Fakery and reverse placebo

This blog is about two lessons that I had for some time understood to be true, but didn’t genuinely understand until recently.

I’ve been ill over the last couple of days. It happens every couple of years or so and is no big deal. Typically, I get very high temperatures of 40 C (for American readers, who persist in a very old-fashioned temperature measurement system, 104 F); sweat buckets; and spend a lot of time in a delirious state. The first time Lorna saw it many years ago, she was very worried that I would die (…and presumably fret over whether there were sufficient life assurance in place). She is now much more sanguine when it happens. This time the temperatures have been a less delirious 38 to 39 C (100-102 F). It’s annoying for me because I have missed trips to the orphanage and schools, always the highlight of any trip for me. But it’s no big deal.

Cambodia has an issue with counterfeit medicine. Estimate vary enormously on the percentage of counterfeit that medicines (less than 1% to over 30%). In the cases of counterfeit, the pills are typically harmless (though of course they don’t alleviate the ailment). Occasionally, the drugs are harmful. What seemed so shocking with Harry Lime is now not commented upon in our more capitalistic society.

Lorna has been dutifully visiting various pharmacies to get some medicines for me (paracetamol and ibuprofen). The first thing she observed was that every drug you could think of was on sale without prescription and the second that the pharmacists appear not to be trained in any meaningful way. This latter point is probably not surprising. At the end of Pol Pot’s regime in 1979, there were only 40 doctors in the whole country from a population of 8 million. It takes time to build up a pool of trained professionals. Therefore – in a country where sachet products dominate (typically, in developing countries, you can purchase the goods you want individually) – it is normal to buy one sweet, one washing sachet or one spoonful of antibiotics).

Obviously, the risk of getting a counterfeit medicine is much higher if you go to a market stall. Lorna has therefore been frequenting shops with tiled floors and glass windows. The products that Lorna has bought me are almost certainly genuine. The interesting feature is that both of us (but especially Lorna!) have low faith that the temperature suppressants are genuine. My temperature took time to come down, and I think that may be partly due to a reverse placebo effect.

This brings me to my second story. About a week ago, Lorna and I visited Shenzhen (or to be more exact about 200 metres over the Hong Kong border). There is a big building there that houses 3,000 shops. You can buy every brand of clothing, handbag, shoe, watch, electronic and DVD. Every product for sale here is a fake, some are poor copies and some so good that you swear they must be made in the same factory. I have often wondered what Lorna does all day, and I realised that she has an encyclopaedic knowledge of every product variation for every brand. She will be able to tell you about the style of stitching on a particular Gucci bag, its clasp mechanism and the colours the bag was made in. It’s a truly impressive bank of knowledge.

Lorna bought a lot of stuff and two roll-ons to put it all in. I’ve never liked big brands (and their marketing), so my guilt level was roughly zero. It seems to me that the unit production cost of, say, a T-shirt is about $1, but the high end brands often sell them for $100+.

Anyway – at the beginning of the blog – I promised you that I would tell you about two things that I knew but that I had only recently learnt. Here they are:

1. Mainland Chinese do their brand shopping in Hong Kong rather than in exactly the same shops in Mainland China.

I believed it before. You can see it in Hong Kong with your own eyes; large malls have been built especially for this market. However, until recently, it seemed odd to me that a Mainland Chinese shopper would go to Hong Kong to buy a product (that was likely made in China) rather than buy it at home. I understand that there is no sales tax in Hong Kong, but you have to buy a lot of things to save on the air fare. I now understand this. (Some of) the fakes are so good that you can’t tell the difference. My guess is that the Mainland Chinese do not have sufficient trust in the honesty of their fellow countrymen and institutions to want to spend a lot of money on something that is worth a fraction.

2. The Philippines Government have a ubiquitous advertising campaign advising their citizens to buy generic rather than branded medicines.

I could see the campaign, so I knew it was an issue. I could also see that the sachets in lthe Sari-Saris were all from Proctor and Gamble, Nestle or Unilever (rather than a cheaper generic*). I didn’t really understand why a Filipino, most of whom are very poor, would choose to spend five times as much on a product than they needed to. I do understand it now. If you believe that there is a possibility that a medicine might not work, the reverse placebo affect will probably mean that it won’t. If you are ill, you need to get better ASAP or you won’t be able to earn money.

I have therefore reversed my position on fakes. They cause more far more issues for a developing country than they offer commercial opportunities (largely to foreigners from rich countries).


*Probably the main reason for these brands success is supply chain

3 responses to this post.

  1. Posted by Melville on July 3, 2012 at 10:50 pm

    I thought seasoned travellers always carried a small kit of essential medications, but am glad that you are now better.


  2. Posted by Anonymous on July 4, 2012 at 3:55 am

    I do but had no ibuprofen.


    • Well you would think so, Dad.

      We do carry a big bag full of medicine. Unfortunately, I don’t have a sprained elbow or housemaid’s knee (both of which would have been well covered)


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