Antidepressants are sold as antiretrovirals in DR Congo

Substandard/counterfeit antimicrobial drugs

Substandard/counterfeit antimicrobial drugs are a growing global problem. The most common substandard/counterfeit antimicrobials include beta-lactams (among antibiotics) and chloroquine and artemisin derivatives (among antimalarials). The most common type of substandard/counterfeit antimicrobial drugs have a reduced amount of the active drug, and the majority of them are manufactured in Southeast Asia and Africa. Counterfeit antimicrobial drugs may cause increased mortality and morbidity and pose a danger to patients. Here we review the literature with regard to the issue of substandard/counterfeit antimicrobials and describe the prevalence of this problem, the different types of substandard/counterfeit antimicrobial drugs, and the consequences for the individuals and global public health. Local, national, and international initiatives are required to combat this very important public health issue.

Counterfeit drugs and medical devices in developing countries

The World Health Organization has reported that counterfeit medicines potentially make up more than 50% of the global drug market, with a significant proportion of these fake products being encountered in developing countries. This occurrence is attributed to a lack of effective regulation and a weak enforcement capacity existing in these countries, with an increase in this trade resulting from the growing size and sophistication of drug counterfeiters. In addition, due to both cost and lack of availability of medicines, consumers in developing countries are more likely to seek out these inexpensive options. The World Health Organization is mindful of the impact of counterfeit drugs on consumer confidence in health care systems, health professionals, the supply chain, and genuine suppliers of medicines and medical devices. Antibiotics, antituberculosis drugs, and antimalarial and antiretroviral drugs are frequently targeted, with reports of 60% of the anti-infective drugs in Asia and Africa containing active pharmaceutical ingredients outside their pharmacopoeial limits. This has obvious public health implications of increasing drug resistance and negating all the efforts that have already gone into the provision of medicines to treat these life threatening conditions in the developing world. This review, while focusing on counterfeit medicines and medical devices in developing countries, will present information on their impact and how these issues can be addressed by regulation and control of the supply chain using technology appropriate to the developing world. The complexity of the problem will also be highlighted in terms of the definition of counterfeit and substandard medicines, including gray pharmaceuticals. Although this issue presents as a global public health problem, outcomes in developing countries where counterfeit drugs to treat malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome not only result in drug resistance, but a number of deaths from the untreated disease, is in stark contrast with the developed world, where lifestyle drugs such as sildenafil (Viagra®) are most commonly counterfeited.

Organised crime and the efforts to combat it: a concern for public health

This paper considers the public health impacts of the income-generating activities of organised crime. These range from the traditional vice activities of running prostitution and supplying narcotics, to the newer growth areas of human trafficking in its various forms, from international supply of young people and children as sex workers through deceit, coercion or purchase from family, through to smuggling of migrants, forced labour and the theft of human tissues for transplant, and the sale of fake medications, foodstuffs and beverages, cigarettes and other counterfeit manufactures. It looks at the effect of globalisation on integrating supply chains from poorly-regulated and impoverished source regions through to their distant markets, often via disparate groups of organised criminals who have linked across their traditional territories for mutual benefit and enhanced profit, with both traditional and newly-created linkages between production, distribution and retail functions of cooperating criminal networks from different cultures. It discusses the interactions between criminals and the structures of the state which enable illegal and socially undesirable activities to proceed on a massive scale through corruption and subversion of regulatory mechanisms. It argues that conventional approaches to tackling organised crime often have deleterious consequences for public health, and calls for an evidence-based approach with a focus on outcomes rather than ideology.

Chemical identity testing by remote-based dispersive Raman spectroscopy

The advent of robust, rugged, and current Good Manufacturing Practices (cGMP) compliant hand-held Raman spectrometers provides a wealth of opportunities for the analytical pharmaceutical chemist to bring the laboratory to the sample. This paper discusses the use of hand-held Raman spectrometers for the development of qualitative chemical identification methods for a number of well-known pharmaceutical products (tablets and capsules). Methods were developed on two different instruments and transferred to a third instrument for application of the methodology to independently obtained drug products. A novel decision algorithm is presented for the assessment of the correlation between the Raman spectrum of the unknown sample to the spectrum of the authentic reference material. This novel algorithm considers accuracy but more importantly precision (uncertainty/reliability), thus removing human bias that is associated with typical spectral searching approaches. The results presented in this paper show the reliability of developing, validating, and transferring chemical identification assays on hand-held Raman spectrometers.

Parallel trade of pharmaceuticals: a review of legal, economic, and political aspects

OBJECTIVES

An overview of the status quo of parallel trade of pharmaceuticals (pharmaceutical parallel trade [PPT]) was performed. The different economic, political, and legal viewpoints as well as the public health perspective are being taken into consideration. Analysis is being undertaken on a worldwide level, focusing on the situation of Switzerland in the context of current developments in the United States as well as in the European Union (EU).

METHODS

Desktop analysis using publicly available information (e.g., scientific literature, congress reports, official statistical databases) was performed during the years 2006 through 2007. Such gathered information was compiled and systematically structured to allow a crude overview of the development of intellectual property law in the last 100 years (as a prerequisite under which PPT legally can exist) as well as a description of the health economic and political context in which PPT is set currently.

RESULTS

It could be shown that PPT is an ubiquitous phenomenon, appearing in industrialized countries as well as in the developing world. Economically, it has gained a significant weight in substantial parts of the EU in the last decade. This has to be seen in the context of EU efforts of enhanced economic and political integration. The worldwide constant growth of health-care expenditures, with its strain on national health-care budgets, has led to increased discussions about the necessity and consequences including possible dangers of PPT, namely, in the United States and in Switzerland, where up to now PPT has been only of marginal importance.

CONCLUSIONS

The analysis of the value of PPT depends strongly on the importance that is given to different perspectives by the individual analyst. It is clear that an item-centered view of PPT is not able to analyze this phenomenon in an equitable way. Further attempts have to be made to standardize evaluation as well as to increase available information to empower science and decision-makers to perform objective analyses and informed decisions.

Dangerous medicines: unproven AIDS cures and counterfeit antiretroviral drugs

Background

Increasing access to antiretroviral therapy (ART) is a critical goal endorsed by the United Nations and all of its member states. At the same time, anecdotal accounts suggest that the promotion of unproven AIDS 'cures' and remedies are widespread, and in the case of The Gambia, Iran and South Africa, have been promoted by governments directly. Although a range of legislative and regulatory measures have been adopted by some governments, and technical assistance has been provided by international agencies to address counterfeit medicines generally, the threat of counterfeit antiretroviral drugs is not being addressed.

Discussion

Countries, charged with fulfilling the right to health and committed to expanding access to ART must explicitly recognize their obligation to combat unproven AIDS treatments and ensure the availability of a safe and efficacious drugs supply. International donors must help support and coordinate these efforts.

Counterfeit or substandard antimicrobial drugs: a review of the scientific evidence

There is growing universal concern regarding counterfeit medications. In particular, counterfeit antimicrobial drugs are a threat to public health with many devastating consequences for patients; increased mortality and morbidity and emergence of drug resistance. In addition, physicians treating these patients lose their confidence in the medications used and report high levels of bacterial resistance. The problem with fake and suboptimal medications got worse with the advent of the World Wide Web; a significant proportion of medications that are sold through Internet pharmacies is counterfeit. Various initiatives of the WHO (the International Medical Products Anti-Counterfeiting Taskforce) are hopefully going to tackle this very important public health issue. In this article, we review the available evidence in peer-reviewed articles and World Wide Web information resources regarding the issue of counterfeit antimicrobials.

The global threat of counterfeit drugs: why industry and governments must communicate the dangers

The production of substandard and fake drugs is a vast and underreported problem, particularly affecting poorer countries. Cockburn and colleagues argue that the pharmaceutical industry and governments must both take action