The paper begins by asking why there is a market for counterfeit medicines, which in effect creates the problem
of counterfeiting itself. Contributing factors include supply chain complexity and the lack of whole-systems thinking.
These two underpin the author’s view that counterfeiting is a complex (i.e. wicked) problem, and that corporate, public
policy and regulatory actions need to be mindful of how their actions may be causal.
The paper offers a problem-based review of key components of this complexity, viz., the knowledge end-users/consumers
have of medicines; whether restrictive information policies may hamper information provision to patients; the internet’s
direct access to consumers; internet-enabled distribution of unsafe and counterfeit medicines; whether the internet is a
parallel and competitive supply chain to legitimate routes; organised crime as an emerging medicines manufacturer and
supplier and whether substandard medicines is really the bigger problem.
Solutions respect the perceived complexity of the supply chain challenges. The paper identifies the need to avoid
technologically-driven solutions, calling for ‘technological agnosticism’. Both regulation and public policy need to reflect
the dynamic nature of the problem and avoid creating perverse incentives; it may be, for instance, that medicines pricing
and reimbursement policies, which affect consumer/patient access may act as market signals to counterfeiters, since this
creates a cash market in cheaper drugs.