Making medicines safer online

At Tribiq we are in the interesting position of working in a number of different industries. One which has been on my mind a great deal lately has been the issues of the counterfeit medicines.

Here are some figures: in the United States 1 in 6 people have purchased counterfeit medicines, that's about 36 million people. I heard estimates that in Nigeria 70% of medicines are fake, and that worldwide 100,000 people have died from taking counterfeit medicines. This is not just about "male enhancement drugs" (you know the kind of thing I mean!), but can be anything from cancer drugs to aspirin.

This week I had the privilege of being invited to sit on a panel at the Global Forum on Access to Safe Medicines, an event which attracted professionals from the US, Europe and other parts of the World. It attracted lawyers, policy makers, pharmaceutical industry professionals and technologists. I met great people from CSIP, ASOP, the MHRA and other federations and associations.

Dealing with the problem is complex; there are tricky legal issues, made harder by the fact that much trade is cross-border. The EU Association for Safe Online Pharmacies (ASOP EU) has done a great job of pushing through legislation, amazingly getting a European Directive put in place in record time, and which has passed into law in the EU member states. Nevertheless, the implementation still needs to play out, made no easier because the rules are not the same in all countries. For example the sale of all medicines online is illegal in Italy, but it is legal in the UK provided the sale is through a certified retailer.

The internet, so much a force for good in many ways, is of course the thing that has fuelled this business based on fake materials, which makes it so easy to buy drugs with a few clicks and for those sellers to make millions in profit. You may not even know where the company is, who you're buying from. It's so easy to set up a website, even with a payment gateway, and be attacting buyers. The sobering statistic here is that 97% of online medicine retailers are believed to be selling counterfeits.

The focus of my talk was to understand this process, and to discuss means to combat it. There are proposals to ask Domain Name registrars to have clauses in their terms and conditions that let them close down rogue domain names. But to have some bite, registrars do need to have the right and the determination to patrol all of their domain names, not just when the name is purchased (there's unlikely to be a site running at that time) but a few weeks down the line, and regularly. They need the legal framework to do this. Encouragingly, I've learned that one of the world's biggest registrars is now near to agreeing to do this.

While the .uk namespace is considered clean, thanks to prompt and effective action by Nominet, there are many less-clean TLDs, not to mention hundreds of registrars. With new TLDs coming online, such as .london, .music and dozens of others, the picture gets no less simple. And even if this battle could be won, rogue sellers would resort to other means; for example using YouTube or Facebook to sell their goods, or merely operating from an IP address to which there are links in promotional emails.

Another approach to the problem is to hope that all sites selling medicines might adopt an SSL Extended Validation Certificate, the likes of which you almost certainly see in your browser's address bar when you visit your bank online. That would need co-operation from Certificiate issuers, and also that there is expectation from buyers in this respect. You'd need to expect that the certificate is there, and know that you are not being duped (such as by the retailer displaying a fake "certified" graphic on the website).

The folks at ASOP in the United States, who work with LegitScript, have taken the approach of establishing the new .pharmacy top level domain. The plan is to restrict the sale of domain names under .pharmacy to retailers who comply with a strict code of conduct. There would also be country-specific subdomains, and the idea is that LegitScript would ensure that sellers comply with the laws of their country. I think that's a great idea, although the problem with too much regulation is that you could actually frighten off the good guys by making it too hard or expensive to trade. I wish them luck, but it remains to be seen whether the honest online medicine sellers will be persuaded to move to .pharmacy.

As a member of the audience commented, the problem is like a "hydra", where you can cut off one head and two grow in its place. It feels like we may drive them off the highway, but they will remain lurking in the side-streets. It's also wrong to assume that buyers are universally being tricked; far from it, many buyers of fakes know exactly what they are getting.