Antibiotics that are laced with rat faeces and floor polish? Cough syrup that contains more than a dash of antifreeze? Antipsychotics with no pharmacologically active ingredients? Medications for heart or erectile disorders that feature floor sweepings and plaster but insufficient chemicals to the job?

Counterfeit drugs are an unintended consequence of globalisation. And they’re one reason why Australian pharmacies matter.

Modern consumer protection began with laws restricting the sale and advertising of quack medicine, alongside those requiring increasingly rigorous qualifications for people dispensing and advising about medications. This made pharmacy a true profession rather than an occupation for vendors of pills and potions.

That emphasis on quality has served Australia well. We have not seen the disasters evident in low-touch (or no-touch) regulatory regimes, such as in India, eastern Europe and the Middle East. Pharmacy, like the pathology sector, has been a quiet performer.

That performance is worth bearing in mind as consumers shift from bricks to clicks in sourcing DVDs, clothes, wine and books. It’s become commonplace to hear forecasts about the death of the department store and dire prospects for retail property.

What’s less apparent is the willingness of some consumers to buy medications online, particularly medications from overseas. That shift is also underway and can be expected to continue. This is bad news for public health rather than just for pharmacists who have spent several years at university and are now competing with no-name entrepreneurs operating out of Kiev, Vladivostok, Tijuana or Mumbai.

There are good reasons for treasuring your pharmacist – and for encouraging her autonomy in the face of competition from the retail juggernauts named Woolies and Coles.

One reason is her expertise – she is aware of inappropriate mixes of medications. Consumers who are self-medicating through offshore suppliers are buying a commodity that isn’t tied to advice and isn’t wrapped up with an effective legal framework if something goes wrong.

If you’re shopping online from a pharmaceutical smorgasbord, the only thing that’s likely to save you from bad choices is the effectiveness of Australia Post and the Australian Customs & Border Protection Service in blocking dodgy imports.

But the officials policing the border can’t be everywhere. The government has acknowledged serious problems at the Therapeutic Goods Administration (TGA), the agency that seems to have been asleep when defective breast implants and hip joints were distributed.

The local pharmacist, on the other hand, is likely to provide cogent advice about what not to mix and match, and cautions about self-diagnosis based on Wikipedia and cyberchondria sites or about what is promoted through global direct-to-consumer marketing.

Another reason is that the conventional distribution chain for medications in Australia doesn’t have the systemic failures evident overseas. Buying your medications online from an overseas supplier may be significantly cheaper but that purchase is accompanied by significant risk.

A succession of independent scholarly studies and government reports has demonstrated serious problems with counterfeits of legitimate pharmaceuticals (estimated at around US$30bn each year) and the appalling bad quality of some generic medications. Some generics are as good as branded products; others fail basic tests of efficacy and safety.

Globalisation means that the main victims of bogus medications are sadly some of the people in greatest need: those on subsistence incomes in the developing world, who depend on genuine anti-malarials and other life-determining pharmaceuticals rather than the “blue pill” that addresses the first-world problems of middle-aged men and their partners.

But we’re not immune, and defective medications with increasing resistance among diseases such as tuberculosis and malaria, affecting Australians visiting overseas.

If you’re relying on offshore clicks, rather than visiting local bricks (or the online presence of an Australian pharmacist) what will you be getting? The answer matters if you’re buying better living through modern chemicals rather than cotton buds, jelly beans and squeaky toys.

You’re out of luck if something goes wrong and you want compensation from the supplier in Kolkata or Bucharest.

In thinking about the future of the pharmacy sector in Australia, we should recognise the significance of the “bricks and mortar” chemist, possibly even subsidising professionals to stay open longer, rather than doing our drug shopping from Amazon.com or DodgyRX.com.

This is the second article in our short series about pharmacies. Click on the link below to read the previous instalments:

Part One: Pharmacy gravy train drives up the cost of prescription drugs

Part Three: Note to pharmacists on how not to sell the morning-after pill

Part Four: Pharmacists should drop products that aren’t backed by evidence

Part Five: Why you have to show ID to buy cold and flu tablets