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Dangerous Doses: How Counterfeiters Are Contaminating America's Drug Supply

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Overview

In the tradition of the great investigative classics, Dangerous Doses exposes the dark side of America's pharmaceutical trade. Stolen, compromised, and counterfeit medicine increasingly makes its way into a poorly regulated distribution system-where it may reach unsuspecting patients who stake their lives on its effectiveness.

Katherine Eban's hard-hitting exploration of America's secret ring of drug counterfeiters takes us to Florida, where tireless investigators follow the trail of medicine stolen in a seemingly minor break-in as it funnels into a sprawling national network of drug polluters. Their pursuit stretches from a strip joint in South Miami to the halls of Congress as they battle entrenched political interests and uncover an increasing threat to America's health.

With the conscience of a crusading reporter, Eban has crafted a riveting narrative that shows how, when we most need protection, we may be most at risk.

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Editorial Reviews

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When investigative medical reporter Eban found a Florida warehouse filled with medicine of every conceivable kind stacked next to bottles of lighter fluid and a bunch of old rags -- the label-changing tools of the counterfeit trade -- she knew she'd hit pay dirt. But by this point in her startling book, Dangerous Doses, readers are already on a first-name basis with the five investigators involved in breaking the case. These five -- drug inspectors, Miami detectives, and a former cop -- had marshaled their forces to protect Floridians from adulterated, expired, or mishandled prescription drugs, and Eban spent two and a half years with them, weaving together her story of drug supply corruption, not merely in Florida but throughout the nation.

Americans spend nearly $216 billion to fill over 3 billion prescriptions a year, and most believe that what they ingest, inject, or apply topically travels from the drug maker to their pharmacy through pristine labs and warehouses filled with men in white coats. But Eban discovered a different route, one driven by middlemen: wholesalers who sell diverted, degraded, and expired medicine traded by felons and accompanied by falsified paperwork. The truth is chilling and complex, but Eban's intelligent writing, careful plotting, and dogged reporting make for a suspenseful and shocking read, and she offers a battle-ready road map for combating the problem, including excellent practical advice for consumers. (Fall 2005 Selection)
salon.com
An exposé that wades into more rank Florida unseemliness than a Carl Hiaasen novel, and easily boasts three times the number of sleazebag villains.
Boston Globe
In a style reminiscent of some of the best detective storytellers, Eban takes us breathlessly through robberies, back-room deals, cluttered and dirty warehouses, crooked dealers, sociopathic profiteers, shell companies, and state and federal laws so porous that convicted felons can become prescription-drug brokers
New York Sun
A riveting tale. "Dangerous Doses" is part detective story, part pharmacological primer.
Washington Post Book World
Warning: Katherine Eban's Dangerous Doses can give you headaches, raise your blood pressure and provoke anxiety. In extreme cases, it can leave you staring at a bottle of medicine and wondering: What do these pills really contain? ... In her vibrant tale, Eban introduces us to these people and makes the message clear: It shouldn't happen to anyone, and it could happen to you."
Newark Star-Ledger
Katherine Eban's expose on the poorly regulated prescription drug distribution system will have you calling your doctor to check your meds. To put it simply, she's done her homework on a terribly neglected system. "—Razor magazine
"In "Dangerous Doses," Katherine Eban showed how vulnerable America's drug supply is to counterfeiters. With such dangers lurking, it often seemed as if the real world trumped fiction this year
Buzz Bissinger
This is a book that comes along so rarely in non-fiction—brilliantly reported, written with the pace of a potboiler and harrowing in its societal repercussions. In Dangerous Doses, Katherine Eban takes us on a journey into the underbelly of the pharmaceutical industry so spooky and strange and sinister and deadly, you will have a hard time believing it is true. But it is, every word, which only makes Dangerous Doses shine even more.
Wayne Barrett
Katherine Eban has delivered a dangerous dose of truth about the drugs that keep Americans alive. Her "murder-she-wrote" dramatic narrative turns everyone's neighborhood drugstore into a possible crime scene."
The Nation - Victor Navasky
Katherine Eban combines investigative diligence, a natural story teller's gift for narrative, and a consumer advocate's practical prescriptions for what to do about the counterfeit drugs that may have contaminated the supply at your local drug store. The result: A rare literary event—muckraking with a human face.
US News and World Report - Bernadine Healy
A riveting account of a 2 1/2-year investigation in south Florida . . . . As Eban recounts, the scam was broken wide open by a 'ragtag' group of seasoned investigators who seem as if they were cast right out of an episode of The Wire."
Publishers Weekly
It's hard to imagine that, with the U.S. government's oversight of the development and production of pharmaceuticals, the pills you get from your pharmacist may be counterfeit. But according to medical reporter Eban, those pills often pass through dozens of hands, exchanged in dark parking lots and the backrooms of strip clubs for thousands of dollars in cash, possibly resold and relabeled several times. It might contain a twentieth of the dosage written on the label, or nothing but tap water. Eban, formerly with the New York Times, follows a group of five investigators to reveal how pervasive a problem drug counterfeiting is in the U. S. Operation Stone Cold, as the South Florida investigation was called, comprised a hodgepodge of pharmacists and policemen who shared a fanatical devotion to stopping adulterated drugs from reaching the public, despite uninterested supervisors, understaffed regulatory agencies and state laws that made offenses almost impossible to prosecute. The book reads like a good novel, though the cast of villains is so dizzying and the timeline so complicated that the action is sometimes hard to follow. Unfortunately there is no happy ending the fight to protect the domestic drug supply continues. If this book receives wide attention, it could deal another blow to an already reeling pharmaceutical industry and users of prescription drugs will be wary after reading it. (May) Copyright 2005 Reed Business Information.
US News and World Report

A riveting account of a 2 1/2-year investigation in south Florida . . . . As Eban recounts, the scam was broken wide open by a ''ragtag'' group of seasoned investigators who seem as if they were cast right out of an episode of The Wire."

— Bernadine Healy

The Nation

Katherine Eban combines investigative diligence, a natural story teller''s gift for narrative, and a consumer advocate''s practical prescriptions for what to do about the counterfeit drugs that may have contaminated the supply at your local drug store. The result: A rare literary event -- muckraking with a human face.

— Victor Navasky, Publisher and Editorial Director

Kirkus
An investigative journalist digs into the chilling story of how degraded, expired, contaminated and diluted medicines are being sold to American pharmacies and hospitals. The result is a story rich in distinctive characters whose actions range form courageous to outrageous. Vivid writing and impressive documentation in a powerful indictment of a system in need of immediate repair."
Publishers Weekly
The book reads like a good novel....If this book receives wide attention, it could deal another blow to an already reeling pharmaceutical industry and users of prescription drugs will be wary after reading it.
Library Journal
Americans pay top dollar to ensure that their prescription medications are safe, yet few realize that the current distribution process involves middlemen who open the way for criminal counterfeiting. Lax law enforcement and weak penalties have allowed counterfeiters to dilute or change the contents of the drugs and resell them for significant profit. Investigative medical reporter Eban spent more than two years conducting research and interviews to measure this problem fully. She follows the work of "the Horsemen"-a group of five dedicated drug inspectors and law enforcement officers in Florida who have diligently tried to put a stop to drug counterfeiting. The Horsemen have had many victories, but there is still a lot of work to be done. Few books have been written about this frightening topic, so Eban's expos will make a valuable addition to any library. Highly recommended. [See Prepub Alert, LJ 1/05.]-Tina Neville, Univ. of South Florida at St. Petersburg Lib. Copyright 2005 Reed Business Information.
Kirkus Reviews
An investigative journalist digs into the chilling story of how degraded, expired, contaminated and diluted medicines are being sold to American pharmacies and hospitals. Eban, a Rhodes scholar whose work has appeared in the New York Times, New York Observer, The Nation and other publications, spent two and a half years interviewing numerous government investigators and regulators, pharmaceutical wholesalers, doctors and patients, and reviewing surveillance videos, investigative reports, court records and other documents. The result is a story rich in distinctive characters whose actions range from courageous to outrageous. Fortunately, the author has provided an annotated list of the major players in her enormous cast. The story begins with a 2002 break-in at a pharmaceutical warehouse in Florida and follows investigators as they pursue those trafficking in counterfeit drugs. What Eban found was that large volumes of drugs made by U.S. pharmaceutical companies don't flow directly from manufacturer to hospital or pharmacy but are sold and resold in a gray market without a paper trail or with phony papers that obscure their origin. To become a pharmaceutical wholesaler in Florida requires only a refrigerator, an air conditioner, a security alarm, $200 for a security bond and $700 for a license. Aided by lax regulations, holders of these licenses, many of them criminal kingpins and street thugs, make fortunes trading in adulterated and counterfeit drugs. Eban shows the tragic results through her stories of patients whose lives have been affected by bogus medicines they believed were legitimate. Even more disturbing is what she reveals about the weakness of federal oversight in thedistribution of pharmaceuticals. Her concluding two-page summary of the steps consumers can take to protect themselves from counterfeit drugs is little comfort. Vivid writing and impressive documentation in a powerful indictment of a system in need of immediate repair.
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Product Details

  • ISBN-13: 9780151010509
  • Publisher: Houghton Mifflin Harcourt
  • Publication date: 5/9/2005
  • Pages: 480
  • Product dimensions: 6.20 (w) x 9.00 (h) x 1.20 (d)

Meet the Author

KATHERINE EBAN, a Rhodes Scholar and investigative medical reporter, has worked for the New York Times, New York, New York Observer, and ABC News. Her articles have appeared in the Nation, Playboy, the New Yorker, Self, Vogue, and Glamour. She lives in Brooklyn.

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Read an Excerpt

1. A Victim of Success

January 2002
Miami, Florida

ABOARD A CRUISE SHIP TO COZUMEL, THE WEATHER SPARKLING and an Absolut and soda in hand, Marty Bradley stared at the Gulf of Mexico from inside a locked suite, his silent misery fed by thoughts of betrayal, financial ruin, and even physical danger.

He had brought sixty employees on the gleaming white ship for his company's annual blowout of dancing, gambling, and sunbathing, a reward for meeting their sales targets. But all Bradley could think of now was armed guards, locksmiths, and lie detector tests- and which of the employees on board had sold him out and gotten away with the score of their lives.

Just twenty-four hours ago, while he had been packing for the cruise, a white van had backed into an alleyway behind his Miami warehouse. Some men climbed from the van and managed to twist the dead bolt, tear off the rear metal door, and enter the warehouse around 8 P.M. Once inside, they knew exactly what to look for.

Shortly afterward, the distribution manager, René Perez, returned from his errand at Dadeland Mall and swung past the back alley as was his habit, partly because he was responsible for keeping it clear and partly because Bradley was his brother-in-law. Perez felt protective and viewed the business as a family affair.

Usually the narrow, dimly lit alley was empty. But tonight Perez saw the white van parked outside the warehouse, its motor running and its side door open. He turned and drove toward it along the dusty street. As he angled to park, a man in a long-sleeved T-shirt holding something in his hand ran from the warehouse and leapt into the van as it pulled out, tires screeching.

Perez followed, peeling down the alley behind the warehouse, almost crashing into a garbage dumpster as he struggled, unsuccessfully, to make out the license plate through the uneven street light. After about fifty yards the van barreled north onto another side street and disappeared into Miami's traffic-clogged arteries.

Stunned, Perez stopped and called Bradley at home to tell him about the burglary.

BRADLEY'S COMPANY, BIOMED PLUS, THE NATION'S LARGEST PRIvate wholesale distributor of blood products, sells fragile plasma derivatives and other specialty medicines to doctors' offices, hospitals, and even competing wholesale companies.

The thieves had headed directly for a freezer that contained blood products destined for patients with compromised immune systems, hemophilia, and other rare disorders. All told, they had taken 344 vials of clear liquids that for many patients meant the difference between life and death. Some of the vials cost almost $4,000 apiece. The heist was worth about $335,000.

What bothered Bradley most was not what they had taken but when. The break-in occurred just hours after the delivery of a shipment that included a rare formula called NovoSeven to help hemophiliacs form blood clots. The thieves had taken all of it. Bradley spent the next day- in the hours before boarding the cruise- hiring an armed security guard for $8,000 a month, repairing the damaged door, and installing new locks and metal gates for $150,000. He also arranged for several of his employees to take lie detector tests.

Then he reported the theft to the Bureau of Statewide Pharmaceutical Services, a regulatory requirement that was sure to solve nothing. The inspector he knew there, Cesar Arias, a tousled Cuban-American with a chipped front tooth whose heart was certainly in his job, had no juice whatsoever. One glance at the man's car, a dilapidated blue Buick that looked like it had been pulled off a junk heap, told the story of his agency's budget woes.

The local cops took a report, but they were too busy chasing cocaine and other street drugs to care much about a theft of clotting factor.

But Bradley knew the stolen vials posed a serious danger. The medicine inside was for critical care. It had to remain motionless at a constant temperature and could only be transported with careful planning. At best, it would become useless to a patient and at worst, might do harm. Bradley also worried that the men in the van would return. Or that next time they would come back armed when his employees were there.

Bradley shared these fears with two of his managers, who also stayed in their cabins during the cruise, drinking and avoiding the festivities. On the last day during the group photograph, the three men looked uneasy amid the smiling, well-tanned sales force.

Bradley was in the ship's cocktail lounge waiting to disembark when his cell phone rang. His purchasing manager, Marlene Caceras, was calling about a deal that had been offered in Bradley's absence. A small pharmaceutical wholesale company, the Stone Group, had called and sent faxes offering to sell some plasma derivatives. Bradley had done business with the fledgling company before.

The pharmaceutical wholesale market operates as an all-hours auction, with deals and discounts materializing suddenly and medicine passing through many hands. And while few patients know that these middlemen exist, much of the nation's medicine passes through companies like Bradley's BioMed Plus and the Stone Group. On this deal, the Stone Group had made a typical pitch.

But as Caceras read off the details of the offer, Bradley said, "I don't believe it." Everything she mentioned-including twenty-two vials of NovoSeven at 1.2 milligrams, another twenty-nine at 4.8 milligrams, along with specific amounts of Gammimune, Gammagard, and Iveegam, all for the steeply discounted price of $229,241-was identical to his list of stolen goods, right down to the specific quantities. The medicine was too rare and was almost never traded freely. Bradley knew the medicine was his.

Copyright © 2005 by Katherine Eban

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording,
or any information storage and retrieval system, without permission in writing from the publisher.

Requests for permission to make copies of any part of the work should be mailed to the following address:
Permissions Department, Harcourt, Inc.,
6277 Sea Harbor Drive, Orlando, Florida 32887-6777.

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Table of Contents

A Note to Readers ix
Who's Who xi
Prologue 1

Part One
A Victim of Success 7
Flamingos in Missouri 11
Is Anything Okay? 19
The R Word 31
Medicine in the Laundry Room 42
The Cheshire Cat 56
One Man's Trash, Another Man's Treasure 67
A Cold Chain Gets Hot 87
Stealing Time 101

Part Two
"My Son Is Not a No One" 117
Two Streams Become One 128
The License Shrine 146
A Do-or-Die Cause 156
A Bad Lot 166
Rats in the State 179

Part Three
Crazy Money 195
A Special Price 206
The Guitar Story 221
"They're Going to Die Anyway" 232
They Know We Know 252
Inspector Arias Goes to Washington 267
Ultimate Box Case 283

Part Four
The Rosetta Stone 299
A Wink and a Nod in Las Vegas 312
The Education of Kevin Fagan 330

Epilogue 348
The Epogen Trail to Timothy Fagan 358
What You Can Do About
Counterfeit Drugs 361

Endnotes 363
Glossary 419
Interviews of Note 423
Acknowledgments 435
Index 439

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Customer Reviews

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Sort by: Showing all of 3 Customer Reviews
  • Anonymous

    Posted September 20, 2006

    The contamination of US drug Supply

    Katherine Eban puts forh a detailed story of counterfeits, involving real life people and problems. This book deserves more than five stars because it details the work of investigators, the trouble of patients who used the counterfeited drugs and the new resolution to stop this serious contamination. This book shocked me because it gave me the truth plainly and simply. Miss Eban, you did a great job. Congratualtions

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  • Anonymous

    Posted May 18, 2005

    Great Summer Reading

    This book is astounding. Told as a thriller, it shows why, unbelievably, your pharmacist cannot tell you where your prescription drugs have come from - they have no idea. One of many great reviews out there - this one in Salon.com - by Katharine Mieszkowski: 'They call themselves the Horsemen of the Apocalypse, and they hold meetings at Hooters. Their uniforms consist of black polo shirts emblazoned with a pack of horses flanking the Grim Reaper, who's wielding a scythe. One Horseman's name is Venema, which rhymes with 'enema.' But he prefers his code name: Ice Station Zebra. These dubious characters are the good guys in 'Dangerous Doses: How Counterfeiters Are Contaminating America's Drug Supply,' by Katherine Eban, an expose that wades into more rank Florida unseemliness than a Carl Hiaasen novel, and easily boasts three times the number of sleazebag villains... Eban mostly lets this stranger-than-fiction cast of characters tell the story, which makes it engaging, even though it's essentially about government failure. The real cause of the corruption of the drug supply isn't the money to be made. It's a weak regulatory system, which doesn't require complete proof of the route a drug takes from its manufacturer to the pharmacist. That opens the door for all kinds of shenanigans among the colorful, corrupt middlemen. The drug industry lobbyists say it would be unduly expensive to keep such records, and that they aren't necessary, even as Operation Stone Cold uncovers more and more stolen, fake and mishandled medicine. And the government continues to buy that argument, even after no lesser force than Gov. Jeb Bush convenes a grand jury to look into the matter. (What it turns up is horrifying to all involved.) ...'

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  • Anonymous

    Posted April 28, 2005

    Kris Venema, son of Gary Venema, my hero

    The fact that my father is the lead investigator in the book's case obviously adds a bit to the excitement of reading it, but it would otherwise still fall in the top 5 most exciting books I have ever read. The fact that virtually every person in America and quite possibly the world, relies, or has relied on, prescription drugs, makes it that much more intense. I feel queezy when contemplating how excrutiating it must have been to acquire all of the information for this book, but the end result is nothing short of thrilling, intense and shocking. Friends and colleagues joke as I incessently spend every possible minute with the book glued to my face. I actually stopped midway through a Palahniuk book to begin this one, which says a lot.

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