Focus 580; Dangerous Doses: How Counterfeiters Are Contaminating Americas Drug Supply

Is there a lot of people here in the United States who are very concerned about the high cost of prescription drugs. If people are taking multiple medications their monthly bills can be very very high. And one of the ways that people are trying to cope with that is buying their medicine in other countries in Canada and Ireland over the internet wherever they can get it. Now people in the federal government have looked at that trend and they are concerned and they have warned that one potential problem might be that people will buy prescription medication and not really know what it is they're getting opening themselves up to the possibility that they might buy counterfeit medicine. Our guest this morning investigative medical reporter Katherine Eban says it's even worse than that because there have been cases and there is a possibility that someone here in the United States could go to their local pharmacy. Wherever they have their prescriptions filled possibly have a medication dispensed by a hospital or by a nursing home and still get a counterfeit medication. We're talking this morning about what you will find in her book Dangerous doses how counterfeiters are contaminating America's drug supply that's the subtitle. It's published

by Harcourt and this is a story that she has been working on for some time now. She has worked for a variety of publications including The New York Times The New York Observer and ABC News. She's also contributed articles to the nation the New Republic The New Yorker self Vogue and glamour. And if you're interested in reading the book you can go out to the bookstore and look for it and questions of course are welcome and we just ask people to be brief and we just ask that so that we can keep the program moving along and getting as many different people as possible. But of course that's one of the reasons we are here and we do this show so you can ask questions here in Champaign-Urbana 3 3 3 9 4 5 5 is the number to call. We do also have a toll free line that means around Illinois and Indiana. If it would be a long distance call you can use the number actually if you would happen to be listening on the Internet. You could also use the number as long as you are in the United States. Eight hundred to 2 2 9 4 5 5 again here locally 3 3 3 9 4 5 5 and toll free 800

to 2 2 9 4 5. 5 ms even fellow Hi how are you. I'm fine thanks and yourself. I'm great to be here. Well we appreciate you giving us some of your time. This is something that I'm sure is a difficult to kind of get a hold on because for a variety of reasons an awful lot of prescriptions are failed in this country every year and sometimes there are bad outcomes. People take a medication prescribed by their doctors. It is an appropriate medication. There are bad outcomes. You just never know exactly what's going to happen there are no guarantees in medicine. And so if you ask this question well out of all of the prescriptions that are filled in this country every year how many do you think you know how many cases are people getting a counterfeit medicine can you even put a number on there. Well the FDA put a number on it and it was a back of the envelope estimate they said about 1 percent of the nation's drug supply is counterfeit. Now that sounds reassuringly small but you've got to consider. One person is

35 million prescriptions a year. And the medicine that has been targeted by domestic counterfeiters is the most expensive medicine generally for the sickest patients who need it. Most So that cancer medicine AIDS medicine and it's for the kind of patients who can least afford to negotiate a counterfeit. Yeah well they're just again you point out something that I'm sure again makes it difficult to get a hold of the story. If we're talking about medications that are going to the sickest people these are the people whose prognosis probably is is not going to be very good so if someone has one of those conditions and they're taking medication and they die how does one know. Well is that is it the medicine did they get bad medicine or is it sadly they just died from the from the condition that they had. Well this is exactly why investigators call it the perfect crime because who's to know whatever killed these patients. Now I spent

three years following around a group of investigators in Florida who called themselves the horsemen of the apocalypse who saw themselves as on a biblical crusade to stop that medicine and counterfeit medicine from reaching patients and they would have loved to charge the counterfeiters. Some of whom they did catch with murder. But again how do you link outcome for a patient to the counterfeit medicine. They took. How. How do we in those instances where we do discover that someone has taken a counterfeit medication. How. How do we discover that I mean how is that. Is it that the person has ill effects or that there are some other way how do. How ultimately do we find out. Well it really depends on both the nature of the counterfeit as well as the reaction of the patient. But just to give you a couple of

examples I follow the story of a 16 year old Long Island boy named Timothy Fagan who underwent a liver transplant and his doctor afterward prescribed Epogen for anemia. He was very weak. His mom figured they'd survived a liver transplant now she was going to save his life with this very expensive injectable medicine and gave it to him once a week and he began suffering these horrible convulsions after each injection. He was on a number of different medications so it was hard exactly to tell what was causing it but he also wasn't getting any better. And then after about eight weeks of these injections the manufacturer of the drug released a counterfeit warning that there were counterfeits in the marketplace. That's how the family put two and two together but it was a horrible realization for the Fagans that they had been injecting their son for eight straight

week with medicine they thought was saving him but was possibly killing him. Well I suppose that gets at the issue that anytime people make medication take medication there can be side effects and that people sometimes don't know what's really going on in and they might ask themselves well is this just part of the. A side effect that maybe is not pleasant for me but it's not life threatening goes with the medicine. Do I call my doctor do I talk to my pharmacist. What in the situation exactly do I do and I suppose it may depend on what the severity of the symptoms there are the reaction you think you're having might be well you know before I started reporting the book of course we all know people who have been patients and suddenly their medicine just stops working. So the doctor has to increase the dose or they have to switch to another medication. You know and I never would have thought twice about that in til I entered this pharmaceutical underworld which exists between the

manufacturers loading docks and the drug store. This is their blood things we could talk about here but let me ask you another question and then I have a caller in on I think we'll get to them rather than make them wait a whole lot longer. You know I think you make the argument in the book that this is a problem that has been growing for some time. It's something that government regulators and some people in law enforcement so forth are aware of and I'm sure people are. The medical community are aware of it but that it's not something that has a high level of public awareness and the question is Why do you think that is the case that we have not in the in the media. We haven't seen more stories about this. Well first of all drug makers historically have done their best to bury these cases from public view they have settled lawsuits confidentially they have of effectively supported what has been a big diversion market in pharmaceuticals. And by

that I mean this all hours auction this trading of expensive pharmaceuticals back and forth between middlemen wholesalers distributors repackage others. But what happened was around the year 2000 a little bit earlier. This diversion market began to get much worse because narcotics traffickers who are fleeing all the criminal penalties of the drug war started looking around for a new line of work. And what they discovered was this largely unregulated hinterland of our pharmaceutical supply chain where the regulation believe it or not is minimal. The criminal penalties are almost nonexistent and the returns are astronomical and those are the guys who introduced counterfeits into what was already a very dangerous arbitrage game with our medicine. We can talk more about that as we continue our conversation. I do have a call I will get right to let me just

also quickly introduce again our guests were talking with Katherine Eban. She's an investigative medical reporter. And this is a story that she has been following working on for some time now. She's contributed pieces to various publications. On this issue and and others and if you're interested in reading in depth on this particular subject that is the problem of counterfeit prescription medications she's authored a book and it's titled Dangerous doses it's published by Harcourt and should be out available in bookstores. Questions too are welcome here on the program 3 3 3 9 4 5 5. That's for champagne Urbana toll free 800 2 2 2 9 4 5. We have caller here listening this morning over in Indiana. Well go right there line for Hello. Hello. On very germane discussion considering the health situation in this country in terms of the government helping things I guess my general question is it's transparency you've mentioned already that it starts right at the back of the doc.

And since you've missed the word counterfeit I presume that the medicines have the same markings on. And if a pharmacist picked one up and looked at it and from his experience he would know that that's for example Tope roll without any problem there would be any reason for him to think that it was out there and that if you looked at the packages that come come into the pharmacy they should have you know certain writings on things like that just sort of hoping that you'll talk about that sort of thing. In some sense relying on the pharmaceutical companies is almost as ingenious because their you don't sing true or respond to public demands one way or the other. That's that's all I wanted to say. Carol thanks for the question Well obviously there the caller raises several questions and we want to talk about all of this maybe. Let me just pick one to start with and that is the question he raised about how easy it is to spot whether something is counterfeit or genuine. It's very difficult. The counterfeiters are very

sophisticated and the you know the printing technology is so ubiquitous that even the packaging specialists at the drug companies can barely tell the difference between the fake and the real. Now you can notice sometimes in pills it tastes a little different. You know they were just tying me distinguishing marks on some of the labels. And it is important for patients to scrutinize their medicine I have safety tips both in my book and on my website which is dangerous doses dot com and patients should always take their pills in the light. Put them in their hands first see if they look any different. It was interesting there was recently a counterfeiting episode in Canada of all places where a pharmacy was dispensing counterfeit Norvasc which is for heart patients. And in that case be usually white pills were slightly grey so they were that counterfeit

easy for a patient to detect. But in the counterfeiting incidence here it has been very difficult. Well let's go to the end and I'll ask you to talk a little bit about how distribution works. Because I think as you point out that people probably to the extent that they think about it at all think well it works like this. You have a manufacturer that makes the product they sell that product to a wholesaler and then the wholesaler distributes the product to local pharmacies to hospitals to nursing homes to all of the end of the line providers. Those are the ones that then preserve you know the prescription comes and they get the prescription they. Give the medicine to the individual. That's that's what people think is going on. But in fact one of the things that you point out is in within the the wholesale world the middleman part of this it's not there are some big major wholesalers but in fact there are an awful lot of small ones and there's a lot of

trading back and forth of passing the medication back and forth. Perhaps in a legitimate way but that that creates the the conditions that make it possible for counterfeits to get into the system. That's absolutely right. Well in an ideal world you've described the distribution system from manufacturer to wholesaler to pharmacy making one stop between the manufacturer and the pharmacy. Let me tell you what I uncovered in the case of Timothy Fagan. There was a tiny little pharmacy in South Florida in Miami that was ordering huge amounts of low dose the pigeon from the big national wholesalers cardinal and AmerisourceBergen. So now in an ideal world those that pharmacy would have dispensed all those vials of low dose the pigeons to patients. But they didn't dispense it to a single patient. Instead what

they did is they sold it out the back door to just an unlicensed guy a middleman in Florida who then sold it to a counterfeiter who had high dose labels 40000 UML printed up. And so what he did and then he soaked the vials overnight removed the low dose labels and glued on the high dose ones increasing the value of about one hundred ten thousand vials of this medicine by 46 million dollars. In turn he sold it to some buyers who were guys who operated a strip club in south Miami. They sold it to some narcotics traffickers who own shell companies. These were licensed companies through the state of Florida that were supposed to be wholesalers but weren't really they sold it to others who sold it to others. Finally it ends up getting sold to a quasar in a legitimate wholesaler who sells

the drugs to AmerisourceBergen the big wholesaler that sold the low dose in the first place. This time they buy the drugs for a discount because they think they're getting a discount on the high dose the pigeon's the drugs moved all the way around the distribution system through about a dozen hands and America source distributed this to CVF pharmacy. I mean. It's a mind boggling chain and I know it sounds incredibly confusing when I describe it but it's anything but a straight passage of the drugs. It's everyone in the middle arbitraging the price of the drugs buying low selling high counterfeiter supply somewhere in the chain up label the drugs the people who buy it think they're getting a discount on the high dose. And it ends up being distributed to Timothy Fagan in Long Island who's just recovering from a liver transplant. So when I'm sure that I would imagine again when people think about when you say

counterfeit drugs they might think that well what we're talking about here is something that is labeled as a particular medicine and that it's nothing of the sort. It could be I suppose it could be anything else it could be an aspirin labeled as something else had copyright. It could be water could be a just a bottle of water. So that would be one thing but then there also is the case where there is adulteration so you might take a genuine medicine and cut it so that you would be able to get more. Or in this particular case take a genuine medicine that has a particular dosage and change the label so the person is getting it is the Medicaid. That they think that they're getting. But not the dosage that they think that they're getting so that they and in fact are ending up taking less. Than they think they are and that they are supposed to be so. Sounds like there are a variety of ways that this can happen I don't know if any one of these particular is more likely than any other. There have been a whole array of schemes but

basically the definition of a counterfeit Is that what is on the label does not match what is in the bottle or in the vial. So in that case the up label the region is a counterfeit. But there are a lot of drugs as they move through this system. They're not counterfeit per se but they are a dolt aerated and what that means is that their origin is unknown. And as a result they are not fit for human consumption because we don't know where they came from and we don't know where they came from. We can't vouch for what's in them. I'm sure as people listen to the example that you gave and think about all these individuals who are passing these medical. Asians from hand to hand. People who are various kinds of shady operators people who are involved in organized crime you know who knows what and perhaps also legitimate drug wholesalers. The question they'll have is well what what do you have to do. Who do you have to

be to be able to be a drug wholesaler is there no kind of licensing or inspection or regulation of drug wholesalers. Well this is really incredible. Let me take Florida for an example and the. A lot of the story of dangerous doses is that they're basically you just needed to have a pulse to be able to get a state license. The statewide Bureau of pharmaceutical services gave you an application form and it had a question on it. Are you a convicted felon. And guess what. All the felons check the no box. There were no criminal background checks. You had to put down 700 bucks proof that you had a refrigerator an air conditioning and a lock on the door and you were in business. And as a result the state ended up giving legitimate licenses to convicted narcotics traffickers.

Given the fact that that there is perhaps some growing it may be small and maybe slow but growing awareness of this issue. Are there places where state regulators are starting to talk about maybe this is something that would happen at the level of I don't know of the state government or the state legislature or whatever are talking about tightening the rules about who can be a drug wholesaler. Yes that's a good do. Nevada Florida actually changed its laws. California New Jersey looks to be heading that way. You know but the problem is these and Vesta gators the horsemen of the apocalypse in Florida say they end up just exporting crime because if you closed loopholes in one state the bad guys just move to another state. And so what you need what we really need is federal regulation of this. And so far your listeners may not be surprised. There has not been any. And has there even been discussion.

Well there has been discussion and in fact there was a law passed in 1988 which would have required a comprehensive pedigree trail or for audit trail for every drug as it passed through the distribution system. But lobbyists for the wholesalers stepped in and gutted that legislation. They made the argument too. To those in power that this was too difficult too costly to burden some to have to document the path of the drug. And that is why. Now when a drug arrives at our pharmacy nobody can tell you where it's been. And it took me three years of investigations with the help of the horsemen of the apocalypse and many other sources to figure out where Timothy Fagan's medicine had been and of course as it turned out it had been sitting in a in a beer cooler in the back of a strip club in south Florida.

One of the parties that I would expect would be very concerned about this because it would ultimately would involve their good name would be the drug. Actors the people who make the medications in the first place. Is that something that concerns them have. And is there something at the production and that they could do to try to minimize the possibility of counterfeit. Yes and they are doing it. They have become very sophisticated about security and packaging of the drugs so they have introduced all kinds of both overt and covert elements into the packaging. There are holograms. There is color changing ink which is the kind used in the new $20 bill. There are even chemical tags or markers that are embedded both in the packaging and in the medicine itself. But they acknowledge that. Given 12 to 18 months counterfeiters can copy anything they have replicated holograms.

So you have to continually shift the security markers on this packaging it's very complicated to do. We are at our midpoint here in this hour of focus 580. Let me introduce again our guests. Katherine Eban is an investigative medical reporter. She's worked for The New York Times The New York Observer. ABC News has also contributed articles to a number of different publications including The Nation The New Republic The New Yorker self Vogue Glamour. She's the author of a book that deals with this subject here we're talking about in depth. The result of several years worth of reporting on the subject. The title of her book is Dangerous doses how counterfeiters are contaminating America's drug supply that's the subtitle. It's published by Harcourt is in the bookstore. If you want to read it and questions here on the program our Welcome to 3 3 3 9 4 5 5 toll free 800 2 2 2 9 4 5 5. You mentioned that the. That there are various states in their regulatory

apparatus that are paying attention to it and are trying to tighten their laws that govern who can be a drug wholesaler. But that your argument is that that they and it's understandable that that simply creates a magnet for those places that have the weak regulation. If you're in the state they tighten the rules on you you can just go someplace else and for that reason the real way of getting at the problem would be to have a national system of regulation. We do have a national agency that is supposed to oversee the safety and efficacy of the drug supply and that's the Food and Drug Administration. How how are they addressing the problem. Or is FDA trying to address. The problem well. Remarkably the FDA says it does not regulate the supply chain. Good regulates what happens in the manufacturer's laboratories to make sure the drugs are are made safely. But as soon as they leave the loading docks it's up to the states. That's what they say.

So effectively our drugs are just falling into this black hole. And that's why it really is like the Wild West out there I mean I have sat down with licensed drug wholesalers who have a long felony record heroin addiction who can't even read and write and these are people who are distributing millions of dollars of our cancer medicine. You know the FDA is now disseminating just proposed voluntary guidelines for industry. They're pushing industry towards something that's called RFID which is radio frequency identification which is like little barcodes with antenna so you can track drugs through the distribution system and it's all very interesting and it's all very James Bond. But the fact of the matter is that the the immediate solutions that we need are really old fashioned ones. In the paper records of where these drugs have been

we need much stronger criminal penalties to lock up these bad guys you know and you've got you know pockets of very dedicated state investigators. The one group the horsemen whose story I tell who are banging their head against the wall and working 18 hours a day to try to stem this tide of bad medicine with absolutely no help from federal regulators. Let's talk about the issue of penalties for a bit because you have talked about the fact that some of the people who have gotten into this business of peddling counterfeit medication are criminals who previously had been involved with illegal drugs and that they made the switch because if you if you get arrested for distributing. Counterfeit prescription medicine the penalties are much less severe than if you were arrested for selling say heroin or cocaine or something like that. What sort of penalties are there for people who are caught doing this.

Well in large part they've just been misdemeanors and penalties for for counterfeiters missed branding a commercial product for example. So you know you're looking at a couple years in jail or nominal fines and the only the only way to successfully prosecute and some states have done it in the horseman managed to do it is. With racketeering cases. You know you go after these guys the way the feds went after the mob. And you you identify the conspiracy that it is with all of the predicate crimes wire fraud money laundering kickbacks all those sorts of things which are going on in this corrupt universe. But those are very very difficult cases to make. And you have to Kedah really dedicated group of law enforcement together to bring those cases. I suppose the extreme would be that if you had someone in the you could establish that

they had knowingly put a counterfeit prescription medication into the system and that it ended up with the patient. And that patient took and that patient died. You could charge that person the one who was responsible with some variety of murder. I guess that that would be the ultimate. Has any any case like that ever come to trial or come anywhere close to going to trial. No. Not criminally. That's you know take the case of a guy named Eddie Goren in Miami who decided that he was going to take pro-create vials and procreated for cancer and just fill him with Miami tap water which has eco law in it I mean any patient with a compromised immune system who's injecting this stuff is going to die. Here is the argument of one of his associates who was captured on an undercover wire was they're going to die anyway because they're so sick so it's OK to do it anyway Goren was caught. He

was sentenced to three years three years in prison and he didn't serve all of it. That's the problem. Well again I want to make sure the people who are listening know they were open to questions as we continue to talk with our guest Katherine Eban. The number here in Champaign Urbana 3 3 3 9 4 5 5 we do also have that toll free line good anywhere that you can hear us around Illinois Indiana if you have to be listening over the Internet as we are a web guesting. You can use that number to as long as you're in the United States there. Eight hundred to 2 2 9 4 5 5 so that's the toll free and the local number is 3 3 3 9 4 5 5 at any point here. You have questions you can give us a call. I'm going to give you the opportunity maybe to talk a little bit more about you mention the fact that you had concentrated a lot of your reporting on the state of Florida and that you had spent some time following this particular group of investigators. The state level investigators who were trying to work on the problem there in in Florida who in under under what branch of or what department of state

government does this happen who the state level is are really responsible. Well it's it's interesting how this group came together. They are two pharmacists from the Bureau of state wide far Mr. pharmaceutical services. One special agent from the Florida Department of Law Enforcement and two Miami Dade cops. The two pharmacists have been warning law enforcement for years that they had seen this gray market in action criminals buying and selling cancer medicine in parking lots ferrying around pro-create vials in their steaming car trunks when this is medicine that needs to be preserved perfectly and kept cold. No one paid attention to them and then one day they walked into the office of a 28 year old prosecutor named Stephanie Feldman who stands about five feet tall. They explained what they had been seeing and she said let's do this case. And the reason she understood it is because she was an

insulin dependent diabetic who had to inject herself five times a day. She knows that if the medicine isn't preserved exactly in the right way to be delivered to patients at the right time. That that their lives are threatened. She called this task force operation stone cold. Because she saw the people who were doing this is stone cold killers. And it brought together this band of investigators. They were all over 50. One of them was 72 years old with two hearing aids. They really had not had a day of luck in their lives. And finally this was the case of a lifetime. And it was the relationship of these five men that led me to write the book because of how much they cared about this and how many obstacles they faced so dangerous doses really their story of their investigation as well as my own investigation nationally of what had happened. But it's

it's you know that's the kind of commitment that you need in order to bring these cases. And that's why it's happened so rarely. Let's talk with somebody else here we're getting some other callers. We have someone listening in. In Bloomington Illinois not too far away when the toll free line line for Hello. Oh yes thank you for your show enjoy and listen as often as I can. Very appreciated. And I did tune in late today so I'm not real clear but. I heard you describe your to the trail of this one drug through one entity after another. At what point I really have 2 questions. At what point did you. Was it discovered that it was there was a problem. And then my other question was I wondered you know what can we as citizens do. Just ordinary citizens.

Right. Well you know unfortunately the counterfeits that were created the counterfeit e-petition was only discovered after it had already reached patients. Now there were one hundred and ten. We know who I identified that you'll meet the counterfeiter in my book. I won't tell you his name because it'll give it away but you will meet him key counterfeited hundred and ten thousand vials of this medicine. Investigators The horseman who I described were desperate to recover this medicine as were some federal agents. Together they were only able to track down 13000 vials which means that ninety seven thousand other Viles were released into the supply chain and are presumed to have reached patients. Now that's enough medicine to treat some 30000 cancer patients for a month. So awful. So that gives you a sense of you know

both the scope and the problem now. What do you do. I want to remind listeners on my web site my interest doses. I have a list of safety tips and things you can look for to help identify your medicine. And obviously as consumers we should reward. Pharmacies and other people who declare that they're only going to buy you know direct that they're not going to purchase from wholesalers who buy from the secondary market of shady wholesalers. And you know try to put pressure on our pharmacies and educate our pharmacists about this problem. And then what point did did did was this drug discovered to be counterfeit. At what point how did how did you do. How is it covered or. Well I mean it was discovered in part because patients were calling the manufacturer to complain that they were having strange side effects or that their medicine wasn't working

right. That's part of the way that they got discovered. I say can we trust reputable pharmacies such as Walgreens to purchase the short answer is no because you know they are purchasing from wholesalers who are purchasing from secondary wholesalers. Now these shady operations. So you know Walgreens Duane Reed write a record. CBS I mean they've all had problems with this. So that that is what the book is about it is it is not about Internet medicine it is not about you know medicine we're buying across the border it is about the medicine that we trust most and pay more for than anyone in the world. Well thank you for all your work and your welcome to the CO. And what really makes this you know gives one pause is we're talking earlier about the fact that some of the medicines that have been counterfeited are

things that are very very expensive. And that's that's understandable from you know from the profit motive because you know if you're going to counterfeit something you wanted to be an item that is a very expensive but when you take a look also on your Web site you take a look at some. The particular medicines that have been counterfeited some of these are very common and are not anything particularly exotic including things like penicillin and sip bro and Vioxx and Zocor Proxima. These are things that there are an awful lot of people in this country that are taking well. That's actually the other profit motive you've just named it. You know it's volume volume volume. Right now it's either phenomenally high cost or big volume sellers. The counterfeiters. There was a huge counterfeit incident with the tour. Which is the nation's number one

selling drug for high cholesterol. And 18 million doses of Lipitor had to be recalled because of the counterfeiting threat now. You know I think that our elected officials ignored this problem for a long time except when they counterfeit it with a door that everybody in the U.S. Congress most of whom take it started saying well we have a real problem on our hands here. We have all the color cereal go to color here in Urbana one number. One well. Yeah. Question one picks up on what you were talking about just just now about the pharmacies. Doesn't matter. There are you know a large or well-known pharmacy chain or whatever. I understood that that CBS was at least claiming to to only buy prescription drugs from anyone who doesn't deal directly with the manufacturer but you apparently you think that

I'm I right to think that you think that's not enough. Well that is correct I mean CBS did recently make an announcement that it was only going to buy from wholesalers who bought directly from manufacturers. You are sounding very good. It's the right direction. The problem is is that really none of the big wholesalers have stopped buying from the secondary market. Now Cardinal Health which is one of the nation's three largest wholesalers made an announcement that they were going to close their trading division and the trading division was the division that bought discounted drugs from the secondary market. But in fact they have not pulled out purchasing from the secondary market entirely. So you know there's a lot of you know beneath the sort of public relations declarations there is there is a lot of fine print that still needs to be understood.

You know this whole we're going to RE market goes completely completely contrary to what our interest through. The pharmacy's principles were and that is when they when they argue against re-imported station of drugs they like to say that that I mean I've I've heard it argued that they don't want drugs coming in from Canada because they they sell the drugs cheaper to candidate Canada because Canada has a has a and it doesn't have our standard of living and therefore can't really afford it at our price. And that and that Congress is going to help them not you know help them. And by making it illegal for people to resell. And the whole idea is that they will therefore recover their

investment in R&D you know right. Well there's been one so how is that no. No win win win. Apparently the industry stands to profit. It's OK to have arbitrage this reselling. Oh well if you know you've really put your finger on it there's a tremendous irony the drug makers say well you know if we bring in drugs from abroad we'll be contaminating our otherwise pure supply. But in fact our supply is not pure. The drug makers know this and we have some of the best criminals in the world and that's what fascinated me about this story is you know everybody thinks oh counterfeit medicine we're talking about you know Mexico India China no actually we're talking about you know Miami or New York. You know it's it's going on here the problem is within our borders. So then when you consider that we are going to these pharmacies we're paying more for our medicines

than anybody in the world and we still may not be getting pure stuff. That's incredible. Let's go to the next caller here real quick I will introduce Again our guest first we'll have about five minutes left in this part of focus We're talking with Katherine Eban She's an investigative medical reporter. She's worked for The New York Times New York New York Observer ABC News contribute articles to him. Different publications if you want to read more on this subject counterfeit prescription drugs. You look for her new book it's titled Dangerous doses it's published by Harcourt. Next is color in Charleston one number to it all. Yes it appears to me that your guest is a Nazi ating the anomalies of private enterprise. And where you have private enterprise you're going to have exactly what your guest is speaking off. I can harken back to a book I read recently that with the Trail of Tears when the government subsidies produce the products we're going to move the Indians West

consisted of rotten meat bad water. The nurse came along and exploited that market. Talking a long time ago and now we're up to date and nothing has changed. It's the first I've heard of what your guest has had to say about the prescription drugs. But is anyone surprised that this stuff goes on and she just said that we have some of the best criminals in the world. Got it. And I think that's reasonable because where is the most exploitable market in the world in the U.S. because we have more money and you have these criminals and subhuman types who come along and then exploit the victim just like the brothers down in a cave in rock. So I mean nothing is change and nothing is going to change until we get some handle on how to organize our society without the opportunists who can come along and then exploit people that have anything to do.

You're you're raising a terrific point. Hello. One question here is well you know should should anything be outside of this arbitrary system. You know and of course like the dirty word is price regulation. But. You know maybe our farm or life saving pharmaceuticals should not be traded like pork belly. It's just something to think about. This wealth of capitalism is what it is and it's never going to change until some revolutionary activity begins. Second who throw that paradigm and set up a new system whereby the criminal has no motive to go and exploit him to kill people and men be the pirate societies that we live in we live in a radical society there is no question from top to bottom. And have you ever heard the story of the Hart brothers and cave in rock. I have not yet they used the watch to down there I had a book out boat coming up the river in pioneer times. We're talking 18 20 and they would

holler down a flatboat and then they get their craft ready had a paddle out intercept the boat kill all of the the passengers on the boat. Them fill their bodies with rocks thrown in a river take the flatboat and all right on down to New Orleans and turn the material and come back and do that over and over again for 30 years that went on. And somehow that a system with a history like that is going to be fixed by laws or by police policing and all that. When the police will turn criminal to whatever the price is right. So what I'm saying is that we must change the paradigm unless we do then work at it. Thank goodness for folk like yourself who can point these things out. But will it institute change Canada institute change. No I think not. Thank you very much. Well they have the go well assuming that we don't have a revolution anytime soon and that the prescription drug. Industry does not decide to convert itself into a nonprofit short of those two things. What what

can be done. What do you think reasonably can be done then. And you do make some suggestions about what consumers can do to try to watch out for themselves. We can we can again touch on that. I guess I'm particularly thinking on the governmental regulatory side. Yeah. First of all I am a big believer in laws I think they do really help the day that my book was published. Congressman Steve Israel of Long Island who represents the Fagan family there his constituents held a press conference and announced a proposal Tim Fagan's law which would close some of the loopholes in the drug supply. It would require much higher standards federally for wholesalers. It would require a comprehensive paper trail for every drug as it moved through the system so there would be some way to you know find out or track back where it had been increase criminal penalties

for tampering with medicine for falsifying pedigree papers. It would strengthen the enforcement arm of the Food and Drug Administration the Office of Criminal Investigation there which does great work but they're woefully understaffed. So you know this is this is a law that is really worth its salt salt. He's looking for a co-sponsor in the Senate now. Your viewers can see that law. It's on my website there's a link to it which is dangerous doses. If you go there you can see that law. So there is you know there is a lot to be done and there are you know inklings that there is a response in the industry so small you know with Cardinal Health announcement and CBS's announcement now that you know those are small. It's not comprehensive but it's a start. You know I think if you get people at least saying the right things it is maybe one step closer to doing the right thing.

The FDA does have a website. They do have information about prescription drugs there is. Is there useful information there. Well the I think you're talking about the med Watch site and I have a link to that on my website as well. That's a place where they do patients can find alerts about counterfeits and they can also enter in information if they suspect they've gotten counterfeits. So it's definitely not a tool to be ignored. It is useful. It's certainly not perfect but it it helps. And as far as end of it. Bulls are concerned that the things that you suggest are if for example you've been taking a medicine and you've been taking it for a long time. If you get a new prescription and something about it seems different seems not right or if you're taking it and you know you're having some sort of symptom there are side effects you never had before any kind of concern like that that you really need to follow up either with your doctor or with your pharmacist or probably both

both. Talk to your doctor and your pharmacist. And also I would suggest calling the manufacturer. Most of those drug companies will have phone numbers on their websites where you can you know reach a human being and talk to them about it. But some of the drug makers will say if you suspect you've gotten counterfeit medicines send us back your medicine send us back all your medicine and we'll send you good stuff. Do not send back all your medicine. Keep some because it is if you've got counterfeit if it's the only evidence you'll have good. And I think you know I feel I should say I have I have no connection with the pharmacy industry but that the people should should realize that their pharmacist the person who's there behind the counter who dispenses the medicine is a good source of information. It happens whenever people have questions about what they're taking what it's supposed to do how they're supposed to take it. Potential side effects

any and all that kind of stuff. They should not hesitate to discuss that with the pharmacist and that in the end if that person doesn't isn't interested in talking with them and answering their questions then maybe they should think about going someplace else. I agree completely People should talk to their pharmacist definitely but a lot of pharmacists to not know about what is happening in the distribution system. They don't know about the you know buying practices of the companies they work for and some of them don't even know about this counterfeit problem. What makes me very pleased now as I go around the country and talk about this issue. I am beginning to address large groups of pharmacists. You know I wish I could get my book into the hands of every single one of them because they need to know so I think you know patients should. Try to educate their pharmacists. That's a very positive thing. Well we're going to have to stop. We're come to the end of the time again people. Were interested

in reading the book it's titled Dangerous doses it's published by Harcourt. You can look for it in library also there's information available on the website that our guest has mentioned which is dangerous doses dot com. You can read more about the book at for some more information on the issue. Our guest Katherine Eban is investigative medical reporter. And thanks very much for talking with us. Thanks so much it was a pleasure. Our program Focus 580 is made possible in part by Strawberry Fields on West Springfield Avenue in downtown Herb Bana starry fields catering department now offers box lunches for professional meetings or casual lunchtime gatherings Strawberry Fields 3 2 8 1 6 5 5. Support for the broadcast today also comes from the corkscrew wine import three north vine in Urbana. The Corkscrew carries a full line of wines beers and spirits for everyone from the serious collector to the first time buyer. Wine tastings held every Friday from 6 to 8 Saturday from 2 to 6 information is available 3 3 7 7 7 0 4. Or on the web at the corkscrew

dot com. Coming up in the next part of this program will do a little art history will be talking about what is probably the most famous American painting ever American Gothic will be talking with Stephen Beal about a book that he's written that looks at the history of the painting and how people have looked at it over the years. That's in the next hour we'll break now though for news an update on the markets so stay tuned. The Carle Center for Rural Health and farm safety a division of Karl foundation Hosp..