If, by chance, you are one of those people who ordered some excellently priced prescription drugs from a slick, clean, multi-colored Canadian website (without having to submit a prescription, of course), and then received, a number of days later, a plain brown package postmarked from India, you MAY have received counterfeit drugs.
You may never know.
Neither may the FDA.
The FDA did discover in June of 2010 that some Tamiflu (an anti-flu drug in great demand at the time) postmarked from India was really cloxacillin (an anti-staph drug unrelated to influenza).
- Estimate of the world market for all types of counterfeit drugs: $75 Billion annually
The yearly appropriation to the FDA is $2.5 billion, or $8 per person per year. That is what the FDA has to safeguard us from harmful or ineffectual prescription drugs. Congress never actually authorizes (“allows the checks to be written”) that much money and a shortfall of about $600 million each year is made up by collecting “user fees” from pharmaceutical companies making new applications for drug approval. Before you jump to the conclusion that this is too cozy a situation, “the hens are paying the fox”, you should know that Big Pharma complains that “sponsors of new applications have had to triple the time taken to respond to FDA inquiries.”
Counterfeit hypertension drugs might make themselves known eventually as your blood pressure climbs, assuming that someone is checking it regularly. Counterfeit diabetes control drugs might declare themselves sooner than that. A kilogram of Viagra can be bought in China for about $60 which when converted into 25 mg. tablets of Viagra is worth $200,000 in the U.S. Counterfeit Viagra, Levitra, Cialis, and the like would probably be the quickest to be unmasked as fake. Maybe they should add an additional warning to the drug ads,
. “If your erection lasts more than four hours, call your physician.
. If it lasts less than four minutes, call the FDA.”
Of course, that may not be true since the literature is now full of papers about the powerful effects of placebo. “If you think you took Viagra, you may be able to act like you did.” That would be a fun study for T. Kaptchuk to do; “Placebo Effect on Penile Erection Compared to Viagra and Fake Viagra; a survey of 100 middle-aged Boston academics”.
There are six pharmacies that are approved by the National Association of Boards of Pharmacy to provide drugs on the internet. One way to make sure you are getting what you have asked for on the Web is to use one of those.
Botox is an apparent favorite for counterfeit drug sellers. In 2006 a “naturopathic” doctor in Colorado pleaded guilty and was sentenced to 9 years in prison for selling $1.5 million of “fake Botox” to doctors across the U.S. There are no less than 20 companies from China selling “botox” on the web. Russia and India are the two next largest suppliers.
Botox is made from botulinum toxin , a powerful neurotoxic agent that was actually developed as an “orphan drug” in 1959. “Orphan drugs” are agents developed for patients with rare or unusual conditions and are subsidized by incentives from the U.S. government. It was approved for a small number of patients suffering from neck and facial muscle diseases in 1989. Its use soon extended to helping control spastic muscles in patients with cerebral palsy.
When its effect of erasing facial wrinkles by paralyzing the underlying muscles was discovered in 1992, its use literally exploded, first by plastic and ENT surgeons for “non-surgical” facelifts, and now, by just about anyone who wants to throw a living room”botox party”. In 2007 use of injectable botox was the most common cosmetic procedure (4.2 million/yr.) according to the American Society of Plastic Surgeons.
As a potent muscle paralytic in very small doses , and a lethal agent in larger doses, Botox is a potentially effective terrorist weapon due to its relatively easy manufacturing and availability through the internet.
HUB's LIST of medical fun facts 
Good to know as I now find I am sending Rxs to Canada for patients more often. And many thanks for your continued , very timely blogs. Hope these are widely read by patients and politicians.