Recently, I went to a medical conference attended by key opinion leaders and experts in disease management. One of the physicians present commented that his patients were resorting to purchasing generic versions of a particular drug online or from abroad because they could not afford to use the name-brand agent.

There happened to be a representative from the pharmaceutical company that manufactures that drug in attendance, and he had to inform the doctors that there was no generic equivalent of this medication available anywhere in the world!

In other words, not only were patients misinformed and taking a drug that was at best unapproved and ineffective and, at worst, dangerous, but even specialists in this field were also misinformed and potentially recommending illegal, harmful, counterfeit medications to their patients. If doctors are unaware that a given drug does not have a generic equivalent, how are we to expect patients to know?

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Disturbed by this episode, I decided to investigate the scope of the problem. Up until that meeting, I had deleted the myriad of “spam” e-mails I receive on an almost daily basis promising “Drugs from a Canadian Pharmacy” without really thinking. These bogus advertisements annoyed me, but hadn’t really troubled me. I had not stopped to think about the implications for patients, who, desperate for affordable and necessary medicines, fall victim to these unscrupulous scams.  

As it turns out, thousands of illegal Internet-based pharmacies exist. In October 2012, the FDA took legal action against more than 4,100 Internet-based pharmacies that illegally peddle unapproved drugs to American consumers.

These actions included l­eveling civil and criminal charges, seizing illegal products, and removing offending websites. The FDA initiative was part of Operation Pangea, an annual global cooperative effort spearheaded by Interpol.

Operation Pangea involved authorities from 100 countries in 2012. Last year, the program led to the shutdown of more than 18,000 illicit pharmacy websites and the seizure of approximately $10.5 million worth of counterfeit pharmaceutical products worldwide. In addition, the Institute of Medicine has just issued a new consensus report, Countering the Problem of Falsified and Substandard Drugs.

Because many patients do not have prescription drug plans and medications are expensive, it is easy to see why people may turn to online alternatives in desperation. As we struggle to cope with the crisis of health-care coverage for all in this country, we as clinicians must carefully question our patients about the source of their prescription drugs to make sure they are obtaining these products from legitimate sources.

We should also ask patients whether the cost of a particular drug is an issue, and choose a medication that is more cost-effective whenever possible, realizing that some patients may be too embarrassed to admit that they cannot afford to fill their prescriptions.  

Last but not least, we must educate patients, caregivers and colleagues regarding the existence of unscrupulous establishments that are ready to make money at the expense of people’s health and even their lives.