Yesterday's New York Times included a story on the growing problem of counterfeit medicine in developing countries, with a particular focus on the market for anti-malarials in Asia. In many cases, the counterfeit products not only fail to cure individual patients but actually make the problem worse by contributing to drug resistance and damaging public confidence in treatment:
Some contained harmless chalk, starch or flour. But the latest, [Dr. Paul N. Newton of Oxford University's Center for Tropical Medicine] said, contained drugs apparently chosen to fool patients into thinking the pills were working.
Some had acetaminophen, which can temporarily lower malarial fevers but does not kill parasites. Some had chloroquine, an old and now nearly useless antimalarial.
One had a sulfa drug that in allergic people could cause a fatal rash.
And some had a little real artemisinin - not enough to cure, but enough to produce a false positive on the common Fast Red dye test for the genuine article.
Those would not merely fool a laboratory, Dr. Newton noted. They could also foster drug-resistant parasites, so if patients were lucky enough to get genuine artemisinin treatment later, they might have already developed an incurable strain and could die anyway.
Such resistant strains could spread from person to person by mosquito and ultimately render the drug ineffective, as already happened with chloroquine and Fansidar, two earlier malaria cures.
Scary stuff.
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