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
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
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.
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