Last week the Health Ministry issued an injunction to close down the Neve Avivim pharmacy in Ramat Aviv. A surprise inspection by pharmacists from the district health office resulted in suspicions that the pharmacy was buying drugs from its clients, drugs they'd received from their health maintenance organizations. The pharmacy would then "fix up" the packaging, blurring its origin, and "recycle" the drug - selling it onwards.
"In practice, they were selling second-hand drugs," says Dalia Cohen, the Tel Aviv district pharmacist at the Health Ministry. "The owners of the pharmacy were even recycling drugs that they'd been prescribed themselves, as patients, from their own doctors."
The inspectors also found packages of drugs bearing future expiration dates, but the drugs inside the packages had already expired. Worse than that, the Neve Avivim pharmacy had been buying drugs from unknown sources, meaning sources nobody was inspecting.
Neve Avivim, like all pharmacies in Israel, is supervised by the Health Ministry. Yet it seems that it still managed to pull off fraud under the watchful eye of the government.
"Inspections of pharmacies include inspection of infrastructure, how they keep the drugs, whether the pharmacists conduct themselves professionally, what their sources of procurement are, how they handle dangerous drugs and controlled substances, and whether they adhere to the law, rules and regulations," says Cohen.
"The Health Ministry inspectors are supposed to visit each pharmacy once every three years. There is no question that this frequency is inadequate," she says. The visits can sometimes be spaced even further apart because the supervisory department is stretched. The Health Ministry is aware of the need to hire more professionals to conduct these inspections, but in practice it has not done so, she says.
The case in Ramat Aviv sounds frightening, but Cohen seeks to assuage any nascent panic, explaining this is only the second case this year in which an Israeli pharmacy got caught "recycling" drugs. The first case also involved a pharmacy in Tel Aviv, which has since been closed down, and the violations there were not as severe. Generally speaking, Israel's pharmacies are reliable and the pharmacists are decent, honest people with a sense of professional obligation to their clients, Cohen reassures.
The sins of Neve Avivim, if nothing else, at least don't include selling fake drugs, meaning drugs made using the wrong ingredients, that lack the active ingredients, or if they do include them, they don't have the right amount. Counterfeit drugs are also likely to include components not found in the real drug, including the wrong active ingredients. In short, they're something else entirely, packaged to fool the buyer.
The danger in taking counterfeit drugs is first and foremost to the person's health. Barring potential placebo effects, a patient's health will deteriorate because he isn't getting the drug he needed. In worst-case scenarios, the fake drug can even kill because of its own toxic properties.
Supervised pharmacies do not sell counterfeit drugs. People find them by answering ads online or in the paper, or when buying from street vendors. Even in Israel, this problem isn't rare: In 2008 Israel was ranked 8th in the world for counterfeit drugs, with 78 reported cases worth between NIS 80 million and NIS 100 million in sales terms.
It isn't always easy to spot the differences between the real McCoy and the imitation. But following a few basic rules should help. Here are tips from David Pappo and Micky Ofer, chairman and vice-chairman, respectively, of the Pharmaceutical Association of Israel.
First of all, look for the piece of paper with information on the drug which comes inside all packages of legitimate drugs. This sheet details the drug's composition, active ingredients, possible side effects, and instructions for use in three languages: Hebrew, Arabic and English. If this paper isn't there, or is there but doesn't have all that information, and especially if there is no information in Hebrew provided, you have grounds to suspect that the drug isn't kosher.
Check whether the production batch code on the package matches that on the actual package of drugs. The code on the external package is usually next to the drug's expiry date.
Buy medicines only at pharmacies, not from people on the street or over the Internet. Pharmacists are supervised by the Health Ministry, while peddlers on sidewalks, or faceless people selling over the phone based on ads in the paper, are not. Not only are you likely to buy a fake drug, even if it's real it may not have been stored properly.
Definitely don't buy drugs from foreign Web sites. The Health Ministry has no way of supervising drugs mailed from abroad. You may think it's significantly cheaper, but you're buying an unknown quality of drug and have no way of knowing what you're actually getting. The Health Ministry says a full 50% of the drugs sold via foreign Web sites are counterfeit.
The online sites of Israeli pharmacies are usually safe: there's a physical pharmacy behind the site, which is supervised by the Health Ministry. It's the same as buying from the pharmacy itself.
Sometimes pharmacists extract a few pills from a package and stick them into a small paper bag for you. Make sure the pharmacist writes down the name of the drug and prescribed dosage, your name, the doctor's name, the amount of pills in the bag, the production code number, and the expiry date of the drug. If he just tosses the pills in the bag and shoves it at you, it's possible that something is fishy. "That's exactly how charlatans would try to pawn off a drug from a dubious source," says Pappo.
And most importantly, if the packaging is dodgy - information deleted, white-out applied - the content may be as well.