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I'm Nick Gillespie with ReasonTV and today 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 is the author of Phake: The Deadly World of
Falsified and Substandard Medicines. Thanks Roger for talking to us.
My pleasure. How widespread is the problem with falsified or fake counterfeit
prescription drugs around the world?
Well it depends where you are. I mean if you're in Africa it's a significant
problem. Maybe ten, fifteen, twenty percent of supply is falsified or at least
sub-standard. There is a gray area between
where there's an intent to deceive the patient or just sloppy production so it
depends on the law. So a sub-standard drug could be something that was just
made poorly but it's not actually fraudulent 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 or conveyed in the right way.
A lot of drugs don't have the right active ingredients or the right amounts.
Some of them are just unstable so that if they are left on the dock or in a
a pharmacy with bad climate-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 in India
so it's not just the price of the drug but having said that if you can break
into the US market faking ***, which a lot of people want to do,
or faking oncology drugs which sell for like 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 incident 0:01:48.910,0:01:50.350 in 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 if you've got a condition like Leukemia
or if you've got a
heart condition.
If you have a heart attack no one’s likely look 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 but it is a lower problem in the US. What
is the government's role in this in kind of regulating this or controlling the flow
prescription drugs and what are the kind 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 so that regulation I think is
important
In and of itself but also because it encourages better behavior to kind of
carrot and stick. Patients can’t possibly tell the difference between a good pill and a bad pill.
So it's important that it’s regulation there is enforced. But of course
the FDA 0:02:36.969,0:02:41.479 can’t have unfettered access to production plants in China, they have to give notice.
Now I'm a typical guy. If my wife, I don’t know If I know that she is coming home in an hour
and the apartment's a mess I could tidy it up in an hour.
If you are given a week's notice in the Chinese production you can probably
make it
look pretty good so the FDA has a role but given how much we get from overseas.
Eighty percent of the ingredients in our drugs come from overseas. It comes down to
the company's primarily. Everyone in the distribution chain has a role to play in
monitoring food problems. The most recent problem is fake Avastin which is uh... a
cancer drug and it was found by the distributor. As new technologies develop
or new markets develop are we seeing all of the
the factors in the supply chain getting better at monitoring things so is this a
a problem that will go down or is it a problem that is starting to get out of
Control?
The data
point to it getting worse but that it could be because we're paying more
attention. So the classic case is where we're finding more cases every year.
But that may be because we're looking at doing a better job of finding it.
But I think the problem is probably getting worse
in rich countries and certainly other parts of the world. As criminals
become more sophisticated it's easier to print packaging. After all to the
counterfeiter the prime job is to make the pill
and the packaging look as good as possible. What would have cost
tens of thousands of dollars in machinery
can now be done in hundreds of dollars with printing technology so it's easier to
fake stuff now. The counterfeiters will try and insert that products wherever they
can.
If you buy online you can do so relatively safely if you go to a
credentialed pharmacy either accredited by the National Associations of the Boards of
Pharmacy
or if you're looking for really cheaper products from overseas pharmacy checker
dot com
credentials about fifty or sixty overseas pharmacies.
The rest are, we talking maybe ten thousand,
are really just web sellers. They’re not pharmacies and often they are gonna sell
you products that may not have been regulated and certainly and sometimes products that totally bogus.
When we sampled from the field 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 we get rid of the prescription drug regime in
America, say, would institutions crop up that would actually start
regulating good housekeeping seals of approval 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 the pharmacist to spot it,
regulation is gonna be important. But yeah, the companies and the technologies
that that are evolving to deal with this problem are
coming online from companies. So spectrometers, handheld spectrometers will
soon be able to spot fakes. Soon, I would be able to imagine within 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 I think 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 often considered the second oldest profession.
And Orson Welles did a good job of demonstrating
this in the movie the Third Man where he plays 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 to hospitals indirectly and sometimes
directly killing kids who have meningitis.
It gets across nicely because
at the time Hollywood actually was ahead 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 of work on malaria and ***.
In 2004 when we were in Zimbabwe we came across people who were
not responding to their *** medication as best as they should have done.
The doctors were not certain of the cause.
Zimbabwe was a mess then and is not that much better now.
And the doctors they didn't have the time
to actually do a kind of audit of where the problems were.
But I think that was the first time I witnessed
fake drugs being ingested by patients and 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 but it was the thing that sparked my
interest, And then like all policy wonks you 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 World of Falsified and Substandard Medicines for
talking with ReasonTV. I’m Nick Gillespie. Thanks.