The global economy is suffering from counterfeiting, but nowhere near as much as kids in Africa and Asia who died after what was supposed to be a painkiller turned out to be antifreeze.
According to US health officials, one in ten medicines sold world-wide is fake, treating nothing but providing about 32 billion dollars (26 billion euros) in annual sales for drug dealers.
In poor countries up to one-quarter of all drugs can be counterfeit, particularly those sold in the streets.
The result can be dramatic, as in 1992 when at least 233 children died in Bangladesh after swallowing a paracetamol-based sirop that had been laced with antifreeze.
In Nigeria, 109 kids had died two years earlier in a similar case.
Around 2,500 people died in Niger in 1995 during a meningitis epidemic after vaccinations provided by Nigeria turned out to be fake.
The World Health Organisation estimates 200,000 annual deaths from malaria could be avoided if available medicines were of high enough quality to be effective.
In south-east Asia, 38 percent of drugs sold to treat the sickness contain no active ingredient, WHO says.
China, Nigeria and the former Soviet republics are countries regularly singled out by pharmaceutical firms as centres of counterfeit production, and officials say its distribution follows routes used by established drug traffickers.
"Making fake pills is not that different from making ecstasy tablets," said Yves Juillet, a French doctor who heads an industry anti-counterfeit committee.
"In Europe, Russia and Ukraine are causes for concern. Given the enlarged European Union, a risk exists that counterfeit medications will penetrate eastern borders, even though such cases are exceptional at present."
Isolated seizures of counterfeit medications have already taken place in Britain and the Netherlands.
Reliable distribution networks equipped with preventive measures like bar codes and electronic chips have also helped protect the public from fakes. In the United States, the world's biggest pharmaceutical market - but where many people lack comprehensive health insurance - cheap copycat drugs roam on much more fertile ground.