Authorities investigating the importation of low-cost foreign pharmaceuticals into the U.S. have identified a supply chain that may have allowed fake cancer drugs to reach U.S. clinics, according to investigators and documents reviewed by The Wall Street Journal (see “Doctors, Drug Distributors Tied to Imports of Fake Avastin“).

“In the case of the fake Avastin, its global route isn’t yet clear, but what is known illustrates the circuitous path that pharmaceuticals can take before reaching consumers. Wherever the counterfeit Avastin was manufactured—possibly China—investigators are examining a zigzagging route that may have taken the product through Turkey and Egypt before it was sold to Swiss and Danish wholesalers and then to Mr. Haughton’s U.K. wholesaler, River East Supplies Ltd., according to pharmaceutical-industry and law-enforcement officials. River East then shipped the product to U.S. doctors through a Tennessee distributor, according to Mr. Haughton.”

It is illegal to import drugs that are approved by regulators in other countries, but not the FDA. It is also illegal for US citizens to knowingly or unknowingly purchase such drugs. This includes the doctors and clinics at the end of the chain who purchased the Avastin at below market prices ($1995 vs $2400 for a 400-milligram vial).

“Buying foreign-sourced drugs that don’t meet FDA approval can carry criminal penalties for doctors who purchase them and then bill Medicare. Penalties can apply even to doctors who weren’t aware the drugs were foreign.”

It is even MORE illegal — ie, immoral — to purchase FAKE, counterfeit drugs such as the Avastin in question, which contained starch, salt, cleaning solvents and other chemicals and none of the drug’s active ingredient, bevacizumab, according to Roche.

Here’s my view of the Fake Avastin Supply Chain (sorry, but I couldn’t fit all the complicit distributors in the image; eg, I left out Switzerland):

WHOOPS! I forgot the last element of the supply chain, the VICTIM, aka PATIENT!