Kinza Waseem, a doctor at the Combined Military Hospital in Karachi, Pakistan, often sees patients who've unknowingly taken counterfeit drugs instead of doctor-prescribed medication that's supposed to help them.
"People will complain of not getting any relief, even after taking medication for a long period of time," she told me in an interview. The patient might begin shivering, feeling tight-chested or short of breath, indicating they're having an unexpected allergic reaction to the correct medicine once they receive it. That means they were previously taking the wrong formula, without realizing.
Each year, millions of Pakistanis spend money on drugs they need—painkillers, Viagra, heart medication or diabetes pills. What they don't realize is that they're often buying fakes laced with dangerous substances like rat poison, paint, and tar. Illegal drug sellers are getting rich off the black market, which by some estimates is more profitable than heroin, and unsuspecting people are dying.
In 2013, Saim Siddiqui, who grew up in Pakistan and was living in Toronto at that time, took a weekend trip to Boston to participate in Pakathon—a hackathon aimed at creating technologies to address some of Pakistan's most pressing problems. He came up with a way to combat the longstanding issue of counterfeit drugs, and his solution netted him first prize. He packed up and headed for Karachi.
His Karachi-based company, ProCheck, now offers the service he envisioned, allowing anyone with a cellphone to verify the authenticity of a drug.
The idea is simple: text the code printed on the medication packet to ProCheck's number, and get an almost instant response on whether the pill is real or fake.
Since the company's launch, in June 2015, it has authenticated over 2 million medications, and that number is about to grow much, much larger. In May, ProCheck launches a new partnership with Ferozsons Laboratories Ltd., a major drug company in Pakistan, to mark as many as 35 million units of medicine, including pills for hypertension, diabetes and heart disease, using its codes.
It's a free service to users, with drug companies fronting most of the expenses. But what many people might not realize is that these drug companies benefit, too—collecting valuable personal data on "patient compliance," for example, from those who sign up.
In a country like Pakistan, where some reports have estimated that as many as 50 percent of all drugs are fake or of shoddy quality, it's a trade-off that countless would be willing to make.
After all, nobody wants to die taking a medication that's supposed to save them.
Counterfeit drugs, including prescription and over-the counter medications, are big business. Investment is low, and return is high. If you invest $1,000 in fake cigarettes, you could make $20,000. If you invest $1,000 in counterfeit medication, you could make $500,000, according to the International Federation of Pharmaceutical Manufacturers and Associations.
Sanofi, a multinational pharmaceutical company, reports that you could make twenty times more money from trafficking counterfeit drugs than from trafficking heroin.
In Pakistan, a lack of basic healthcare, rampant poverty, and spotty government regulation all aggravate the problem. People try to skimp and save by buying generics—pills that sometimes come loose in a bag, not in properly sealed packaging—instead of spending more on brand names.
People in Pakistan might not have reliable access to drugs, but the good news is, according to one 2012 report, 87 per cent of households do have access to a cell phone.
In some cases the pill will contain brick dust, concrete or tar
In 2012, in one single incident, 120 Pakistanis died from taking a fake heart medication. Siddiqui, 28, who grew up in Lahore and later moved to Canada to attend the University of Toronto, was deeply affected. "I just wanted to do something to help, to solve the problem," he said.
He moved to Karachi with no external funding, but got a break in July 2014, securing a $100,000 through the Grand Challenges Canada Stars in Global Health program.
Siddiqui says the problem of fake pharmaceutical drugs is a high stakes one for Pakistanis. Sometimes people are taking plain sugar pills, which is dangerous enough when they should be on a proper drug. "But in some cases the pill will contain brick dust, concrete or tar," he said.
Procheck isn't reinventing the wheel. Other developing countries have used similar services to address a problem often arising due to ineffective or non-existent government regulations.
PharmaSecure, based in New Hampshire, offers a similar service in India, Nigeria and Pakistan. Users simply text or scan the unique alphanumeric code on the medicine packet, and within ten seconds they'll know if their drug is authentic. To date, it's checked two billion packets of medicine.
Sproxil, headquartered outside of Boston, checks drugs in places including Ghana, Kenya, Zimbabwe, and India, labeling packets of medicine with a unique code that can be verified through text, online or through a call to a local call center. Since 2009, the company has performed over 21 million verifications.
Getting the word out among people at risk of ingesting brick dust instead of real medication has been a challenge. India alone has a population of 1.2 billion, and "the question becomes how do you raise awareness geographically about the dangers of counterfeit drugs," explained Nakul Pasricha, CEO of PharmaSecure. A vast country with 22 official languages and a number of different cultures, there isn't one standard way to spread information.
Some governments have embraced mobile drug authentication. In 2012, Nigeria mandated that anti-malaria drug manufacturers come on board, and while they initially pushed back, they were forced to comply. Observers say this made Nigeria the biggest success story so far, so much so that counterfeit anti-malaria drugs reportedly fell from 19.6 percent in 2012 to 3.6 percent in 2015.
The Drug Regulatory Authority of Pakistan is tasked with making sure drugs are safe, effective and of a certain quality, but it has yet to pass any similar legislation.
Drug companies foot the bill for these services. It's not just a gesture of goodwill on their part, though. They get something out of it, too: data. Data and insights that can be used to narrow down marketing efforts and make lots of money.
"If we see that a patient is re-filling their medicine 15 days later than they were supposed to, we may just give them a call to tell them about the benefits of taking their medication on time," said Siddiqui.
Data can be used to tailor health care tips and patient reminders, but Pasricha encourages drug manufacturers to think of mobile authentication as an investment rather than as a cost—they can gain a lot of valuable data on patient compliance and adherence.
Consumers might have no idea they are handing off this kind of information.
Squashing the black market for fake drugs will require the cooperation of the government regulators, drug companies, pharmacists and patient groups.
Until that happens, check your pill bottles.
CORRECTION: An earlier version of this article stated that ProCheck's partnership with Ferozsons Laboratories Ltd. would see pills for hypertension, diabetes and malaria all authenticated through the service. In fact, malaria pills do not fall under this agreement, and the piece has been corrected to reflect this.