Contents of the counterfeit product may:
(1) cause neither harm nor benefit (plain water or sugar pill)
(2) be something that is directly harmful (bacterial contamination, heavy metal or toxin)
(3) be an active pharmaceutical, but not the one listed
(4) be the same active pharmaceutical as listed, but with a different formulation, concentration, release characteristics and/or kinetics
(5) be the actual drug as listed, but outdated
(6) be the exact same active pharmaceutical, such as a generic formulation being sold under the brand name
Drugs more likely to be bad copies:
(1) ones involving sustained or extended release formulations, since these are technically difficult
(2) protected formulations where the exact contents are not generally known
Some conditions that may have a poor outcomes if the right drug is not given (denial of therapeutic benefit):
(1) HIV disease
(2) anemia treated with erythropoietin
(3) diabetes
(4) cancer
(5) asthma
(6) depression or psychosis
(7) malaria
Even if no harm occurs, the economic loss can be significant for a developing country.
