Much is said and written about the global trade in illegal drugs such as cocaine and heroin: We know about the cartels and the drug wars, and we see the devastation wrought by drugs in the eyes of addicts and in crime statistics.
But rarely do we hear about an equally shady activity that almost rivals "recreational" drugs in size, scope and impact - the counterfeiting of medicines.
The U.S. Center for Medicine in the Public Interest estimates that the counterfeit drug market is worth about $75-billion a year.
About 15 per cent of all medicines sold worldwide are fakes. In developing nations of Africa, Asia and Latin America, it's about 30 per cent.
It's a deadly business, one that kills an estimated 700,000 people a year. That's because a lot of medicines for treating life-threatening diseases such as malaria and tuberculosis are fakes. So, too, are many antibiotics, painkillers, hormones, cancer meds and drugs for hypertension, high cholesterol and diabetes.
"Yet there is strangely little outrage at this globalized evil," according to the authors of a paper about counterfeit medicines published in the Journal of International Criminal Justice this week.
Consider that if you are caught smuggling a kilo of heroin across a border, you will likely go to jail for a long time. But if you're caught with a kilo of counterfeit medicines, you will likely be treated the same as someone smuggling a box of T-shirts - with a fine and a slap on the wrist.
The authors of the paper - Amir Attaran and Megan Kendall of the University of Ottawa and Roger Bate of the American Enterprise Institute in Washington - want that incongruous situation to change, and quickly.
The paper, Why and How to Make an International Crime of Medicine Counterfeiting, points out that counterfeiting of currency became an international crime in 1929: If you decide to print up some fake U.S. money, you are liable to prosecution in any country in the world, not just in the country where the activity took place.
"Humanity and the defence of public health requires doing likewise for counterfeit medicines," Dr. Attaran and his team wrote.
It's true that counterfeit medicine is a peripheral issue in Canada, though some of our infamous Internet pharmacies have been known to sell phony meds transited through other countries.
But Canada is - or should be - a good global citizen and look beyond its borders. It should be tackling the problem of counterfeit medicines with the same vigour as terrorism. And, according to Interpol, there is a link - al-Qaeda generates a significant portion of its revenues from counterfeit drugs.
For the most part, medicine counterfeiting is organized crime. The guy selling phony malaria pills at a roadside stand in rural Kenya is just the last cog in a criminal machine that turns ersatz ingredients into pills, prints plausible packaging, forges trademarks, distributes the products by tricking, bribing and evading customs and health officials and police, then launders the revenues from the illegal sales.
A criminal enterprise of this sort is not haphazard, and the response to it shouldn't be either.
But the World Health Organization, in a study of the impact of counterfeit drugs, said the trade is flourishing because laws are so weak.
The WHO highlighted myriad problems with the current legal regime, including insufficient regulation of drug manufacturing in many countries, poor enforcement of existing legislation, weak penal sanctions for violations and, above all, a lack of co-operation between countries.
"Knowingly making fake medicines that do not help people, or that harm and kill them, ought to be considered a more serious transnational crime than it is," Dr. Attaran said.
But there is a right way and a wrong way to fashion international law.
The Council of Europe is currently promoting the Medicrime Convention, a treaty to criminalize the manufacturing and trading of counterfeit drugs. The approach is inadequate because a) it applies only to Europe and b) it focuses too narrowly on protecting intellectual property.
This treaty seeks to criminalize a lot of what generic drug companies do - test the limits of patent law - but it does nothing to protect the poor Nigerian who is buying crushed chalk that he thinks is lifesaving malaria medication. It's a cynical attempt to shore up market share for brand-name companies. If that is what governments want to do, they should do so, but they shouldn't allow the victims of counterfeit drugs to become collateral damage.
A much better model for a treaty, Dr. Attaran said, is the Framework Convention on Tobacco Control, which tackles an international health problem in both developed and developing worlds by promoting measures and laws that cut across borders and attack the problem at its root.
In their paper, Dr. Attaran and his colleagues note that what they are proposing is nothing radical, and such a treaty is easily achievable, just as it was for counterfeit money. The sole impediment is a lack of political will.
"Meanwhile, counterfeit medicines go on killing. … Absolutely no country is immune," Dr. Attaran said. "A more dismal commentary on the contemporary state of public health diplomacy is scarcely imaginable."