Your child is sick, as the caring and attentive parent that you are you decide to play it safe and take him to see the paediatrician. You know your paediatrician well by now, and you like her a lot. She always has time for all of your worried questions, answers them confidently and appears to genuinely care deeply for the well-being of your child. This time she recommends a course of antibiotics, so on your way out you visit the pharmacy and pick up your prescription. It’s by no means a pleasant week after that, but your child quickly recovers and it’s back to normal for you and your family in no time at all.

When we enter into an interaction such as the one described above it is often easy to forget that the benefit we derive here is based almost entirely on trust. Not just trust in one medically trained individual but in an extremely complex interconnected healthcare system, where the healthcare professional we see is just one of its many nodes. For trust in a health system to exist trust needs to permeate throughout, if it is eroded or lost completely the consequences can be disastrous. We trust that the recommendations from the healthcare system are based on the most up-to-date scientific research, we trust that the healthcare system doesn't receive incentives from pharmaceutical companies to recommend one drug over another and we trust that the medicine that we receive are safe, effective and reliable.

The latter of these is what I want to talk about today. We often take for granted that the medicines we buy from our pharmacies and supermarkets are genuine and do what they say on the box, but this is not always the case. Now, this isn’t one of those What you don’t know might kill you posts, if you live in high income countries there is a high likelihood you will never be exposed to fake pharmaceutical (unless perhaps if you like to buy your pharmaceuticals online), however if you live in a low or middle income country this issue can be all too common and presents a major burden on already stretched healthcare systems.

The devastating effect of fake pharmaceuticals

The World Health Organisation define fake pharmaceuticals as substandard, unregistered/unlicensed or falsified medical products [1]. These products can have various levels of danger associated with them. On the safer (but still dangerous) end of the fake pharmaceutical spectrum the products may contain the active ingredient in the incorrect amounts or contain inactive ingredients. On the more dangerous end the product may contain the wrong pharmaceutical ingredients or even toxic ingredients.

No matter what form the fake pharmaceuticals take they present a very real threat to human life and can prolong suffering far longer than they would have otherwise. In the case of antibiotics and vaccines the effects can be felt wider still as the ineffectiveness of the products may increase the likelihood of antibiotic resistance [2]or facilitate the spread of infectious diseases.

Current estimates suggest that 1 out of every 10 pharmaceutical products bought worldwide are fake [1], although this can be as high as 3 out of 10 in low and middle income countries [3].

To put this into perspective, when the conservative estimate (10% fake) is used for anti-malarial drugs in Sub-Saharan Africa this equates to 529 deaths per million individuals seeking treatment, or an approximate 72 000 - 267 000 preventable deaths per year [2]. Not to mention the additional financial cost to the health care systems of such additional burden.

Cheating the system and those that use it

Due to their relative ease of production and high profit margins it likely comes as little surprise that there is big money to be made in creating fake drugs. Current estimates put the global fraudulent drug industry anywhere between approximate $30 billion USD [2]and $200 billion USD [4]. With many criminal industries seeing the fake drug market as a viable alternative to the illicit drug market.

Fake products sneak their way into the existing supply chains and unless you have a deep working knowledge of the current fraud detection devices there is little chance of you being able to distinguish between the fake and the genuine.

As it can be with so many law enforcement efforts, it works like an arms race. We put branding on the pills, they work out how to manufacture the same branding. We put a bar-code on the box, they work out how to put the same bar-code on their box. We add a holograms, sealing tapes and other tampering devices [3] and these are either replicated again or too obscure for the public don’t know about their viability.

The solution

While reading up on this topic I’m reminded of the old psychic trick of claiming to have knowledge of a objects past through the power of Psychometry.

You know how the story goes; a detective come to a dead end in a grisly murder investigation, out of desperation they hire a mysterious psychic to help on the case. The detective brings the psychic to the crime scene where they touch the murder weapon and are instantaneously transported back in time through that objects history to see who the killer is.

This is exactly what is needed for pharmaceutical drugs (only without having to talk to an annoying con-artist of a psychic), the ability to pick up a box and trace its history all the way back to the source of its creation.

Psychometry is of course ridiculous, but luckily for us we live in ridiculous times where technology is now starting to take the very real place of fictitious psychic powers. The technology behind FarmaTrust is one such technology (big claim I know but hear me out).

Like most dramatic technological developments in recent time FarmaTrust utilizes the blockchain and applies it to tackle this issue of fake pharmaceuticals. There solution is as follows:

When a drug is packaged it is first printed with a QR code linked to a unique identifier (a long string of numbers and letters). This identifier is stored in the FarmaTrust blockchain (a blockchain is basically a magical database that lives in the sky and is accessible to everyone). When the drug is transported along the supply chain the package is scanned (with a simple smartphone app) and the new location information is logged on the blockchain.

Image source

At any point along the chain anyone with the FarmaTrust app can scan one of the unique QR code and see the complete history of that package from its source through every other point on the chain.

Image source

This process builds trust through transparency. With the addition of this information a distributor anywhere in the world is able to see exactly where the box they are holding has been. This process also has the added bonus of creating a massive data set that allows for more efficient drug chains and predictive ordering further increasing efficiency and reducing logistical costs.

While the direct effects of fraudulent drugs are reason enough for the issue to receive attention what is perhaps often overlooked is important is the indirect ripple effects that a lack of trust can cause. Take the scenario I laid out at the beginning of the post, parents have enough to worry about when their child is sick the last thing they need is to have to way up the chances of giving their child and actively dangerous substance. It is the role of the healthcare system to actively work towards maintaining trust and as such innovations those proposed by FarmaTrust make it so that their is one less thing for patients to worry about.

For more on FarmaTrust and their work see:

FarmaTrust Website
FarmaTrust Whitepaper

And follow them on:
Twitter @FarmaTrust
Facebook @FarmaTrust
Reddit

This was my entry into @originalworks contest: https://steemit.com/blockchain/@originalworks/260-steem-40-bonuses-sponsored-writing-contest-farmatrust
Farma2018

References

[1] World Health Organisation: A study on the public health and socioeconomic impact of substandard and falsified medical products

[2]Popular Science: Counterfeit drugs are putting the whole world at risk

[3] Woods K. Anti counterfeiting strategy. Medicines and healthcare products regulatory agency (MHRA) UK 2007-2010. :1–42.

[4] Mackey, T. K., & Liang, B. A. (2013). Improving global health governance to combat counterfeit medicines: a proposal for a UNODC-WHO-Interpol trilateral mechanism. BMC medicine, 11(1), 233.