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Catching Fake Meds in a Snapshot

Two-dimensional bar codes could reduce drug counterfeiting in the developing world.
September 8, 2009

Researchers from New York University have proposed a system for authenticating and tracking drugs distributed in the developing world. The system, called Epothecary, would use cell phone cameras to read two-dimensional bar codes affixed to packages and assigned to distributors and pharmacists. The researchers hope the system can be used to prevent the distribution of counterfeit drugs through legitimate channels.

Coded message: A new anticounterfeiting system would use two-dimensional bar codes, like the one shown above, to tag medication distributed in the developing world. The images would hold information about the kind of drug contained in a package and the legitimate owner.

The World Health Organization estimates that more than 10 percent of drugs in the developing world are counterfeit. Some counterfeit meds contain the right ingredients in the right quantities, but others are substandard or even poisonous.

Michael Paik, a PhD candidate at New York University’s Courant Institute of Mathematical Sciences, saw the problem firsthand while working with a relief agency in Sudan three years ago. “One of the problems that we were seeing was in the tracking of medication,” Paik says. “I’d also read reports of people dying due to poisoned meds or subtherapeutic meds.”

Paik thinks that Epothecary can greatly reduce such incidents and provide a simple drug-tracking scheme as well. Under the system, every shipping crate, box, and individual drug container would be labeled with a unique two-dimensional bar code: a black and white image that represents information about the contents of the package, such as the name of the drug and the number of tablets included. Each distributor and retailer would also get two-dimensional bar codes, printed on a photo ID.

To buy new medication, a retailer logs in to the Epothecary system on his cell phone and provides his password. The retailer then takes a picture of his own bar code, as well as the distributor’s bar code and the bar codes for the medication he wants to buy. Cell phone software deciphers the information encoded by the two-dimensional bar code, and that data is encrypted and sent to a central server via Short Message Service (SMS). The software then checks that the distributor is the legitimate owner of the drugs in question. (If possible, the phone would also transmit its GPS location to the server and that information would be checked against the known address of the distributor and retailer.) If everything checks out, the retailer can purchase the drugs and record that transaction on the server, via his cell phone.

The retailer, now the official owner of the medicine, is free to sell the drugs to consumers. At the time of purchase, the retailer can allay fears about counterfeit meds by logging in to the Epothecary system, sending pictures of the two-dimensional bar codes for the drugs and his own bar code to the central server. The server would respond with an eight-digit number that the consumer could then send to an advertised phone number, to retrieve information about the drug he is about to purchase. “On the spot I can receive some kind of guarantee that I can check against what I see in front of me,” explains Paik. A paper outlining the approach was presented last month at the MobiHeld 2009 conference in Barcelona, Spain.

Low-tech solutions for authenticating drugs, such as serial numbers and holograms, are easily faked, and Paik says that other high-tech solutions “rely a lot on there being a large installation of network technology.” A pharmacist might, for example, scan a radio-frequency identification (RFID) tag on a carton of pills to authenticate the meds. But that means exchanging a lot of data with a database far away and also requires him to have an RFID reader and, quite likely, a laptop. Such technology isn’t as abundant as the cell phone in many parts of the world.

“Even where there is no power and water there will be cell phone service,” says Shaffiq Essajee, chief medical officer of the Clinton Foundation’s HIV/AIDS Initiative. “People charge phones with hand dynamos or car batteries.”

Bill Thies, a Microsoft researcher and co-founder of Innovators In Health, an MIT initiative to improve health care in developing regions, says he thinks the system could have a “real impact.” As a part of Innovators in Health, Thies developed the uPhone, cell phone software that lets medical workers record patient data to be saved in a central location for further review. Thies notes that others have suggested using SMS messages to authenticate drugs. One such system, known as mPedigree, involves the use of scratch-off stickers affixed to each package. Before a consumer buys the drugs, she scratches off the sticker’s silver coating to reveal a verification code, which can be sent via cell phone for authentication, in much the same way that Epothecary authenticates transactions with end users. The difference is that Epothecary tracks the drugs through each stage of their journey–not just during the final sale.

“The key step for Epothecary is that it looks at every [transaction] before it hits the end user. You couldn’t do that with a single scratch-off sticker,” Thies says.

This makes the scheme particularly interesting to the Clinton Foundation, Essajee says. Counterfeit drugs aren’t a big problem for the organization, he says, since it provides HIV medicine free of charge, so there isn’t much of a black market. But Epothecary is still of interest to the foundation as a means of increasing efficiency. “It can be used to monitor supply chain, by giving you a snapshot of where your commodities are at any point in time and place.”

Essajee admits he does see obstacles to implementing Epothecary, though, particularly because drugs currently aren’t labeled with two-dimensional bar codes. Tagging every package once it reaches drug warehouses in the developing world would take considerable time and effort, and the process could be prone to human error, he says. Someone with access to the tags could also undermine the system and label counterfeit meds with legitimate tags while reselling the real drugs on the side.

“If it was actually the drug manufacturers placing those bar codes–that would be best. In fact, that’s the only way to ensure that counterfeit has not entered the supply chain,” he says.

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