The headline read: “Fake Avastin Sends Docs Scrambling to Check Records.”
Avastin is kind of an exotic medication, not one I’ve had occasion to prescribe, since it is used only for cancer chemotherapy. But apparently, larceny lives in the pharmaceutical world as well.
I’ve heard of counterfeit watches and Cuban cigars, and even the intentionally mislabeled nice piece of fish. If they say it’s Hawaiian Ono, how would I know if it’s actually Grouper or Fillet of Sunfish for that matter? I picture a guy in a trench coat with pill bottles lining the inside saying: “Want to buy some cheap Viagra?”
But the economics must be compelling to work for the dark side. The retail price for a small vial of Avastin is somewhere in excess of $2,500. It comes in a little glass medicine bottle that would hold about a teaspoon worth of liquid, and is about a quarter filled with crystalline white powder. That’s what you get for $2,500 these days!
Avastin, like a lot of chemotherapy drugs, often makes you nauseated when you take it. And to be getting chemotherapy in the first place, you have to be pretty sick. Chemotherapy is an inexact science, since not all tumors respond. So counterfeit Avastin may be the perfect crime. Many patients, and even doctors, would never figure it out.
And then there is the placebo response. Non medically-trained people are surprised by the reliability and the strength of “the cure” simply by placebo effect. The placebo is no small-time lame excuse for treatment, but it is often the reason a treatment works (although few would admit it).
Two weeks ago, National Public Radio ran a story about putting the world’s best violinists in a large dark area and letting them blindly play Stradivarius and other lesser violins. The musicians picked the best sounding, most exquisite to play instruments and were very surprised to have mostly chosen modern violins of no great reputation. Placebo effect apparently makes even Stradivarius violins sound and play better.
So do we need to be suspicious of the next bottle of pills we get (even if they work)?
The pharmaceutical manufacturing industry is complex and widely scattered geographically. The medication you took this morning may well have been made in a factory in India, even if it’s a trade name (non-generic) drug.
The foreign manufacturer is inspected by the local government, as well as, the drug company it is working for. Shipments are quality inspected and carefully tracked from creation to arrival at the local pharmacy. The DEA is involved when they hit American soil. But these countries are on the other side of the planet, and mischief is possible, given enough incentive.
Fortunately circumstances usually work against that.
Most treatment courses of very expensive medications are brief, like the exotic IV antibiotic, or chemotherapeutic drug. So few actual doses are given that there usually isn’t the market to make a counterfeit drug profitable.
Longer term medications are often obvious enough in their effects that people can do their own quality control. For instance, you can check your blood pressure on your antihypertensive medication, or your cholesterol on your statin. And, even though generics take up a large segment of the market, they are not expensive enough to induce larceny.
So while there will never be a shortage of charlatans trying to sell you Laetrile or the latest snake oil cure for cancer or ingrown toenails, these fakes won’t likely be showing up in the bottle of pills you bring home from the local doctor or pharmacy.