( CNN ) -- Everyone knows about the risks that narcotics pose and the lethal war waged against them . But there are probably far more deaths caused by dangerous therapeutic medicines . Lazy , cost-cutting manufacturers and criminal counterfeiters make billions of dollars a year peddling products that may kill you , which you might find online or even at your neighborhood pharmacy . I first came across dangerous drugs while evaluating HIV and malaria projects in Southern Africa eight years ago . Patients were dying because the pills did not provide the needed medicine . Fakes contained chalk , talcum powder , road paint and occasionally dangerous heavy metals , instead of the expensive , hard-to-make medicine . FDA commissioner talks counterfeit drugs . Terrorist organizations such as Hezbollah have profited from this trade , but no group has so far used it as a weapon . Most producers of bad products are not trying to kill patients . They are out to make money and simply do not care who gets hurt , or even dies , in the process . It is impossible to know the exact size of the trade or its lethal impact -- some guesses are as high as 700,000 deaths globally each year . I estimate that bad medicines cause at least 100,000 deaths annually . Some markets are barely affected , while others are replete with substandard products . Playing Russian roulette with fake drugs . `` Pharmaceutical counterfeiting is a low-risk , high-profit criminal enterprise that attracts entrepreneurs and organized criminals , '' says John P. Clark , vice president and chief security officer for the drug company Pfizer . `` What was once seen as a problem limited to lifestyle medicines is now recognized as a threat from which no therapeutic area is immune . '' Up to a third of the market for anti-malarials are suspect in some way , and around 10 % of all essential drugs in emerging markets fail basic quality tests . While the United States is much better served -- far less than 1 % of all drugs are faulty -- even if only 0.001 % of the 4 billion prescriptions filled in this country every year were compromised , 40,000 prescriptions could be deadly . More worryingly , lethal drug incidents are on the rise in the United States . Fakes of heparin , a blood-thinning drug , killed 149 Americans in 2007 and 2008 , and many more deaths likely go undetected every year . FDA : Beware of 'fake ' potassium iodide . In most cases , no crime is suspected as the consumers are often quite sick and the evidence is swallowed . If a relative with a heart problem dies from a heart attack , who would think to investigate the medicine ? But fake Plavix , Medicare 's most-often reimbursed heart medication , has been found in numerous countries . Before the civil war in Syria , its capital , Damascus , was home to a major counterfeit drug operation that made tens of millions of dollars between 2003 and 2009 . The ring manufactured more than 80 brands -- including Plavix -- of fake medicine very convincingly , only distinguishable from real drugs by experts . Yet none of them contained the correct ingredients . Fake antibiotics , cancer and heart medications penetrated every major market of the Middle East , including the one funded by U.S. tax dollars in Iraq . While part of the operation was shut down in 2009 , some gang members fled and reassembled in Iraq and Iran . My sources in the Middle East believe that this gang may have begun operations again in Damascus , bribing officials with their vast wealth to turn a blind eye . Most worrying for Americans , they may have been the source of the fake cancer-drug Avastin that surfaced in California , Illinois and Texas in March and April . Fighting the growing menace of fake drugs . U.S. authorities are limited in combating illegal trades outside the United States . International law is currently inadequate to combat international fake drug rings , and there is a need for a global treaty against such products . I am optimistic that this will change within the next decade ; international laws will be strengthened , and global efforts against counterfeiters will constrain their activities . But I am less certain that governments will effectively tackle legal producers who make bad products . These companies pay their taxes , provide jobs and have political clout across numerous emerging markets . Cutthroat competition among chemical and drug manufacturers keeps prices low , but it also encourages corner-cutting . In some emerging markets , there are more than 300 brands of the same class of medicine . Local regulators do not have enough competent staff to conduct either thorough inspections of all production plants or survey products in the market . Consequently , companies routinely get away with substandard production . Most tragically , these producers undercut better producers on price and sometimes force more responsible players to exit the market . Chinese and Indian producers dominate many drug categories in emerging markets , notably anti-infectives . While many of these companies make good medicines , a substantial subset routinely target poor markets with substandard versions . Until regulators and customers in emerging markets demand better products , tens of thousands will be killed by substandard drugs , and unfortunately some of these products will make their way to U.S. markets , too . The opinions expressed in this commentary are solely those of Roger Bate .
Author says manufacturers and counterfeiters make billions peddling killer products . Comment: International law is inadequate to combat international fake drug rings , Roger Bate says .