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Bad Medicine

BMJ 2006; 333 doi: https://doi.org/10.1136/sbmj.0607298 (Published 01 July 2006) Cite this as: BMJ 2006;333:0607298
  1. Jihène El Kafsi, medical student1,
  2. Peter Raven, senior lecturer2
  1. 1Royal Free and University College Medical School
  2. 2Department of Mental Health Sciences, Royal Free and University College Medical School, UCL, London

Trade in counterfeit drugs is a growing but illegal business worth billions of pounds a year. Jihène El Kafsi and Peter Raven examine some of the implications

There is a famous scene in the 1949 film The Third Man that illustrates the driving-force behind the counterfeit drug industry. Orson Welles, a black marketeer who has made a fortune by selling fake penicillin in occupied Vienna at the end of the second world war, is at the top of a big wheel with his friend, looking down at the people walking around on the ground below, like so many tiny dots. He asks his friend if his conscience would really trouble him if he were to be given ten thousand dollars for each dot that stopped moving.

Today the business is worth a staggering $35bn a year,1 but for a long while the West has largely ignored the distant dots in the developing world that have stopped moving as a result of the counterfeit drug trade.

The first documented cases of counterfeit drugs date back to the 4th century BC.2 However, for over 2000 years, the issue of fraudulent production of these compounds has mostly been ignored. It was only in 1985 in Nairobi that the World Health Organization adopted eradication of counterfeit drugs as a priority. More recently, it is only because fake drugs have spread insidiously from local markets to more global outlets, aided by the rise of the internet, that the developed world has recognised the magnitude of the problem.

Definitions

A recurring problem in the literature on fake drugs is the lack of agreement on a single workable definition. How can the clandestine trade be put to a halt when we don't have a clear and internationally agreed description of what constitutes a “fake drug”? The …

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