Counterfeit pharmaceuticals are flooding hospitals, Web sites, pharmacies and street markets around the world. Visibly indistinguishable from life-saving medicine, the pharmafakes plague the developing world, affecting millions of people and undermining confidence in public health.
Counterfeit drug sales will reach $75 billion globally in 2010, a more than 90 percent increase from 2005, according to the Center for Medicines in the Public Interest. Some pharmafakes enter the United States hidden in plain sight inside the 70,000 packages of legitimate medicines that pass through JFK and Miami airports alone, each day.
But the developing world is where most fakes are manufactured, most victims live and where up to half the drugs in some countries are bogus.
Feeding on desperate need and feasting off fabulous profits, narcotics and arms traffickers are embracing this global industry. Lack of international agreement, uncoordinated enforcement and low penalties ensure that drug counterfeiters enjoy that most traditional of capitalist draws: high profit with low risk.
Part of the blame goes to a "war on terror" that has sucked up international policing efforts and "is making it harder to look at the fake drug trade," Dora Akunyili said. In 2001 Akunyili, a pharamcologist in her 50s, accepted what has been called "the most dangerous job in Nigeria," heading the country's National Agency for Food and Drug Administration and Control (NAFDAC).
Until Akunyili's reforms took hold, Nigeria was the epicenter of the pharmafake pandemic. In 2003, when surgeons there administered adrenaline to restart the hearts of anesthetized children, a useless counterfeit left four dead on the operating table. A painkiller made from toxic ethylene glycol killed more than 100 Nigerian children. A Nigerian newspaper reported that "80 percent of cases of kidney failure in the country are linked to the intake of fake drugs."
The counterfeit medicine trade "is mass murder but not with guns," says Akunyili. "It is solely profit motivated, but the money the counterfeit drug makers make can be plowed into evil. It is also a form of terrorism against public health as well as an act of economic sabotage."
Akunyili came by her commitment the hard way: Fake insulin killed her diabetic sister. As agency head, she found that only 20 percent of the country's drugs were legitimate and vowed to put the pharmafake manufacturers and dealers out of business. She raided warehouses, seized tons of pharmafakes, burned them in the street and ordered the arrest of notorious traffickers who had operated with impunity for decades.
The price that traffickers put on her head was evidence of the campaign's efficacy. One day as she rode to work, assassins opened fire on her car. One bullet pierced her headwrap and grazed her skull. Another shot killed a bystander. Akunyiyi sent her children abroad and accelerated her campaign. She faced down threats, blackmail and a corrupt legal system that let off major dealers despite ironclad cases, one of which included a boastful confession.
Factories in China and India are the main source of a counterfeit trade that is growing faster than cholera in a warm petri dish. China's new capitalists, skilled in knocking off Gucci and Nike, are turning to Lipitor and Norvasc. Some fakes are far cheaper that the real drug, some are not even a bargain, and some, especially a new wave of Russian knockoffs, are as effective as expensive originals. Consumers, however, have no way to know if their pill is crushed chalk or toxic waste; if they bought amusingly impotent Viagra or an antibiotic, an antiretroviral or malarial drug with doses too low to work, but high enough to encourage disease-resistant strains that circle the globe inside unknowing travelers.
"Bacteria don't need visas," says Akunyili, who argues that even if human compassion fails to inspire Western officials to tackle the problem, enlightened self-interest should. Health experts point out that 2 percent of TB cases are "extremely drug resistant," and view with alarm a new South African TB strain, resistant to all antibiotics, that killed 52 of the 53 people infected.
The counterfeits also create resistance to public health campaigns. After watching pharmafakes fail or kill, people may reject polio vaccinations, anti-malaria drugs, and HIV/AIDS treatments and preventions. Experts worry that fake Tamiflu available on the internet may undermine efforts to contain bird flu if it evolves into a serious human threat. The pharmafake trade also lends credence to the view that all Western medical initiatives are profit-driven fraud and bolsters quacks promoting such home-grown tragedies as treating AIDS with garlic and beetroot instead of antiretrovirals, as Manto Tshabalala-Msimang, South Africa's criminally deluded minister of health, has said.
As the trafficking grows, pharmaceutical corporations have failed to attack the problem with the zeal they unleash to maintain high prices, protect patents and create demand for new lifestyle drugs.
Sometimes it's the small abuses scurrying below radar that reveal how profoundly the Bush administration has changed America in the name of national security. Buried within the Intelligence Reform and Terrorism Prevention Act of 2004 is a regulation that bars most public access to birth and death certificates for 70 to 100 years. In much of the country, these records have long been invaluable tools for activists, lawyers and reporters to uncover patterns of illness and pollution that officials miss or ignore.
In These Times has obtained a draft of the proposed regulations now causing widespread concern among state officials. It reveals plans to create a vast database of vital records to be centralized in Washington and details measures that states must implement -- and pay millions for -- before next year's scheduled implementation.
The draft lays out how some 60,000 already strapped town and county offices must keep the birth and death records under lock and key and report all document requests to Washington. Individuals who show up in person will still be able to obtain their own birth certificates and, in some cases, the birth and death records of an immediate relative, and "legitimate" research institutions may be able to access files. But reporters and activists won't be allowed to fish through records, many family members looking for genetic clues will be out of luck, and people wanting to trace adoptions will dead-end. If you are homeless and need your own birth certificate, forget it: no address, no service.
Consider the public health implications. A few years back, a doctor in a tiny Vermont town noticed that two patients who lived on the same hill had ALS or Lou Gehrig's disease. Hearing rumors of more cases of the relatively rare and always fatal disease, the doctor notified the health department. Citing lack of resources, it declined to investigate. The doc then told a reporter, who searched the death certificates filed in the town office only to find that ALS had already killed five of the town's 1,300 residents. It was statistically possible, but unlikely, that this 10-times-higher-than-normal incidence was simply chance. Since no one knows what causes ALS, clusters like this one, once revealed, help epidemiologists assess risk factors, warn doctors to watch for symptoms,and alert neighbors and activists.
Activists in Colorado already know what it is like when states bar access to vital records. For years, they fought the Cotter Corp., claiming that its uranium mining operations were killing residents and workers. Unwilling to rely on the health department, which they claimed had a "cozy" relationship with the polluters, the activists tried to access death records, only to be told that it was illegal in this closed-records state. An editorial in Colorado's Longmont Daily Times-Call lamented, "If there's a situation that makes the case for why death certificates should be available to the public, it is th[is] Superfund area."
Some of state officials around the country are questioning whether the new regulations themselves illegally tread on states' rights. But the feds have been coy. Richard McCoy, public health statistic chief in Vermont, one of the nation's 14 open-records states, says, "No state is mandated to meet the regs. However, if they don't, then residents of that state will not be able to access any federal services, including social security and passports. States have no choice."
But while the public loses access to records, the federal government gains a gargantuan national database easily cross-referenced in the name of national security. The feds' claim that increased security will deter identity theft and terrorism is facile. Wholesale corporate data gathering is the major nexis of identity theft. As for terrorism, all the 9/11 perpetrators had valid identification.
Meanwhile, the quiet clampdown on vital records is part of a growing consolidation of information at the federal level. "That information will dovetail with the Real ID Act of 2005," says Marc Rotenberg of the Electronic Privacy Information Center. "Real ID cards are the other shoe that is scheduled to drop in three years." That act, signed into law last May, establishes national standards for state-issued driver's licenses and ID cards, and centralizes the information into a database.
Aside from public health and privacy concerns, closing vital records incurs a steep intangible cost: It undermines community in places where that healthy ethos still survives. In small town America, the local clerk's office is a sociable place where government wears the face of your neighbor. Each year, Vermont's 246 towns distribute their vital statistics to all residents. "It's the first place everybody goes in the Town Report," says state archivist Gregory Sanford. "Who was born, who died, who got married, who had a baby and wasn't married."
This may not be the most dramatic danger to democracy, but it is one of the Bush administration's many quiet, incremental assaults on the health of America's body politic. And it may end up listed on the death certificate for open society.