An internal medicine physician by trade, John Ayers has spent the past 10 working as a safety physician at Eli Lilly and Company.
My role in safety is a little unique. I assess issues that might impact the quality features of a medication such as strength or safety—that might result in harm to patients if substandard. In that work I have been exposed to the unpleasant world of counterfeit pharmaceutical products. Counterfeit medications are the embodiment of all things devoid of quality “on the inside” but with the veneer of authenticity “on the outside.” Counterfeit medications are like a movie set—the Hollywood set looks real and inviting but behind that door are a mishmash of sawdust, drywall and paint—not unlike the ingredients in many counterfeit medicines. The acceptable appearance of a counterfeit medication is no less a façade than the movie prop.
Counterfeit medications are simply the product of criminal activity. Unfortunately, these are not ‘victimless crimes.’ People are injured and die. An Institute of Medicine study reports that counterfeit meningitis vaccines were responsible for the deaths of nearly 3000 people in Nigeria in 1995 and that poor quality drugs create a significant risk of treatment-resistant diseases such as malaria and tuberculosis.
In my opinion, therein lays the real problem. Individuals tend to behave complacently if they do not believe that the perceived risk can have a personal impact. But with the global nature of our lives and ease of international travel communicable diseases and their vectors can hitch-a-ride and strike anywhere. And on a local or regional level, impoverished populations with limited access to health care can serve as a reservoir for disease and if treated with substandard counterfeit medications will provide the necessary environment for these multi-drug resistant organisms to emerge and flourish.
Finally, it is not just Nigeria or sub-Saharan Africa where counterfeit drugs inflict their damage but anywhere in the world since access to counterfeit medications is as easy as logging onto the internet. Counterfeit drugs contain toxins and biologic waste, contaminants such as lead, paint, and drywall, the wrong ingredients or too little or too much of an active ingredient, and have components that can interact with other medications in a dangerous and sometimes lethal way. Counterfeit drugs threaten both our safety and security. Purchases of these drugs cannot only result in your own harm but also to others while funding criminal activity.
It is really this simple: There is no such thing as a safe counterfeit medication.