Phake by Roger Bate

Author:Roger Bate
Language: eng
Format: epub
ISBN: 9780844772349
Publisher: AEI Press

Dangerous Dealings: Fakes Infiltrate the Markets

The process by which drugs first enter supply chains in the region varies enormously, but Rashid, a thirty-one-year-old Jordanian private investigator, explained one common method to me. A criminal with fakes or expired medicines approaches a pharmacist and asks if he will take a box of an expensive drug at a low price (experts tell me anywhere between 15 and 40 percent of retail face value is possible, usually nearer the lower end).3 The pharmacist will not be able to sell the drugs to patients (either because they are inappropriate for pharmacy distribution, like vials of oncology drugs that are injected only in sterile hospital conditions, or because he does not have enough customers for the drugs), so he sells them to a distributor. Pharmacists regularly purchase drugs from particular distributors, so the distributor will likely agree to take the drugs from the pharmacist (at a substantial discount, perhaps 50 percent of retail price) to maintain the relationship, though the distributor should wonder how the pharmacist came by the drugs. Rather than cash, the distributor will often exchange products of equivalent value with the pharmacist. The distributor then uses his network to distribute the potentially lethal product—in many instances the products will be sent out of his local area to a market that can absorb the product (especially if it is a drug only administered in hospitals). Each of the parties involved will take a percentage of the normal retail price (allegations abound that hospital administrators pocket 10–20 percent) because of the deep discount given at the beginning of the chain. Only the final patient will pay the retail amount, in addition to the full price of the possibly lethal consequences of the substandard product.

What is interesting and tragic is that once this process starts, fakes can flood the market in a matter of weeks. To my knowledge, this has happened with oncology drugs in Cairo, Egypt, and Beirut, Lebanon. Up to one-third, and in one or two instances as much as half, of products in the market for some drugs are suspect, especially in the less-regulated markets in Syria and Iraq. This means not only that many patients are paying good money for bad products but also that legitimate companies are losing vast amounts of revenue.

I spoke briefly with medical officers of the allied troops in the region in 2004, and they were primarily concerned with leishmaniasis (known by the troops as Baghdad boil), a disgusting disease spread by sand flies which can, in its visceral form, prove fatal. But I also heard conversations about stolen medicines and shortages they had to overcome periodically. It didn’t seem like a big deal at the time, but I later remembered these conversations as my research progressed.

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