For millions of people in developing countries, access to lifesaving antibiotics and antiretroviral drugs is fraught with economic hardship and social barriers. A whole family may give up food to buy medicines for a sick child; a teenager will drop out of school or take up dangerous work while a parent is ill. What if the medicines they sacrifice so much to obtain turn out to be ineffective — or worse, toxic?
As Stefano de Luigi reminds us in this powerful article and photo series, this is too often the heartbreaking reality. He uses his camera to capture impressions of the shadowy pharmaceutical market in Nigeria, a country that has been repeatedly hit by scandals involving counterfeit meds. But the problem is global, and its pervasiveness poorly monitored.

(Copyright Stephano de Luigi and VII Gallery)
For a comprehensive review of recent scientific and public health literature on the problem of counterfeit medicines, see S.E. Nsimba, Problems associated with substandard and counterfeit drugs in developing countries, East Afr J Public Health, Dec 2008 (PubMed ID 19374325).