NEW DELHI – Private investigator Suresh Sati rattled off the popular brand names listed on the boxes of cough syrup, supplements, vitamins and painkillers sprawled across the desk and shelves in his basement office.

“They look real, but all these are fakes,” said Sati, head of a New Delhi-based agency that helps police conduct raids against counterfeit-drug syndicates across the country. “A regular customer cannot make out if a drug is fake. The biggest giveaway is when someone is selling medicines very cheap. It is almost always fake.”

Additional Photos

“When we bust one operation, two more spring up elsewhere,” says investigator Suresh Sati, sitting, next to colleague Pankaj Dutt. India has become a center for making and selling fake and substandard medications. Rama Lakshmi/The Washington Post

India, the world’s largest manufacturer of generic drugs, has become a busy center for counterfeit and substandard medicines. Stuffed in slick packaging and often labeled with the names of such legitimate companies as GlaxoSmithKline, Pfizer and Novartis, the fake drugs are passed off to Indian consumers and sold in developing nations around the world.

Experts say the global fake-drug industry, worth about $90 billion, causes the deaths of almost 1 million people a year and is contributing to a rise in drug resistance.

Estimates vary on the number of these drugs made in India. The Indian government says 0.4 percent of the country’s drugs are counterfeit and that substandard drugs account for about 8 percent. But independent estimates range from 12 to 25 percent.

Indian officials say the clandestine industry has hurt the image of India’s booming pharmaceutical industry and its exports, worth $8.5 billion a year, mostly to African and Latin American countries.

To clamp down on the illegal trade, the health ministry launched a reward program this year offering $55,000 to those who provide information about fake-drug syndicates.

Last year, the ministry also strengthened its drug law to speed up court trials. Suspects found guilty of manufacturing and selling fake drugs can be sentenced to life in prison.

The number of people arrested for manufacturing and selling fake drugs rose from 12 in 2006 to 147 last year, and drugs worth about $6.5 million were seized over this period.

“It is very difficult to dismantle the entire operation,” Sati said. “When we bust one operation, two more spring up elsewhere. Convictions are rare.”

The tricks of the trade include sticking fraudulent labels on expired products, filling vials with water, stuffing small amounts of real ingredients in packages of popular licensed brands and putting chalk power in medicine packets.

But more than the concern for public safety, officials here have been particularly alarmed about recent incidents that discredit India’s image abroad.

In June, officials at Nigeria’s Abuja airport caught a shipment of fake antibiotics, containing no active ingredients, with a “Made in India” label.

Nigerian investigators later said that a Chinese company shipped the drugs via Frankfurt. In a similar incident last year, a shipment of fake anti-malaria drugs from China arrived in Nigeria with an Indian tag.

Last year, Sri Lanka banned imports from four Indian companies after officials discovered substandard medicine in shipments.

Over the years, drug companies have used holograms or embossed their logo on packaging to protect their brands, but these have also been counterfeited in India.

One company, MSN Labs, is using a technology developed by U.S.-based startup firm PharmaSecure that allows consumers to check the authenticity of medicines by sending in a text message of the code written on them.

But many Indian companies are “apprehensive of pursuing the cases for fear of bad publicity and possible loss of confidence among consumers,” said Barun Mitra, director of the New Delhi-based think tank Liberty Institute.

Co-writing a report on a recent survey, Mitra said that 12 percent of sampled drugs from the capital’s pharmacies were substandard. “We are behaving like ostriches with our heads in the sand and pretending that nothing is amiss even as the problem keeps growing and affecting Indian patients.”

On a recent morning in the northern city of Varanasi, a young man named Ashish waited for a shipment of counterfeit painkillers and postpartum pills to arrive by train.

He said his order of pills to control postpartum bleeding contained chalk powder but came with the brand name Methergine in a Novartis package.

The painkiller had insufficient ingredients and carried a Bidanzen Forte label inside a knockoff GlaxoSmithKline package.

“There is a lot of profit in this,” said Ashish, 28, describing the extent of fake drugs in Varanasi. He declined to give his surname because his operation is illegal.

“I do not think about right or wrong,” he said. “I am not killing anybody. The worst is that these medicines will not show any result and the patient may have to check into a hospital.”

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