Adequate health care remains unavailable to most of India's citizens, especially in rural areas. Even those fortunate enough to have access to good care, however, cannot be certain that a prescription from a reliable doctor will ensure their recovery. VOA's Steve Herman in New Delhi explains why.

A customer - in this case, someone sent by Voice of America - complains of sleeplessness and gets a New Delhi pharmacist to hand over a packet of pills without a doctor's prescription.

In India, it is easy to get around the law requiring a prescription for most medicines. But, with or without a prescription Indians cannot be sure the drugs they buy are real, or safe.

Experts say millions of people in India each day are sold counterfeit medicines.

Dr. Sanjiv Zutshi, a New Delhi physician, thinks nearly anybody in India who receives medication is taking a gamble.

"I think it must be 20 to 30 percent of the drugs might be counterfeit or substandard in that nature," he said.

Surveys have found that in some medicine bazaars here, more than 90 percent of the drugs bought and analyzed are fakes, although many come in sophisticated packaging and look just like the real thing.

Dr. Zutshi says the widespread problem undermines the country's entire health care system.

"I need to be pretty sure that the medicine which I am giving is going to treat the disease," he said. "Otherwise, what's the use of a physician seeing a patient? The whole exercise becomes useless."

There are only 35 drug inspectors at the national level and little more than one thousand spread across India's 28 states. This for a country with more than half a million retail drug outlets and a population exceeding one billion.

Sushma Swaraj

"Such crime is committed always in connivance with the police," she said. "So many people are being benefited by the money trail. But they don't think how many hundreds of thousands of people are being killed."

She drafted an amendment to India's Drugs and Cosmetics Act, which would have enacted the most severe punishment for those making counterfeit medicines.

"Only you need one or two convictions and one or two hangings. If they think that 'oh, these two drug manufacturers have been given death sentences, they've been hanged,' it will give such a big effect," she said. "Today they are not afraid of anything."

Those in the illicit trade may have little to fear. The legislation, which is still pending, has been watered down and the maximum penalty now is life imprisonment and fines. And there is no indication if or when parliament will act on the bill.

For now, worried physicians, such as Dr. Zutshi, can offer few assurances to patients that they will exchange prescriptions for authentic medications.

"Get it from a reliable chemist," he said. "And do take a receipt for the medicines you have bought and, if possible, go back to the doctor if the effectivity [effectiveness] of the drug is not there."

Authorities say that is good advice for consumers everywhere, not just in India. Counterfeit drugs are being produced and sold in other parts of South Asia, China, Eastern Europe and Latin America. The Center for Medicines in the Public Interest in the United States predicts that sales of bogus pharmaceuticals will total $75 billion by 2010, double the market in 2005.