Dear Editor,

I read your articles (Gambling with life: Buying medication on the black market) and enjoyed them.

In our local newspapers the journalist most of the time just reports one side of the story and then the next day the other side reacts. However, this time Ms. Judy Fitzpatrick did a much more professional job by interviewing different parties involved before finishing the articles. This shows different angles of the topic and gives the reader better insight and a good overall view of the topic. I hope to see more of this type of informative reporting in the future.

Now on the topic itself: As I told Ms. Judy Fitzpatrick before she started this series about illegally imported/sold black market medication, I see a much bigger threat to public health from non-prescription medication that is legally imported and sold in health shops, sex shops, pharmacies, etc.

I think the legally imported/sold non-prescription medication is a bigger public health threat than the illegally imported medication. Because of the numbers, legally imported/sold non-prescription medications are widely and openly sold and advertised by respected businesses. Therefore people might think they are okay.

It is way-way easier to get a legally imported/sold non-prescription medicine then it is to get an illegally imported/sold medicine. So I bet you there are way-way more legally imported/sold non-prescription medicines used than there are illegally imported/sold medicines used.

Are these legally imported/sold non-prescription medications then not okay? And if so, then why is nothing done to stop it? Is any medication safe?

To start with the last one, is any medication safe? Prescription-only medication and some over-the-counter (OTC) non-prescription medications are subject to control by health authorities from testing even before selling them, to storage and dispensary by the pharmacist.

First, the medicine gets tested and when regarded safe and effective by the health authorities it can legally be sold. In the USA the regulating health authority is called the Food and Drug Administration (FDA). The product is added with all its detailed information to the books the doctors use to know what to prescribe and when not to prescribe it and what possible side effects to expect. The product gets launched and shipped from manufacturer to distributor to wholesaler to pharmacy and finally gets into the hand of the patient

Not only manufacturing of prescription drugs is controlled. Prescription drugs have a chain from manufacturing plant to patient (distributor-wholesaler-pharmacy) and all these steps are spot checked

A health inspector can at anytime unannounced walk into a distributor, wholesaler, or pharmacist and ask how/when/where the stock of a particular medication got there, is stored and/or transported, etc., and can forbid further sale if he does not get a satisfactory answer.

After the launch of the product the health authorities keep track of reported incidents by encouraging doctors, pharmacists and patients to report possible side effects to the health authorities, which sometimes leads to a recall of a bad quality batch or a bad medicine.

Remember Vioxx? After initially being approved as a painkiller by the FDA, bad reports kept coming in from doctors and patients. The FDA evaluated these reports and decided to ban Vioxx from the market for safety reasons. Vioxx is not the only medication removed from the market after being launched.

Therefore, some doctors now prefer to prescribe medicines that are longer on the market, assuming that after a longer while the safety is proven by lack of complaints.

Just as with luxury watches, bags, expensive liquors and perfumes there is a huge market in fake medicine. Real Viagra costs US $12.50. If you can just make a pill and a package that looks like the real Viagra for let's say US $0.25, imagine the profit if you sell a box of 1,000 for let's say US $3 to a sex shop or a club owner, etc.

A pharmacy would risk a lot, because if the health inspector walks in and catches this batch, the pharmacy risks losing its licence and can be sued by the manufacturer of Viagra on top of that. But a health inspector never goes to a sex shop or club (unless maybe privately) so they would get away with it. And what is in the pill if it is not Viagra? Is the blue dye safe? What powder is used for the fake? Is it safe?

Now you know how much control goes into a legally imported/sold prescription medicine you might wonder how the legally imported/sold non-prescription medicines are checked and by whom? The answer is easy. There is no independent third party check whatsoever.

The only guarantee you get for legally imported/sold non-prescription medication is the word of the salesman that it is a good and safe product. And he just happens to make money from the sales, by the way. If that is comfy enough for you to pop a pill feel free to do so. I prefer not to if you don't mind.

Now why am I so afraid of these legally imported/sold non-prescription drugs?

Well, of course, in the first place because there is no check at all.

Second, because of effects and side effects which have been reported in the media and my own experience with patients using legally imported/sold non-prescription medications.

Sample 1: Sex shop erection enhancer. Patient reports a stiff penis and headache from a sex shop US $10 enhancer. These are the same side effects from Viagra! Wow! Now imagine I buy generic (not made by the original manufacturer, but by another legal manufacturer) Viagra wholesale for US $3 (you can get it retail here for US $5 and patients report it works), repackage it and sell it for US $10, just below the original Viagra for US$12,50. Clients are happy and so am I with a nice profit.

Unfortunately clients that should not use Viagra might use this sex shop enhancer and get into trouble, but who cares. Front page Daily Herald advertising.

Sample 2: Estrogen tea for menopause. Fifty-year-old female patient gets diagnosed in health shop for not sleeping because of menopause (of course, big chance she is in menopause anyway at age 50) and gets recommended estrogen teabags. She uses it but still doesn't sleep. (Was not because of menopause?) Tells me about it a month after she stopped taking it and I ask if she has tender and/or enlarged breasts lately from estrogen overdose and she asks, "How do you know?"

So I suspected the estrogen in the tea was for real and sent patient to lab. Her test came back something like 800 and normal maximum is 200. Two weeks later I sent her to another lab to check and it came back 400, still too high. Calculating back, her estrogen level must have been over 2,000 or 10 times more than normal when she stopped taking it six weeks ago.

If the lady had real menopause-like complains like hot flashes, she would certainly be relieved from it by the high doses of estrogen and would have told her doctor that she doesn't want his estrogen pill anymore because she got something better natural, while the massive overdoses greatly increase the risk of blood clots and breast cancer, etc.

Sample 3: Natural anti-cholesterol medication. Red rice yeast dye has been used in China since ancient times as food colouring. It is made by fermenting a certain rice with a certain yeast. Nowadays it is replaced by the much cheaper Sudan Red food colouring.

In Japan they discovered that red rice yeast dye contains Lovastatine, a cholesterol-lowering drug in small amounts. Health stores started to sell this dye on the American market. Soon it was discovered that some brands contained much more than naturally-found Lovastatine levels and there was suspicion that the manufacturers of these brands spiked/boosted their products by adding more artificial Lovastatine to the natural occurring Lovastatine of the red rice yeast dye.

Eventually all brands were taken from the market because patients were not checked and warned about side effects as would happen when you get Lovastatine from your doctor.

When a doctor prescribes cholesterol-lowering medicines like Lovastatine, he should check your cholesterol via a blood test to see if it drops, but also via the same blood test check your liver function and your muscles to see if you develop side effects that might be so severe that you would have to stop using this medication.

In natural red rice yeast dye this might not be an issue due to the natural low doses of Lovastatine in it, but with the enhanced/spiked red rice yeast dye it certainly is necessary to check the possible side effects, but the manufacturer does not disclose this enhancement. He just says it is very, very good for your cholesterol. O yeah, and of course it is natural (Ha! Ha! Ha!).

Sample 4: Noni juice and cholesterol. A patient of mine recommended noni juice for a staff member of mine who had high cholesterol. The patient brought the noni fruit to the clinic and instructed my staff member how to use it. The staff member did use it and her cholesterol dropped from high to normal a month after starting to use the noni. The patient became our staff's noni supplier.

I can go on and on but the picture should be clear by now:

1. Try to live as healthy as you can and avoid any medicine.

2. If you still need medication get it via your doctor/pharmacy.

3. Anything that is packaged is not natural anymore.

4. There is a lot of good natural stuff out there, but most doctors are not trained in these products and most health stores sell only unnatural products.

5. Any information on real natural medication is more than welcome to science.

Dr. Mike Mercuur