Israelis and former Israelis are behind many of the world's Internet sites that sell counterfeit or other illegal drugs involved in pharmaceutical crimes, providing useless or dangerous products to people who think they are getting the real thing. So says Mickey Arieli, director of the Health Ministry's Pharmaceutical Crime Unit, which has, with the help of the Israel Police, the Customs Authority and foreign units, caught numerous criminals. Yet Arieli and the two other professionals who constitute the unit told The Jerusalem Post in an interview that they were reaching only the "top of the iceberg" and that these activities seriously endangered public health. Arieli, a pharmacist who made aliya from Chicago nearly four decades ago and established the unit in 2007, said that prescription drugs meant to treat serious diseases like cancer, malaria or attention-deficit hyperactivity disorder but whose retail prices were unaffordable, were reaching the public, especially via illegal Internet sales. Often, preparations claimed to be food supplements actually contain active pharmaceutical ingredients that could harm and even kill. He said that before the establishment of the Internet and the appearance of erectile dysfunction drugs, pharmaceutical crimes had been quite rare. Because hospital emergency room doctors are so overburdened, said Arieli, there is no effort there to determine and register cases in which patients have been harmed by taking drugs they obtained illegally. Thus Arieli has "no idea" how many Israelis die as a result of ingesting these products. He does know that last year, a number of people died in Singapore from taking counterfeit food supplements that actually contained a drug meant for diabetics that brought down glucose levels. Elsewhere overseas, counterfeit drugs meant to treat malaria and/or cause abortion were actually made of paracetamol, which is a pain reliever and fever reducer and can be toxic to the liver if taken in high doses. In addition, erectile dysfunction drugs claiming to be Viagra and Cialis are widely marketed through illegal Internet sites and Hebrew newspaper ads, but are rarely the real thing. Rather, they are either harmless pills, or they contain drugs meant for other conditions. "Our job is not to protect the intellectual property of legitimate pharmaceutical companies, but to protect public health," said Arieli, whose unit is located in two small rooms in the ministry's national drug lab. Based on intelligence information and other means, the unit has caught imported ping-pong balls containing sildenafil, the active ingredient in Viagra and Cialis. The unit has also impounded shipments of counterfeit empty boxes and capsules that give the impression they are authentic drugs; they are filled with illegal ones by criminals. Fake or otherwise illegal "lifestyle" drugs such as erectile dysfunction drugs, diet pills and baldness treatments are the biggest sources of income for pharmaceutical criminals. Most counterfeit drugs, said Arieli, are manufactured in China, while generic "Viagra" is usually made in India and shipped to Israel. Illegal factories abroad and in Israel almost always function in very unsanitary conditions and not at the necessary temperatures and humidity. According to Arieli, illegal Web sites operated by Israelis or former Israeli residents usually have nothing to do with the manufacture of phony or illegal drugs, but expedite the transfer and payment for them. Besides the Internet, illegal medications such as amphetamines are sold at sex supply stores and in kiosks around the country, Arieli added. All of this is "black money." He said that another enforcement problem was that a non-pharmacist selling medications was liable to get only six months in jail and a NIS 12,000 fine, but even with these minimal sanctions, "nobody has yet been punished." Other global crimes include diversion, in which subsidized AIDS drugs meant to go to Africa, where the infectious disease is rampant, are shipped to Europe instead to be sold at higher prices. Counterfeit, illegal or dangerous medications often reach West Bank pharmacies. Arieli believes this rarely occurs in licensed Israeli pharmacies, but sometimes they do slip through, unintentionally or intentionally, via private pharmacists. Health fund pharmacies are the safest, he said, because the funds purchase medications in bulk and supply their pharmacies nationally from a central source. He urges people to purchase medications, both over-the-counter and prescription drugs, only from pharmacies licensed by the Health Ministry. But Arieli stressed that people should also carefully look at medications they purchase, making sure that boxes and containers do not suddenly look different from what they have received before; that the printed warnings appear in Hebrew, Arabic and English rather than only in English or Arabic; and that the serial numbers and expiration dates on the packages are identical to those on the vials, dispensers or tubes inside. A feature on pharmaceutical crime will appear in the Health section on Sunday, November 29.