False Medicines: Another culprit in the rise of resistant organisms

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drugs-e1349801738965-225x138-1In April, the American Society for Tropical Medicine and Hygiene (ASTMH) published a special supplement to their monthly journal that covered the global pandemic of falsified medicine. The supplement included 17 articles that covered a range of topics related to falsified medicine including pieces on the impact it s had on antibiotic resistance and what we need to do globally to combat this problem.

Falsified medicine is the sale of outright fake medicine or medicine that contains a reduction in the active ingredient(s). Overall ASTMH estimates that the sale of these fake and sub-standard drugs generates 75 billion dollars in illegal revenues. Some may think of counterfeit drugs as a black market phenomenon that exists on the fringes of poor countries; however recent reports have shed light its impact in larger, wealthier countries. In particular, they make specific mention of (an ACSH favorite topic) vitamin supplements which have increasingly been shown to not contain the active ingredients they purport to have.

It is important to point out that falsified medicine is not just fake pills; it can also describe medicine that lacks the full dose of active ingredients. In fact, the overall trend of completely fake medicine (no active ingredient at all) is estimated to be trending downward. On the other hand, medicine with incomplete doses of the active drug(s) are trending upward. In combining all the study s data in the publications, which includes over 16,000 samples, the researchers collectively found that as many as 41 percent of drugs did not contain the necessary dose.

A drug that fails to contain the necessary full amount of an active ingredient is particularly troublesome when it s for treating an infectious disease, like malaria. When a person takes a drug for malaria that contains less active ingredients than prescribed, not all the parasites will be killed during the course of treatment. Furthermore, those that are left behind can develop resistance to the drug. The infection will persist and now it will be characterized by a drug resistant strain that can spread to the uninfected.

One study found that a quarter of all anti-malarial drugs in Laos were substandard. Another found that 120,000 children under 5 yo died in sub-saharan countries in 2013 due to receiving falsified malarial drugs. This problem was not just unique to antimalarials, as many antibiotics were found to be lacking in active ingredients too. Sixty percent of co-trimoxazole tablets tested were found to be substandard in a study conducted in Ghana, Nigeria and Britain. Also, 65 percent of ampicillin samples did not meet their requisite criteria in a study of south-east Asia.

The publication also spends time discussing solutions to this problem, one of which is better detection. Currently, many obstacles exist to creating new detection kits. For example, although some companies have developed cheap and easy to use colorimetric detection methods, they require a standard for comparison, something pharmaceutical companies are not currently making available. Furthermore, price will always be an obstacle to better detection, as the greatest need for these tests is in the poorest countries.

Another solution to the issue is to establish better policies in countries where the fakes are being produced. In particular, China where 28% of all falsified drugs are manufactured there must be better governmental enforcement.

For more on this topic, read ACSH s 2009 (but still valid) publication on this topic:
Counterfeit Medications: Coming to a Pharmacy Near You