Just when our society seems to be advancing a few critical steps, it's disheartening to learn about the latest scam that’s no less than deplorable from any perspective. Consider the following fictional scenario as an illustration of my point.

An adolescent suffering from kidney failure is receiving dialysis three times each week. In addition to facing incredible health challenges and ongoing treatments, she's being shunned by her peers. Considerably shorter than her classmates due to her body's inability to produce sufficient amounts of growth hormone, she is depressed and withdrawn. Awaiting a possible kidney transplant, this young woman is receiving prescribed growth hormone replacement on a regular basis. Thirty minutes after the last dose, she is no longer able to concentrate on her homework. Confused and delirious, she lapses into a coma and her parents immediately call 911. Upon reaching the Emergency room, she's experiencing uncontrollable grand mal seizures. Her mother insists it must be a drug reaction. After learning this patient has received the same medication on a regular basis over the last 6 months, the ER physician discounts that possibility.

While his conclusion was scientifically rational, unfortunately he was wrong!

How was the doctor to know that the medication she received was counterfeit? There was no detectable amount of growth hormone in the formulation. Instead it contained insulin, a substance that lowers blood sugar levels. If taken by a non-diabetic individuals, the effects can be life-threatening.

As stated previously, the scenario I presented is fictitious. The situation, however, is not.

The FDA recently disclosed that fake prescription drugs were sold to patients by pharmacies. Cases involving three rather expensive preparations included Serostim and Nutropin AQ (two formulations of growth hormone), and Neupogen, a substance that helps decrease the incidence of infection in patients with certain types of cancer. In one case involving Nutropin AQ, the preparation actually contained insulin instead of growth hormone.

While the manner in which these counterfeits landed on the pharmacy shelves is unknown, it is believed that at least one of these drugs reached the public through unscrupulous distributors. I can't imagine the process is difficult especially for individuals willing to take advantage of others. Using existing technology, anyone can counterfeit a drug label and packaging. Distribution shouldn't be challenging eitheræ armored cars are not used to deliver drugs to pharmacies ... yet! Unfortunately, there always seems to be a way to prey on people whose lives are hanging by a thread.

Solutions, however, require a multifaceted approach.

One potential advance is based upon the FDA's recent consideration of stopping the importation of drugs from overseas. More than 2 million packages containing drugs enter the US each year and many contain substances that are extremely difficult for FDA scientists to identify. The government's ability to effectively screen these packages does not exist.

According to William Hubbard, the FDA's senior associate commissioner for policy, "The inescapable conclusion is these drugs are virtually all unapproved in the United States. ... They may be counterfeit or worse."

Many people are now using internet-based suppliers or pharmacies in order to gain access to drugs that are illegal or difficult to attain in the US. It's time we realized that a security net large enough to contain the world wide web does not exist.

Although the FDA can help to some degree, we must accept our responsibility make a reasonable difference. It's up to all of us to carefully examine any drug we receive. We should always ask our pharmacist about any change in appearance (compared to a prior prescription) that may be apparent. Ultimately it is in our best interest to avoid all online pharmacies not licensed in the US.

How can we be sure? You can check with the National Boards of Pharmacy (NAPB) in the US, (http://www.nabp.net/vipps/intro.asp), an organization that developed the Verified Internet Pharmacy Practice Sites (VIPPS) program in the spring of 1999. According to the NAPB, "To be VIPPS certified, a pharmacy must comply with the licensing and inspection requirements of their state and each state to which they dispense pharmaceuticals. In addition, pharmacies displaying the VIPPS seal have demonstrated to NABP compliance with VIPPS criteria including patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy, and provision of meaningful consultation between patients and pharmacists."

While I applaud the NABP for taking such comprehensive measures, if we extend our discussion beyond prescription drugs, the situation becomes murkier and potentially more devastating. Just consider the myriad of herbal preparations and supplements for which even the most basic safety measures are practically non-existent. From toxicity and poisoning due to environmental factors, to failure to ensure the inclusion of any listed substance, the additional problems associated with the world-wide sale of natural substances is frightening.

In the final analysis, that old bit of wisdom, "Buyer Beware" now has new life-threatening meaning. Unfortunately, in an era of global consumerism, it's time we realized the cure can kill you. As P.T. Barnum once said, "A customer is born every minute." So is a charlatan. - Mind Over Matter!