Interesting and Scary; More Government Fumbling

While the FDA and drug companies rail about the potential dangers of imported drugs, they ignore or downplay reports about adulterated, counterfeit drugs from within the U.S., and fight efforts to improve the reliability of the system. Meanwhile, law-enforcement efforts to correct the problem are frequently blocked by political intervention for donors, legal threats, a patch-work of varying State laws, fraudulent paperwork, regulators giving drug wholesaling licenses to known criminals, and inter-departmental squabbling over who's in charge or gets the credit.

Sources of problem drugs include theft from warehouses, trucks, and hospitals, diversion from lower-priced markets (eg. foreign sales), purchase from Medicaid recipients, relabeling vials containing weak doses with fraudulent labels claiming much stronger contents, and pills made from worthless ingredients.

The book also summarizes the serious impact in two instances of seriously ill patients receiving adulterated drugs.

So what is the motivation for dishonesty in the U.S. drug market? Eban attributes it to a combination of high U.S. drug prices, and low odds of substantive prosecution.

Finally, how big is the problem? Eban reports FDA estimates of about 1% of total U.S. drug use. That is serious enough, particularly given the vulnerability of many of the patients victimized; however, the "bad news" is that the FDA has already shown a strong bias towards covering up the problem, and thus it could be much larger.

Great Summer Reading

This book is astounding. Told as a thriller, it shows why, unbelievably, your pharmacist cannot tell you where your prescription drugs have come from - they have no idea.

One of many great reviews out there - this one in Salon.com - by Katharine Mieszkowski:
"They call themselves the Horsemen of the Apocalypse, and they hold meetings at Hooters. Their uniforms consist of black polo shirts emblazoned with a pack of horses flanking the Grim Reaper, who's wielding a scythe. One Horseman's name is Venema, which rhymes with "enema." But he prefers his code name: Ice Station Zebra. These dubious characters are the good guys in "Dangerous Doses: How Counterfeiters Are Contaminating America's Drug Supply," by Katherine Eban, an expose that wades into more rank Florida unseemliness than a Carl Hiaasen novel, and easily boasts three times the number of sleazebag villains...
Eban mostly lets this stranger-than-fiction cast of characters tell the story, which makes it engaging, even though it's essentially about government failure. The real cause of the corruption of the drug supply isn't the money to be made. It's a weak regulatory system, which doesn't require complete proof of the route a drug takes from its manufacturer to the pharmacist. That opens the door for all kinds of shenanigans among the colorful, corrupt middlemen. The drug industry lobbyists say it would be unduly expensive to keep such records, and that they aren't necessary, even as Operation Stone Cold uncovers more and more stolen, fake and mishandled medicine. And the government continues to buy that argument, even after no lesser force than Gov. Jeb Bush convenes a grand jury to look into the matter. (What it turns up is horrifying to all involved.) ..."

An amazing read

This is a book about an terribly important story--how our most expensive and important medicines are being counterfeited and debased and then sold by good pharmacies to unsuspecting citizens. But it is also a wonderfully exciting read, the kind of narrative nonfiction that doesn't come along very often. The author tells of a rag-tag group of investigators who have personality to spare, and an amazing young DA who decided to go after the counterfeiters in southern Florida. It's an exciting chase story, with lots of personality and humor.
Even though the theme is scary, the story is riveting.