Sooner or later, most travellers to southeast Asia will eventually buy a fake. I used to have drawers of the stuff - a reproduction gold Rolex was one unfortunate purchase and I'm sure the odd counterfeit designer handbag made it home as a gift. It's tempting to view the trade as harmless. If the accessories of the super-rich lose a little of their cachet, so be it.

The truly dark side of this business, however, is not the Hermes scarves or the Gucci wallets. It's the drugs.

Britain's Guardian newspaper is reporting an "epidemic" of counterfeit therapeutic drugs that it says is sweeping southeast Asia, effectively killing hundreds of thousands of patients who believe they are receiving vital - and life-saving - treatment.

Quoting Dr Paul Newton of the Oxford University Centre for Tropical Medicine, who is working in the Laotian capital Vientiane, the report says criminal manufacturers are particularly targeting a new malaria wonder-drug, artemisinin.

The real thing has proved especially effective against parasites that have become resistant to older remedies such as chloroquine. Its increasing popularity has obviously caught the eye of the counterfeiters, who mostly seem to be based in China.

According to Newton and his colleagues, bogus anti-malarials are now being manufactured on "an industrial scale", including highly sophisticated reproductions of anti-forgery holograms on the packaging.

The U.N. World Health Organisation (WHO) estimates that 200,000 of the one million malaria deaths every year would be prevented if all the drugs taken were genuine. Up to 50 percent of all drugs sold in Asia and Africa are fakes - not to be confused with generic drugs, which is the term for medicines that are identical in efficacy to big brand name drugs in every way, but are manufactured independently.

The debate goes on over the licensing and distribution of generic drugs. Meanwhile, counterfeits are flooding onto the market, including critically important anti-retrovirals for HIV/AIDS and medicine for bird flu. In 2003, the estimate for the developing world was only 25 percent.

As the Guardian reports, not only are thousands dying needlessly, but diseases themselves are becoming drug-resistant because fake medicines sometimes contain small "sub-therapeutic" doses of the active ingredient. Proving the maxim that every good lie contains at least a kernel of the truth, it fools patients into thinking the treatment is working because they will notice a slight change in their condition. But it also causes the parasite itself to mutate, survive and often strengthen.

But before we start viewing this as an exclusively Third World problem, Britain and the United States are also facing a growing threat. A report in Britain's The Independent newspaper last month revealed that the trade is switching its attentions from small-scale internet deals to pharmaceutical wholesalers supplying the National Health Service (NHS).

Depressingly, the growth in criminal activity has been driven by the growth in demand for lifestyle drugs for obesity and impotence - the amoral feeding off the insecure. Fake Viagra, for example, has reportedly been a runaway success for the gangs.

A special report in the Los Angeles Times in 2004 said that while officials were still unsure of the full extent of the counterfeit trade, they had seen a tripling in the number of cases in the previous few years.

It is almost impossible to underestimate the cynicism, venality and blank disregard for human life that the trade in fake drugs represents. But where there's a market, there's money, and where there's money, there's crime. So what if they kill a few hundred thousand people in the process?

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