Doctor Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The Doctor, for The New York Times Syndicate.

Dr. Anderson invites you to send your questions regarding travel health issues to ericmd@lorrypatton.com

Eric Anderson MD

Question: Can I truly depend on drugs I buy in pharmacies overseas?

The short answer is no - not consistently.

Travelers should carry twice the medications they need when visiting foreign lands -- one lot in your hand luggage and the other in your checked suitcases. Then if your luggage goes astray, you have a backup in your possession, or if you are robbed, you have extra bottles back at your hotel.

Carry your medication in its original marked bottles and have a duplicate prescription from your doctor. If you extend your stay and start to run out of medication, go to a qualified physician (he may give you his own prescription) and ask where you should fill it.

OK. There are two issues here.

First, is it still potent, or could it have degraded into a chemical with toxic side effects? For example, that can happen with tetracycline, an antibiotic often used in the tropics.

Second, is it counterfeit? At The World Health Organization held in Geneva in April, 1999, reports said 2,500 people died in Niger in 1995 after they had been given a fake meningitis vaccine.

Basically, it depends on whether the medication in the pharmacy has been stored properly and for how long. It's quite complicated, because, at one extreme, if you're filling a physician's prescription in a professional pharmacy in a Western European country like Germany or the United Kingdom you shouldn't have any difficulties but, on the other hand, if you are buying antibiotics or antimalarials from drug stores or other sources in developing countries like Nigeria or parts of Asia like Thailand you might have problems.

A study published in 1997 in the Tropical Medicine and International Health magazine found that of the 96 samples of medications bought in the developing world and then subjected to sophisticated chemical analysis, one-third were substandard by Western world parameters. Contrary to the long-held suspicions of many Western physicians at that time, the problems were due not to widespread fraud but to either poor quality control at the foreign manufacturers or to the high temperature and humidity of the area in question. However, that was five years ago before pharmaceutical companies cottoned on to the second issue: counterfeit drugs.

This has now become a significant concern and although there has been a lot of posturing by international agencies since 1997 I don't see much in the way of results to help you and me when we travel.

For instance, the Food and Drug Administration (FDA) and the UK's Medicines Control Agency (MCA) made a great show in February 1998 of joining forces to combat international traffic in counterfeit pharmaceutical chemicals. The press had a field day in this "creation of an informal model for future international projects that was going to focus on achieving results, not generating paperwork." The project received from then Vice President Gore his Hammer Award, "a down-to-earth symbol of his National Partnership for Reinventing Government, a five year-old, major initiative to make the government work better for less." The program was to honor federal employees and their partners who joined forces to cut red tape, streamline procedures and get back to basic concerns of consumers.

The World Health Organization(WHO), for instance, reported from Geneva in April 1999. that in 771 cases of counterfeit drugs, about 59 percent contained no active ingredients, 17 percent contained an incorrect amount of active ingredients, 16% contained quite different active ingredients and only 7 percent contained the correct amount of active ingredients. Unbelievable! It was at this meeting that the report was read that 2,500 people had died in Niger in 1995 after they had been given a fake meningitis vaccine.

At the World Health Assembly in May 2000, again in Geneva, the headlines had become COUNTERFEIT DRUGS: COTTAGE INDUSTRY OR ORGANIZED CRIME? Said Dr. Yasuhiro Suzuki, WHO Executive Director of Health Technology and Pharmaceuticals, "A deadly combination of demand for cheap drugs and fat profit margins makes counterfeit drugs irresistibly attractive to greedy criminals. Clearly, there is an urgent need for action if unnecessary human suffering is to be stopped."

In October 2001 a conference in Moscow brought together 200 leading government and industry experts to discuss strategies for stemming the tide of counterfeit drugs swamping the Russian Federation. "Counterfeiters of medicine are terrorists in their own right," said Nikolay Gerasimenko, Chairman of State Duma Health. "These criminals prey on the health and lives of Russia's sick and poor, and seek economic gain by exploiting those whose lives depend on high-quality."

And finally at the 50th Annual Meeting of the American Society of Tropical Medicine and Hygiene in Atlanta in November 2001 Michael D. Green, a chemist in the CDC Division of Parasitic Diseases, reported "Counterfeit malaria drugs are a widespread problem in many parts of the world, especially in southeast Asia where surveys determined 38% of samples of the malaria drug artesunate purchased at retail outlets contained no active ingredients whatsoever. "In 1999," he continued, "More than 30 malaria deaths in Cambodia could be linked to inadequate treatment due to counterfeit drugs."

Green felt a simple $100 gadget to test urine samples could be used by governments to test for drugs that lacked active ingredients but so far, this so-called refractometer has only been used in the laboratory.

Have a Plan B in place before you leave

Leave an International FedEx envelope and a credit card number with your next door neighbor or regular pharmacist. Or if you are going to be staying overseas at a long established, reputable hotel, mail extra medicine to yourself for arrival. Me? I'd rather carry double.

This problem is not going to go away and it's not limited to medications as anyone who has bought a "Rolex" for $20 in Hong Kong knows. Just last month Steve Smith, managing director of Eveready Batteries (Kenya) said 40 percent of the batteries sold in that African country are counterfeit. But that's another story.

NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician before following any medical advice and to please read the Travel Tips 'n' Tales "Terms of Use" found on the bottom of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.