When we become ill and take prescribed medication, we do so because we have confidence in the doctor and his expertise and skills, and because we are 100 percent sure of the safety and effectiveness of whatever drugs we are taking. But how much do we really know about the pharmaceutical industry — often referred to as Big Pharma — and the often dark and murky side of what is a multibillion-dollar business? It is not only patients who suffer when there is malpractice in the pharmaceutical business; entire countries and governments do too, especially those who set aside large budgets to provide health insurance and health care for their citizens. Over the past 30 years in the United States alone, major pharmaceutical companies have reached out-of-court settlements with the US Justice Department amounting to more than $20 billion, to avoid prosecution for a raft of illicit practices, some of them criminal. These include making false and misleading claims about the safety of medication; paying bribes and kickbacks to physicians to prescribe some drugs rather than others, and to prescribe medication when none is needed; the use of drugs for purposes for which they are not recommended (known as “off-label promotion”); unsafe or poor manufacturing processes; and fraud in relation to the US Medicare and Medicaid programs. From a patient’s point of view, perhaps the most nefarious practice is that of offering bribes and kickbacks to physicians and pharmacists. When our doctor prescribes medication, or a pharmacist recommends it, we are surely entitled to know that it is because we need it, not because they have been offered inducements to do so. As if the issues with genuine medication were not concerning enough, there is also the matter of counterfeit medicine. Research by a team at the University of North Carolina, published in the Journal of the American Medical Association, suggests that more than 13 percent of essential drugs traded in low and middle-income countries are counterfeit. The World Health Organization (WHO) works with Interpol to combat the global criminal networks behind this miserable trade, but it is an uphill struggle. WHO estimates worldwide sales of counterfeit medicines to be more than $75 billion, and they double every five years. In addition, the market for counterfeit medicines is expanding with the increasing commercial use of the internet to promote, sell and deliver them. According to WHO, more than half the medicines bought online from illegal websites that conceal their geographic location are fake. Some sites are even selling counterfeit versions of cancer medication. In Saudi Arabia, the importance of the regulatory role of the Saudi Food and Drug Authority in promoting and protecting public health cannot be overstated. It includes the adoption of drug pricing rules and inspection controls on pharmaceutical institutions. But the effort we need to fight corruption in this important and significant industry is a global one that cannot be limited to one country alone. There is an anonymous saying that the discovery of new drugs is too dangerous to be left in the hands of pharmaceutical companies. It would be good to look forward to the creation of genuinely effective medicines, rather than worry about the motives of the people who make them. • Dimah Talal Alsharif is a Saudi legal consultant, head of the health law department at the law firm of Majed Garoub and a member of the International Association of Lawyers. Twitter: @dimah_alsharif Disclaimer: Views expressed by writers in this section are their own and do not necessarily reflect Arab News" point-of-view