IN NEW DELHI Private investigator Suresh Sati rattled off the popular brand names listed on the boxes of cough syrup, supplements, vitamins and painkillers sprawled across the desk and shelves in his basement office.

"They look real, but all these are fakes," said Sati, head of a New Delhi-based agency that helps police conduct raids against counterfeit-drug syndicates across the country. "A regular customer cannot make out if a drug is fake. . . . The biggest giveaway is when someone is selling medicines very cheap. It is almost always fake."

India, the world's largest manufacturer of generic drugs, has become a busy center for counterfeit and substandard medicines. Stuffed in slick packaging and often labeled with the names of such legitimate companies as GlaxoSmithKline, Pfizer and Novartis, the fake drugs are passed off to Indian consumers and sold in developing nations around the world.

Experts say the global fake-drug industry, worth about $90 billion, causes the deaths of almost 1 million people a year and is contributing to a rise in drug resistance.

Estimates vary on the number of these drugs made in India. The Indian government says that 0.4 percent of the country's drugs are counterfeit and that substandard drugs account for about 8 percent. But independent estimates range from 12 to 25 percent.

Indian officials say the clandestine industry has hurt the image of India's booming pharmaceutical industry and its exports, worth $8.5 billion a year, mostly to African and Latin American countries.
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To clamp down on the illegal trade, the health ministry launched a reward program this year offering $55,000 to those who provide information about fake-drug syndicates.

Last year, the ministry also strengthened its drug law to speed up court trials. Suspects found guilty of manufacturing and selling fake drugs can be sentenced to life in prison.

The number of people arrested for manufacturing and selling fake drugs rose from 12 in 2006 to 147 last year, and drugs worth about $6.5 million were seized over this period.

"It is very difficult to dismantle the entire operation," Sati said. "When we bust one operation, two more spring up elsewhere. Convictions are rare."

The tricks of the trade include sticking fraudulent labels on expired products, filling vials with water, stuffing small amounts of real ingredients in packages of popular licensed brands and putting chalk power in medicine packets.

But more than the concern for public safety, officials here have been particularly alarmed about recent incidents that discredit India's image abroad.


In June, officials at Nigeria's Abuja airport caught a shipment of fake antibiotics, containing no active ingredients, with a "Made in India" label.

Nigerian investigators later said that a Chinese company shipped the drugs via Frankfurt. In a similar incident last year, a shipment of fake anti-malaria drugs from China arrived in Nigeria with an Indian tag.

Last year, Sri Lanka banned imports from four Indian companies after officials discovered substandard medicine in shipments.

Over the years, drug companies have used holograms or embossed their logo on the packaging to protect their brands, but these have also been counterfeited in India.

One company, MSN Labs, is using a technology developed by U.S.-based start-up firm PharmaSecure that allows consumers to check the authenticity of medicines by sending in a text message of the code written on them.

But many Indian companies are "apprehensive of pursuing the cases for fear of bad publicity and possible loss of confidence among consumers," said Barun Mitra, director of the New Delhi-based think tank Liberty Institute.

Co-writing a report on a recent survey, Mitra said that 12 percent of sampled drugs from the capital's pharmacies were substandard. "We are behaving like ostriches with our heads in the sand and pretending that nothing is amiss even as the problem keeps growing and affecting Indian patients."

On a recent morning in the northern city of Varanasi, a young man named Ashish waited for a shipment of painkillers and postpartum pills to arrive by train.

He said his order of pills that controlled postpartum bleeding contained chalk powder but came with the brand name Methergine in a Novartis package.
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The painkiller had insufficient ingredients and carried a Bidanzen Forte label inside a knockoff GlaxoSmithKline package.

"There is a lot of profit in this," said Ashish, 28, describing the extent of counterfeit drugs in Varanasi. He declined to give his surname because his operation is illegal.

"I do not think about right or wrong," he said. "I am not killing anybody. The worst is that these medicines will not show any result and the patient may have to check into a hospital."

Scientists have developed a new brain scanning method that could reveal the maturity of a child's brain, a technique they claim could also help track abnormal brain development and disorders like autism early.

The five-minute scanning technique involves mathematically sifting through magnetic resonance imaging (MRI) data to form a picture not just of the brain's structure, but the way its various regions work together.

"The beauty of this approach is that it lets you ask what's different in the way that children with autism, for example, are off the normal development curve versus the way that children with attention-deficit disorder are off that curve," said lead researcher Bradley Schlaggar at the Washington University School of Medicine in St Louis

According to the researchers, the tightest connections in young children's brains are between areas that are physically near one another. As the brain ages, these connections shift and networks connecting distant regions become the strongest.

To measure these shifts over time, Schlagger and his colleagues used a method called resting state functional connectivity, LiveScience reported.

For their study, the researchers collected five-minute MRI scans from 238 healthy people ages 7 to 30. They ran data on 13,000 functional brain connections through a tool called a support vector machine, which crunched the numbers and selected the 200 connections that best predicted brain maturity.

The result was a single index of the maturity of each person's brain. After the data were analysed, researchers were able to predict whether subjects were children or adults just from their brain organisation.

Much like a child's height or weight chart, the data formed a curving line that tracks the average path of normal brain development.

Traditional methods of looking at brain structure alone with an MRI often miss kids with even severe psychiatric disorders, Schlaggar said. That's because brain structure doesn't always correlate with psychiatric disease.

Mapping out the brain's function, on the other hand, can lead to psychiatric insights, the researchers said.

Michel D. Kazatchkine, executive director of the Global Fund (GF) to Fight AIDS, Tuberculosis and Malaria, arrived in India on Tuesday to get greater Indian support and funding for global health spending ahead of the United Nations Millennium Development Goals (MDG) summit in New York.

While he signed agreements with some new partners and promoted community-ownership of projects, Professor Kazatchkine's primary task is to meet top government officials and the Union Health and Finance Ministers to solicit political support in the advocacy efforts to replenish the GF.

Disease burden

India's position is perceived to be critical at two levels - as a country with a significant disease burden, and also as one being looked up to for leadership in keeping the focus on health issues.

In a telephonic interview from New Delhi, Professor Kazatchkine said: "My first objective is to ask the Indian government for political support in our advocacy effort to replenish the Global Fund.

"The replenishment conference for the Global Fund - which is seen as key to the achievement of the MDG by 2015 - will be held in October. Two weeks prior to that, world leaders will meet in New York for the MDG summit. Mrs. Sonia Gandhi will represent India.

He has also asked the Indian government to directly enhance its contribution to the GF replenishment fund.

"We are seeking to see if India, as a beneficiary of the GF with remarkable results on the ground in AIDS, TB and malaria, could support our advocacy efforts."

Professor Kazatchkine will also ask the government to directly contribute to the GF replenishment, as he did with other emerging economies - China and Brazil - earlier this year.

"It is the right time as the world moves politically from G8 to G20 [in terms of global governance] that the emerging economies also participate in a global solidarity effort," he said.

He went on to clarify: "I'm not asking for India to go from net beneficiary to net donor. Only that, while it remains a strong beneficiary, it also contributes to show its political willingness to that collective effort."

Professor Kazatchkine stressed that there could be no let-up in efforts to address the key development issues.

Matter of life and death

"I understand all of the constraints. I'm also saying this is a matter of life and death. Overall it is not big money, if you think of the wealth that is being generated everyday in just Wall Street, or the monies that go for war."

As a beneficiary, India has received up to $1.1 billion from the Global Fund, the amount being split for the three key sectors - AIDS ($800 million), TB ($200 million) and malaria ($100 million).

Targets being reached

"Overall, India is a strongly-performing portfolio for the Global Fund and targets are being reached. The Global Fund is supporting 2,60,000 people on Anti Retro Viral treatment for AIDS - a huge achievement that has happened in the last three-four years."

However, India continued to struggle with malaria, and with the current round of funding, it was proposed to scale up efforts to combat the disease, said Professor Kazatchkine.

"As the economy grows, I expect India - currently it is one of the countries with the lowest percentage of GDP for health - to put more resources into health.

"Part of the advocacy with member-nations is to increase the health component of the budget. Donors are telling me that we are ready to make larger efforts but to make sure domestic investments in health are increasing as well. It cannot be just a one-sided story," Professor Kazatchkine said.

In India, road rage claims one life in every two minutes, making it the highest rate of road trauma deaths in the world. According to the Global Status Report on Road Safety published by the World Health Organization (WHO), India recorded 30 deaths per 100, 000 people in 2009. Experts in trauma care said the numbers could be considerably brought down if better laws and stricter penalties are introduced on speeding, drunken driving and cellphone conversations while driving.

"Every day, nearly 300 people die and 5,000 people sustain serious injuries," Dr B. K. Rao, chairman, Sir Ganga Ram Hospital said while addressing the 23rd International Trauma Care Conference on Tuesday.

While 70 per cent deaths occur on the spot, 30 per cent of the victims could be saved if there is a better network of trauma centres, he said, adding that cities like Pune, Hyderabad and Mumbai have a network of trauma centers, which involve the private hospitals.

However, all trauma cases in Delhi are handled by the Centralised Accident and Trauma Services (CATS) service, he added.

As number of dengue cases rose to 1370, Delhi Government today asked citizens not to panic and said there was no shortage of platelets in any of its designated hospitals offering treatment to the people affected by the vector-borne disease.

Health minister Kiran Walia said the city government was prepared to treat any number of dengue affected patients as adequate infrastructures have been put in place in all the major hospitals.

The capital reported a fresh dengue death and 75 new cases today, taking the total number of patients to 1370.

"There is no shortage of platelets in any of the Delhi Government hospitals. All the major hospitals have enough quantity of platelets," Walia said when asked about reports of shortage of platelets in many city hospitals including in AIIMS.

Dengue affected patients need transfusion of additional platelets as their platelet count in blood go down depending on severity of the disease.

She said new machines have been bought by several hospitals to segregate platelets from blood.

"We have installed new machines in Malvya Nagar hospital, Deen Dayal Upadhaya hospital, Rao Tula Ram hospital, Lok Nayak hospital, Guru Teg Bahadur hospital, Ambedkar hospital and Lal Bahadur Shastri hospital," she said.

Walia, who visited Games village and many other areas to inspect the drive to kill mosquitoes and their larvae, said no Delhi government hospital has sent back any patient without offering treatment.

Noting that there was no need to panic as the dengue strain in circulation was not virulent, Walia said cleaning drive has also been launched in various hospitals also to ensure that mosquito breeding sites are destroyed.

Asked about spread of the disease at a time when Commonwealth Games are just 26 days away, she said "all necessary efforts are being taken to contain the disease."