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Doctor's Consultation  by Dr. Iain Corness

 

Dangerous prescribing and copy drugs

I was reminded of the state of the pharmaceutical industry the other day when a new ex-pat from the USA asked me about the safety in buying drugs/medications in this country over the counter or from the net.

Now, every day I receive at least four email offers of cut-price drugs that will keep me in a state of perpetual priapism. For those unsure of this condition, it is a state of continuing (and painful) male erection and the term was coined after the Greek god Priapus who is shown in paintings to have a central member that puts the (in)famous John Holmes of porn movies to shame.

However, this is actually a serious situation. If most drugs are only available through pharmacies world-wide, on the prescription of a doctor, is it safe to just buy over the internet, without any doctor’s advice?

I believe it is not safe. As the American Food and Drug Administration (FDA) reports in its website, “Patients who buy prescription drugs from websites operating outside the law are at increased risk of suffering life-threatening adverse events, such as side effects from inappropriately prescribed medications, dangerous drug interactions, contaminated drugs, and impure or unknown ingredients found in unapproved drugs.”

The FDA goes on to warn “… certain drugs be dispensed only with a valid prescription because they are not safe for use without the supervision of a licensed health care practitioner. Generally, before the practitioner issues a prescription for a drug the patient has never taken before, he or she must first examine the patient to determine the appropriate treatment. Subsequently, the patient receives the drug from a registered pharmacist working in a licensed pharmacy that meets state practice standards.” That situation is certainly not the case when you look at buying blue diamonds over the ‘net, is it?

The incidence of internet pseudo-pharmacies is also very high. In the US, according to the American Medical Association, there are at least 400 web sites that both dispense and offer a prescribing service - half of these sites are located in foreign countries. Some have estimated that the number of websites selling prescription drugs may now be closer to 1,000.

As far as I can see it, one of the big problems is the lack of regulation that these “net pharmacies” work under. Are the blue diamonds ‘real’ blue diamonds?

According to the World Health Organization (WHO), it has been fighting drug counterfeiting since it became a major threat in the 1980s. The problem was first noticed by the pharmaceutical industry. They saw that their own products were being copied, and it went on from there.

In fact, the WHO estimates that 25 percent of medications bought in street markets in developing countries are fake. My own experience in some of the poorer SE Asian countries has been that another 50 percent are real but out of date, leaving around 25 percent genuine manufacturer’s stock.

Some authors say that the figures are even worse than that. An international study published in Tropical Medicine and International Health in 2004 found that 53 percent of Artesunate tablet packs sold in the region did not contain Artesunate, a vital antimalarial drug. You can see the danger.

The reports come in from all over the world. The WHO cited the case of a counterfeit iron preparation that has killed pregnant women in Argentina. Hundreds of children in Bangladesh suffered kidney failure and many died due to a fake paracetamol syrup diluted with diethylene glycol, according to a study published in the BMJ.

The FDA in the US estimates that worldwide sales of fake drugs exceed USD 3.5 billion per year, according to a paper published in April 2005. The Center for Medicines in the Public Interest in the US predicts that counterfeit drug sales could reach USD 75 billion globally if action is not taken to curb the trade.

According to WHO, drugs commonly counterfeited include antibiotics, antimalarials, hormones and steroids. Increasingly, anticancer and antiviral drugs are also faked. And you can add to that, the ‘blue diamonds’. Never forget the phrase “Caveat emptor” (Let the buyer beware).

You have been warned. Get your medications on prescription from a registered pharmacy you can trust.