What’s at stake in the fake? Indian pharmaceuticals, African markets and global health

For the past several decades, global health researchers and policy-makers have raised the alarm about the growing threat that fake pharmaceuticals pose to global health. Often these concerns are framed in terms of particular places and people, for example, fake drugs from India imperil Africans’ health. We subjected these high-profile and oft-repeated claims to scrutiny. This exercise produced some unexpected findings. Across scientific, policy and popular literature, we found substantial misalignments between (1) the strength of claims about fakes alongside (2) the relative weakness of these claims’ evidence. Scientific literature in particular raised questions about apparent certainties, such as: What, exactly, are fake drugs? Are fake drugs necessarily dangerous? Where do they come from? When the global supply of life-saving medicines is beset by worries about safety, governments and citizens face difficult decisions about how to allocate scarce resources. By asking questions about these worries, we hypothesize that the problem of fake drugs is not solely a pharmacological problem; it is also a social problem. Two questions guide our project’s historical and ethnographic research 1. What accounts for the rise of fake-talk—the wide-spread and urgently-reiterated set of concerns about the dangers that fake drugs present? 2. What are the effects of fake-talk?