Almost one-third of the residents of Moscow and Samara encountered" counterfeit medicines during 2002. The majority of them are very concerned about this issue: 84 percent of respondents said that counterfeit medicines are "absolutely unacceptable," while they are much more lenient regarding other counterfeits.

These figures are the result of an opinion poll, conducted on 1,500 consumers in Moscow and 800 in Samara, jointly commissioned by the Coalition for Intellectual Property Rights (CIPR) and the Pharmaceutical Research and Manufacturers of America (PhRMA), with support from the International Confederation of Consumer Organizations (KonfOP) and the Consumer Union of Russia.

The most "suspicious" medicine turned out to be No-Spa. Almost one-third of the respondents (27.3 percent) said they suspected that this medicine was counterfeit. Respondents suspecting Aspirin (without indicating its producer) of being counterfeit made up 8.5 percent. Aspirin UPSA and Analgin followed. Validol, Summamed, Mezim Forte, Bromgeksin, Trikhopol, Suprastin and some other medicines, the majority of which known from TV commercials, were mentioned as being counterfeited.

Let's look at this list more attentively. Would you be able to distinguish between counterfeit and genuine No-Spa, Analgin or Validol with the naked eye? In this vein, I remember the story about Summamed that took place several years ago. Counterfeits of this popular antibiotic were discovered accidentally. The representative office of Pliva (the producer of this medicine) paid attention to strange statistics: the number of Summamed sold in Russia exceeded the quantity of the medicine that had been imported. A careful investigation, including intensive laboratory examinations, revealed an abundance of counterfeits practically identical to the original. The question arises: can ordinary consumers do this?

Here is another story. A patient discovered that Finalgon was counterfeit "by taste": the ointment had previously saved him from backaches, but the last time it failed. The drugstore where the patient bought the ointment made an unprecedented move: it requested and paid for an examination of the ointment, which appeared to be genuine. It is possible that respondents determined their counterfeits in the same way. Other facts also confirm the discrepancy between data obtained during the poll and the real number of counterfeits.

"Rumors about the circulation of counterfeit UPSA appear from time to time," an employee of the Bristol-Myers Squibb representative office said under the condition of anonymity, "But the company has been operating in Russia for over ten years, and not a single counterfeit package has been disclosed during this period. The thing is that producing fizzy pills is so complicated and expensive that it is very unprofitable to counterfeit Upsarin UPSA. Additionally, there are no Russian companies producing fizzy pills. It is very strange that Aspirin UPSA is mentioned in the questionnaire because in 1999 this medicine was renamed Upsarin UPSA."

A representative of Sanofi-Sintelabo also said, under the condition of anonymity, that No-Spa is counterfeited, "The more the medicine is demanded, the more frequently it is counterfeited. However, the real scope of counterfeited No-Spa is evidently smaller than the figures obtained through the poll. It is not always possible to distinguish counterfeits from originals by appearance. The price alone may be suspicious - counterfeits are less expensive.

How can one regard the results of the survey: as a realistic reflection of counterfeits being sold or as a phenomenon of social psychology indicative of our demands and concerns over medicines?

"This is the most delicate issue of the research," explains Alexander Shelemekh, CIPR Senior Vice President. "We too gave a great deal of thought to the question of whether the consumer is able to determine whether a drug is counterfeit or not. For instance, specialists told us that the real troxevasine capsules differ from the counterfeit product by the color of the powder contained in each capsule. However, first of all, the patient is not supposed to know that, and secondly, he/she should not open the capsule, as it should be swallowed whole. Naturally, the survey reflects the subjective opinion of the consumer, and the findings do not characterize the scale of counterfeits, but the way the consumer perceives reality. We believe that the fact that people are aware of the danger presented by counterfeits is much more important. Moreover, many consumers are willing to pay more for medicines if there is a guarantee that they are real. For example, 54 percent of Muscovites are ready to pay from 2 to 20 percent extra for medicines if such a guarantee is available. At the same time, 73 percent of the respondents consider the prices for medicines to be too high.

"We really consider this phenomenon a very important one. Society is ready to fight for its safety. Moreover, 80 percent of the respondents label the problem of counterfeit medicines as very important. The RF Ministry of Health should pay special attention to this fact. The ministry has been "feeding" us information about counterfeits and creating new more expensive certification systems, but has not once caught any of the counterfeiters red-handed. They give a pretty naive explanation - the legislation does not provide for legal actions or punishment against the producers or distributors of counterfeit medicines.

"Anyone at all familiar with jurisprudence understands that it is easy to find laws applying to counterfeiters of medicines. At this point it is necessary to remind the government officials that 84.1 percent of respondents regard counterfeit medicines as impermissible. This number could provide a new angle: consumers might educate themselves enough in the law that they could find the right articles in the legislation to sue the ministry, which is not doing its best to protect our health from counterfeit tablets."

The most frequently counterfeited medicines, according to respondents