Say what you will about the U.S. health care system, at least when you pick up a prescription at the pharmacy, you can be reasonably sure that the medicine meets the necessary standards. The same cannot be said for drugs in less-developed countries. According to two reports in the current issue of The Lancet, fake and poor-quality drugs are alarmingly common in some African and southeast Asian nations.

In one study, Robert Taylor of Robert Gordon University in Aberdeen, U.K., and his colleagues studied samples of drugs, including antimalarial, antibacterial and antituberculosis preparations from 35 pharmacies in Nigeria. Nearly half of the 581 samples, they found, contained either too little or too much of the active ingredient. These substandard drugs, the authors note, could lead to "therapeutic failure and select for drug-resistant organisms." In the second study, Paul Newton of the John Radcliffe Hospital in Oxford, U.K., and his colleagues analyzed products marketed as the antimalarial drug Artesunate, which they procured from various shops, hospitals, pharmacies and nongovernmental organizations in southeast Asia. More than a third of the 104 samples, the team determined, were actually fakethey did not contain the active ingredient at all.

In a commentary accompanying the reports, Alain Li Wan Po of Aston University in Birmingham, U.K., notes that although policing drug manufacture and distribution will be difficult, governments need to make every effort to protect consumers by implementing quality-assurance procedures, barring offenders from trading, and educating the public about fake and poor-quality products. "Drug companies making genuine products can of course also help by considering affordability in their pricing strategies, and so make fraud less profitable," he adds. "Although optimism is hard to come by in this area, there is hope that the combination of these efforts may yield some success."