedy is not that drug resistance will worsen if we allow fake anti-malaria pills to be sold. It is that in Africa 3000 people die every day of a treatable disease.

Scientists help nab fake drug dealers Science News 12/02/08
Researchers hunt down fake drug Nature news 12/02/08

A Collaborative epidemiological investigation into the criminal fake artesunate trade article in PLOS Medicine 12/2/08

Tracking the fake malaria drug threat
BBC 06/07

The importance of throwing money at the global health threat Indian Journal Medical Ethics

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