Every year, a million people die of malaria. Up to twenty percent of those deaths may be the result of sick individuals taking counterfeit drugs. The new issue of Smithsonian features an engaging story about the trade in fake anti-malaria drugs and efforts to squash it. Sometimes, spotting bogus pills, often sold in small village pharmacies, is easy due to mistakes on the packaging: blister packs reading “tabtle” instead of “tablet.” However, the best counterfeits require high-tech forensic tests to identify. Public health officials teamed up with the World Health Organization for Project Jupiter, an effort to throw a wrench in the trade. First they have to identify the source though. From Smithsonian (click image for full photo by Jack Picone):

Bogus medicines are by no means limited to malaria or Southeast Asia; business is booming in India, Africa and Latin America. The New York City-based Center for Medicine in the Public Interest estimates that the global trade in fake pharmaceuticals–including treatments for malaria, tuberculosis and AIDS–will reach $75 billion a year in 2010. In developing countries, corruption among government officials and police officers, along with weak border controls, allow counterfeiters to ply their trade with relative impunity. Counterfeiting is “a relatively high-profit and risk-free venture,” says Paul Newton, a British physician at Mahosot Hospital in Vientiane, Laos. “Very few people are sent to jail for dealing in fake anti-infectives.”

When the fake artesunate pills first appeared in Southeast Asia in the late 1990s, they were relatively easy to distinguish. They had odd shapes and their packaging was crudely printed. Even so, Guilin Pharmaceutical, a company based in southern China’s Guangxi autonomous region and one of the largest producers of genuine artesunate in Asia, took extra steps to authenticate its medication by adding batch numbers and holograms to the packaging. But the counterfeiters quickly caught on–new and improved fakes appeared with imitation holograms…

Dallas Mildenhall is an expert (some would say the
expert) in forensic palynology. Working from his lab at GNS
Science, a government-owned research institute, in Avalon, New
Zealand, he is a veteran of more than 250 criminal cases,
involving everything from theft to murder. In 2005, Paul Newton
asked him if he could extract pollen samples from
antimalarials. “I was fairly certain I could,” Mildenhall says.
He views the trade in fake antimalarials as his biggest case
yet. “It is mass murder on a horrendous scale,” he says. “And
there appears to be very little–if any–government involvement
in trying to stamp it out.”

In the fake
drugs, Mildenhall found pollen or spores from firs, pines,
cypresses, sycamores, alders, wormwood, willows, elms, wattles
and ferns–all of which grow along China’s southern border.
(The fakes also contained fragments of charcoal, presumably
from vehicle tailpipes and fires, suggesting the phony drugs
were manufactured in severely polluted areas.) Then Mildenhall
discovered a pollen grain from the Restionaceae family of
reeds, which is found from along the Vietnam coast into
southernmost China. That location matched the source of the
calcite identified by Jupiter Operation’s geochemists.
“The
Fatal Consequences of Counterfeit Drugs”