False Deafness When the Pill Covers Drugs That Many People Do Usually

i'm nick gillespie with reasontv andtoday we're talking with roger bate who is a resident scholar at aei the american enterprise institute . he's got a phd_ in applied economics and he isthe author of phake: the deadly world of falsified and substandard medicines. thanks roger for talking to us. my pleasure.how widespread is the problem withfalsified or fake counterfeit prescription drugs around the world? well it depends where you are. i mean ifyou're in africa it's a significant problem. maybe ten, fifteen, twenty percentof supply is falsified or at least sub-standard. there is a gray area between

where there's an intent to deceive thepatient or just sloppy production so it depends on the law. so a sub-standarddrug could be something that was just made poorly but it's not actuallyfraudulent or it hasn't been adulterated. that's correct yeah. and a lot of drugs lose their potency right? that's right, they are not done orconveyed in the right way. a lot of drugs don't have the rightactive ingredients or the right amounts. some of them are just unstable sothat if they are left on the dock or in a a pharmacy with badclimate-control, which is most of africa, then they can decay.what are the biggest drugs that get counterfeited

or get sold in a kind of gray market?the key thing is work that out is actually put yourself in the place of the counterfeiter. the key thing for them is to be able to make drugs, sell them regardless of the price to a certain extent and be able to get away with it.i’ve seen fakes of pills that cost forty us cents inindia so it's not just the price of the drugbut having said that if you can break into the us market faking viagra,which a lot of people want to do, or faking oncology drugs which sell forlike two thousand dollars a

prescription, you can make a lot more money.a few years ago wasn’t there a massive lipitor scam going around the world?hundreds of thousands of pills of lipitor were faked. there were recent, the most recent for fatal incident0:01:48.910,0:01:50.350in the united states that we know is that about 149 americans dying from fake heparin, which is a blood thinning drug. but often it's very difficult to know ifyou've got a condition like leukemia or if you've got a heart condition.

if you have a heart attack no one’s likelylook for did the drug not work? you know the evidence is usually swallowed so i would argue that there are more cases than is generally reported butit is a lower problem in the us. what is the government's role in this in kind ofregulating this or controlling the flow prescription drugs and what are thekind of market approaches… well, the fda, the food and drug administration does a reasonable job of overseeing the production plants where they can get to them and sothat regulation i think is important in and of itself but also because itencourages better behavior to kind of

carrot and stick. patients can’t possibly tellthe difference between a good pill and a bad pill. so it's important that it’s regulation there is enforced.but of course the fda0:02:36.969,0:02:41.479can’t have unfettered access toproduction plants in china,they have to give notice. now i'm a typical guy. if my wife, i don’t knowif i know that she is coming home in an hour and the apartment's a mess i could tidy it upin an hour. if you are given a week's notice in thechinese production you can probably make it look pretty good so the fda has a role butgiven how much we get from overseas. eighty percent of the ingredients in ourdrugs come from overseas. it comes down to

the company's primarily. everyone inthe distribution chain has a role to play in monitoring food problems. the most recentproblem is fake avastin which is uh... a cancer drug and it was found by thedistributor. as new technologies develop or new markets develop are weseeing all of the the factors in the supply chain gettingbetter at monitoring things so is this a a problem that will go down or is it aproblem that is starting to get out of control? the data point to it getting worse but that itcould be because we're paying more

attention. so the classic case is where we'refinding more cases every year. but that may be because we're looking atdoing a better job of finding it. but i think the problem is probablygetting worse in rich countries and certainlyother parts of the world. as criminals become more sophisticated it's easier toprint packaging. after all to the counterfeiter the prime job is tomake the pill and the packaging look as good aspossible. what would have cost tens of thousands of dollars inmachinery can now be done in hundreds of dollarswith printing technology so it's easier to

fake stuff now. the counterfeiters will tryand insert that products wherever they can. if you buy online you can do sorelatively safely if you go to a credentialed pharmacy either accreditedby the national associations of the boards of pharmacy or if you're looking for really cheaperproducts from overseas pharmacy checker dot com credentials about fifty or sixtyoverseas pharmacies. the rest are, we talking maybe tenthousand,

are really just web sellers. they’re notpharmacies and often they are gonna sell you products that may not have been regulated andcertainly and sometimes products that totally bogus. when we sampled from thefield there were about three hundred seventy different products we found quite a few fakes coming out of china. we're big libertarians at reason. if weget rid of the prescription drug regime in america, say, would institutions crop up that would actually start regulating good housekeeping seals ofapproval that would be much more stringent and much more effective than the fda? in this instance because it's very

difficult for the patient and even thepharmacist to spot it, regulation is gonna be important. but yeah,the companies and the technologies that that are evolving to deal withthis problem are coming online from companies.so spectrometers, handheld spectrometers will soon be able to spot fakes. soon, i would be able to imaginewithin the next five ten years, there will be an app for an iphone shere if you’re a regular taker of lipitor you will be able to scan the pill itself because you will be able to see. and ithink putting the path to the consumable will ultimately be the test and if a pharmacy routinely is selling bad product it'll get sued.

talk a little bit about the third man, the great 50’s thriller set in post-war europe and vienna. shat is the main plot point of that story?faking products, be it pharmaceuticals or currency or whatever is oftenconsidered the second oldest profession. and orson welles did a good job ofdemonstrating this in the movie the third man where heplays a counterfeiter. he's doing the classic trick of the counterfeiter,which is to dilute the product. in this case he's diluting penicillin to make more money in selling it tohospitals indirectly and sometimes

directly killing kids who havemeningitis. it gets across nicely because at the time hollywood actually wasahead of the curve. it was four years before a lot of the pharmacy associations in europe set up specifically to deal with adulterated, diluted penicillin. how did you get into the interested in this topic? well over the last fifteen years i’ve been doing a lot ofwork on malaria and hiv. in 2004 when we were in zimbabwewe came across people who were not responding to their hivmedication as best as they should have done.

the doctors were not certain of the cause. zimbabwe was a mess then and is not thatmuch better now. and the doctors they didn't have the time to actually do a kind of audit of wherethe problems were. but i think that was the first time iwitnessed fake drugs being ingested by patientsand i went back the year later and the two patients that i'd spoken to had died. so that i think that that was not conclusive proof butit was the thing that sparked my

interest, and then like all policy wonksyou know you start looking at the data and realize there aren't very good data and started investigating from there. i wanna thank mr. roger bate of the american enterprise institute and the author of phake: the deadly worldof falsified and substandard medicines for talking with reasontv. i’m nick gillespie. thanks.

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