Developing nations are pressing pharmaceutical giants to make treatments for HIV/AIDS available at affordable prices, or to allow them to import generic drugs. The need for affordable drugs has had another side-effect: counterfeiting. It has been nearly a year since the Russian government announced a crackdown on imitation versions of brand-name medicines.
Counterfeit medicines abound across Russia, in kiosks in the underground labyrinth of the Moscow Metro and above ground in gritty, white mobile medical buses.
One man says he is a regular customer, buying his heart medication at this mobile truck every month. The man says he does not trust the reliability of even the more expensive medicine he could buy at a pharmacy, so he says he might as well buy here, where the drugs are cheaper.
It is that kind of attitude that helps make counterfeit drugs a nearly $300-million-a-year business in Russia, which accounts for about 20 percent of the country's drug market.
Everything from heart medication to hormone replacement therapy is on offer, and all without a prescription. Some people do not even know they are buying products, which may not be what their labels claim.
Some of these drugs are chemically similar to their brand name counterparts. But experts say others are not, and may be harmful to people who take them.
The Russian government is working to stamp out both kinds of counterfeit drugs, in part to improve the country's chances of being admitted to the World Trade Organization.
Russian Health Ministry official Vladimir Shipkov, who is heading the government's year-old pharmacy inspection service, says it is a mammoth fight, especially given, what he calls, the absolute vacuum in the Russian law base.
Mr. Shipkov says the present Russian law on medicine does not cover the production, storage or sale of counterfeit medication. He says that, coupled with the profitability of the trade, makes the Russian government's task even harder.
Mr. Shipkov says the average counterfeit drug business can earn a profit of 300 to 500 percent. He says that is similar to the profits earned in the narcotics and weapons trades.
Not surprisingly, the problem is growing. Six years ago, the Russian authorities had detected only one imitation brand. Today, that number has swollen to 170, and experts say the number of counterfeit brands sold in Russia is still growing.
The government's effort is expanding, too. But it is still modest compared to the scope of the problem.
According to Mr. Shipkov, last year, his inspectors checked 48 reported violations and closed eight businesses dealing in counterfeit drugs. This year, he says, the inspectors have checked 64 reported violations and stopped sales at 19 locations.
The Moscow-based Association of International Pharmaceutical Manufacturers acknowledges the government's effort is a start. But the association's director, Robert Rosen says if Russia really wants to protect its citizens from fake medicines, senior officials will need to exhibit far greater political will. "I do not think it is improving as quickly as we would like to see it, and I think, now is the step where you have to enforce the legislation and take the appropriate steps," he said. "And this obviously requires that the tools are made available and the resources are given. And, this is where I think we have to put our efforts today. And I still think that we have to really get the highest levels of the Russian government really to make a very firm, strong public stand against counterfeit drugs to give that added extra push."
Russian consultant Anatoli Zlatkis agrees. Mr. Zlatkis says the Russian government could do more to fight the counterfeit drug trade, but he charges it lacks real will to fight the problem.
Mr. Zlatkis' company has patented a system to help consumers identify counterfeit drugs. The company maintains a call center, which consumers can use to check the serial numbers on their medicine containers. He says the company's database can determine whether the packaging and its contents are authentic or counterfeit.
Mr. Rosen of the Association for International Pharmaceutical Manufacturers says that knowledge is more important than many consumers realize. "Unlike other pirated products, where people want to make maybe like a pact with the devil saying 'well, I know its a pirated video cassette, and it might not work, but I am paying much less.' In counterfeit medicine, one; you are paying the full price in almost every case, and two; you never know what is in there," emphasized Mr. Rosen. "So there is no such thing as a safe counterfeit or a good counterfeit, because there is no one standing behind it [the product]. And you are talking about your health."
Mr. Rosen recommends purchasing medicines exclusively from doctors, hospitals and legitimate pharmacies.
At least some Russian consumers have gotten that message. A woman passing by one of the white medical vans, says she would never buy medicine at a mobile drug store. She prefers to visit the formal pharmacies where she says she has confidence the drugs are real. She acknowledges she probably pays more at the pharmacy, but she feels her health, and that of her family, is worth the extra cost.
Experts like Robert Rosen say, if Russia does not effectively deal with its counterfeit drug problem, it could spread to other countries. Most of the bogus brands sold in Russia are also made there, and the experts say if the problem is not dealt with at its source, the fake medicines now in Russia could start showing up elsewhere.