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Matthew J. Edlund M.D.
Matthew J. Edlund M.D.

Fake Drugs, Fake Food, Fake Everything

Fake is in. How can we protect ourselves?

Pork That's Beef

Swedish diners were surprised recently to discover that 20 tons of beef were ingeniously dyed pork. Some of the meat originated in cash-strapped Argentina, then was routed by the Hungarian company Filetto into Scandinavia. The job appears to be have meticulous — an unknown dye injected by hand through needles — which is also a great way to spread to infections.

Fake is very popular these days.

Fake art has been around for millennia and remains highly profitable. Thomas Hoving, former director of New York’s Metropolitan Museum, estimates at least 15 percent of old master paintings and older decorative objects sold at major international auctions are fake; estimates are much higher for other items. “Branded” fake handbags are the basis for many manufacturers’ earnings (“They look as good as the real ones.”) But people are less comfortable recognizing their food and drugs are faked — whether it’s melamine in milk or fake injectable heparin, which recently killed about 150 Americans. Getting sick and dying concentrates public attention.

There is the additional issue of poorly manufactured and contaminated products. In the U.S., old drug manufacturing plants, much more likely to put hair into IV vials, are periodically shut. But their products are still actively, even desperately desired. Into the breach arrive compounding pharmacies, which for a variety of reasons are more lightly regulated. Old problems create new ones.

In the Oct. 18 New York Times, a vice president of the Generic Pharmaceutical Association declared the widespread belief that many compounded drugs are produced in “old, dilapidated facilities” was “absolutely untrue.” Instead, he described many of the plants, dating from the 1970s, as similar to well maintained muscle cars of the era, Camaros and Mustangs, tended with “pride.”

Are you feeling safer?

The problem of counterfeit food and drugs is only getting bigger.

How Big Is the Problem?

Large — though nobody is sure how big, because there is often so little study of a truly international problem. A recent article in The Economist pointed out that until recently half the drugs in Nigeria — and 64 percent of the antimalarials — were fake. Operation Pangea, an international police operation, recently shut down 1,800 online pharmacies in 100 countries. China executed its drug “czar” in 2007 for corruption, and recently detained 2,000 in a sweep of fake drug producers.

Why Are There So Many Fakes?

Many reasons — but important ones include 1. Huge profits 2. Globalization 3. Lax Standards.

Cancer drugs can be several thousand dollars a shot. Viagra often costs several dollars a pill — and has been faked mercilessly. Global supply chains mean that drugs and food — like cars — come from and are partially assembled in multiple countries. In the U.S. 80 percent of drugs’ active ingredients are of foreign origin.

As for standards, bribery exists everywhere. Our Food and Drug Administration has opened offices in many countries. Yet the FDA gets a very large chunk of its money from the companies it is tasked to investigate, so conflicts of interest are rife — and federal money has grown much tighter.

Organic? Really?

People often think their health will be better protected by eating organic food.

But what definition of “organic” is used by your food retailer?

The FDA has several different versions of “organic.” There are “strict” guidelines for “100 percent certified organic.” That can include “organic” chickens allowed free run of a strip of grass 20 by 2 feet for however many minutes the owner desires.

Things get more interesting when looking at the “organic label” designation where “95 percent of ingredients” must be organic. A separate designation of organic can be made with only 70 percent of the ingredients actually “organic."

Then there is also the question of enforcement. A 2010 USDA inspector general study discovered virtually no periodic testing of residues by state inspectors — particularly in the “prime” organic state of California. Even when outed as fake, products mislabeled as organic might take over two and a half years to become relabeled or taken off the shelves. And in virtually every state there are far too few inspectors to even visit “organic” producers.

So there may be multiple reasons why some recent studies show little nutrient difference between organic and regular products — and why pesticides show up in the “organic” ones.

How To Fake a Drug

If you want to unscrupulously make money, make fake expensive drugs.

Let’s look at a very expensive medication — modafinil or provigil — which often costs $15 or more per pill.

Modafinil is a stimulant that keeps people up. It can be lifesaving for narcoleptics — but is often bought by global financial traders or students trying to beat the human circadian clock.

And for some circumstances, like keeping soldiers awake, researchers Walter Reed demonstrated long acting caffeine can produce similar effects.

So here’s what you can do — first go overseas. Package cheap caffeine together with other xanthines — the same class of stimulants — from green tea or other plants. Add a binding agent that allows them to drip out slowly — the most expensive part of this fakery. Imitate the company capsule’s exterior. Then ship to an online pharmacy in the nation of your choice (Canada and New Zealand are preferable addresses).

Voila! A fake that keeps people up, is really cheap, and can fool a skeptical day trader in Hong Kong.

When you’re discovered, just tweak the ingredients, change online pharmacies, and try again.

How To Fix The Mess

There are at least two major ways to fix the drug, food, and medical device fakery business.

First up — rebranding by the large international pharmaceuticals and food companies whose brand recognition represents a large part of corporate value.

Pfizer loses a lot of money on fake Viagra. The company employs many investigators throughout the world. It will typically create a legal case and hand it over to local police.

But in July of this year, 106 countries had identified at least 60 different fakes of Pfizer drugs.

However, public transparency — showing the quality controls on production and the measures used to find and destroy fakes — can be marketed by drug and food manufacturers to reassure consumers and to publicize the standards which have brought their brands fame and profits. Such companies have much to gain by convincing people of their honesty and careful product preparation — and will also help convince government agencies while they convince the public.

Second, regulation requires teeth. Drug fakers need to go to jail.

And to catch them you need to spend money. Spectrophotometers are costly but can tell real drugs from fake. Quick bioassays can identify fake fish and mixed wines. Companies that fake should be both shamed and prosecuted. And companies that lose billions from fakes can work directly with regulators to unmask the fakers.

Economies survive on trust. If you don’t pay the costs of transparency and regulation, you pay the price.

About the Author
Matthew J. Edlund M.D.

Matthew Edlund, M.D., researches rest, sleep, performance, and public health. He is the author of Healthy Without Health Insurance and The Power of Rest.

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