the scary, science-muzzling link between spam, online drug sales, and big pharma

Generally, if you follow Brian Krebs, odds are that you’re into true tales of cybercrime, particularly of the Russian variety, or are a security researcher trying to figure out what you might be hit with next by following his very thorough, old school style investigative beat on the digital underworld. So when you pick up his now two year old book Spam Nation, you may think you’re in for a lot of stories about phishing, ransomware, and what are now called advanced persistent threats, or APT, trademarks of a state-sponsored hacking effort. And since much of the book points the finger to Russia and its satellite states, you almost expect something about APT 28 and APT 29, also known as Fancy Bear and Cozy Bear respectively, strongly suspected to be Russian intelligence services’ efforts underpinning Putin’s asymmetrical warfare capabilities. Instead, the book is dominated by investigations into a number of online pharmacies, the kind that send you botnet-aided spam for discount erectile dysfunction pills, antibiotics, and painkillers, ran by a few shady Russian companies that ship them out of China and India where they are produced in bulk, along with generics for brand name medication.

If you ever watched any political ads sponsored by Big Pharma, you probably recall stern spokespeople warning you of the many dangers of buying drugs from these countries. Who knows what you might get, they caution, why the seemingly legit looking package may contain poison, fillers, and sugar pills, so even if you come out of the transaction unharmed, you definitely will be worse for the wear in the long run. But are these threats true? As it so turns out, nobody knows because Big Pharma does not want any objective studies done on the drugs shipped from these shady online pharmacies. Chapter 5 is pretty much devoted to dissecting who buys these drugs and why, and how a long pharmaceutical companies have been dragging down efforts to pinpoint the risks of buying drugs online without a prescription. According to what is admittedly an unscientific survey by Krebs, many of the people who bought from these pharmacies were looking to save money, pointing to the insanely high drug prices common in the U.S. Some were definitely sickened by pills tainted with toxic metals, a few people even poisoned themselves. But there was a contingent of people who got exactly that they wanted.

It’s that last contingent that keeps the spam flowing and the pharmacies so profitable. They’re saving thousands on what seem like real pills, which are working exactly as advertised, and which seem to have the same exact active ingredients in the same amounts as the drugs they buy at their local CVS. So the next step for researchers would be to buy a wide variety of drugs from a wide variety of these online pharmacies and figure out your odds of getting actual medication vs. dangerous fakes, right? Not right. It turns out that the pharmaceutical companies which would provide the clean samples for a side by side test emphatically do not want researchers to say that any of the pills they tested were the real thing. They will only participate if the scientists go along with their message that any drug not bought in America at your local pharmacy is either fake or poisonous, and scientists refuse to go along with the condition that their research match corporate PR, as they absolutely and indisputably should because they may as well not do the research if they are told exactly what they should publish at the conclusion of the study.

It’s yet another glaring illustration of why tenure has to remain sacrosanct in research institutions. Imagine if enough people on the board of a university were being paid by pharmaceutical companies and had the power to dismiss scientists for not marching lock-step with their PR efforts. It would be pretty much impossible to do any objective research at the institution; not that it’s easy to do it now. And I do understand why Big Pharma doesn’t want any of those online pharmacies being confirmed as legit. The political optics, given today’s scandals over drug pricing, are beyond horrifying. These companies make ungodly amounts of money in America by using this market to recoup lost profits from dealing with price controls in other nations, and using both law and their cash piles to buy up competition, restrict supply, and lobby for protecting them from international competitors’ already approved products commonly used in advanced markets. To have science confirm that they’re a price gouging, competition bashing machine whose products are plentiful on the web and are being bought by people driven to risk being poisoned just to afford their medication, would be a massive political disaster.

But before you rush off to answer those ads everyone who is even remotely computer-savvy warned you to ignore, looking for cheap pills, keep in mind that we don’t know what you’ll get. It could be legit medication, it could be poison. Your antibiotics could be Chinese lead contaminated talcum powder, a diet supplement could be bathtub meth, and your hypertension drug may end up being sugar pills in the same blister packs you’re used to seeing. But you might also get exactly what you want at a fifth of the price since those online pharmacies, like an outlet store commercial says, buy wholesale and passes the savings on to you. And all indications from poring over leaked or hacked logs shows that there are lots of satisfied customers who aren’t just scammed and either left waiting or get hurt, driven by financial necessity to give their money to unlicensed, illegally operating online pharmacies, and a lot of pharmaceutical companies do not want to help study the problem not because it would be difficult for them, but because they’re terrified of being asked about this sorry state of affairs by politicians during a hearing, letting this cycle continue year after year as they settle other scandals.

Hold on, you might say, didn’t I see a commercial for some drug saying that if you can’t afford your medication, the company can help? Yes, you did, and yes they can. However, they will pass along the cost of helping those who’ll qualify for assistance on those who don’t and use the demand to justify huge price hikes with these programs as a cover, saying that because they help so many of those who can’t afford their drugs they need to make up the cost in some other way, and that patients won’t feel it because insurance will cover the costs. Instead, insurance companies just hike our premiums, which gives that cheap-brand-name-drugs spam an almost siren quality when you have to make a choice whether to make rent or get your monthly supply of meds, playing with your health and safety. And these same drug companies really don’t want you to know exactly how many times you’re likely to get lucky as they stonewall scientists who want to give you a real number. We need this research to happen and we need to have a conversation about it. Will it be a huge embarrassment to Big Pharma? Yes. But so what?

Illicit drug markets will always exist and they’ll always be risky since they’re not licensed, regulated, or inspected. Online pharmacies selling legit drugs a month ago could’ve been taken over and shipping poison today, killing their customers. But it’s asinine to pretend that no one is turning to them because they’re basically a last resort, not researching exactly how many are, and not asking why this is happening just because a pharma exec will be red faced in Congress. Some of the databases indicate that Americans shopping in these pharmacies are buying necessary, life-saving drugs some 33% of the time vs. just 8% of Europeans. We cannot pretend that this is not a problem when a burst of headlines about pharmaceutical price gouging comes every several months and tens of millions of Americans may lose their health insurance at any minute, making them very likely to shop at these pharmacies and take a risk, figuring that they have nothing to lose by gambling on the contents of the meds they’ll get at this point. We need to do the research, and we need to address this problem head on armed with real, concrete numbers.