What is really inside: counterfeit medicines and their risks

Mrs S. has brought a Wegovy pen with her. She pulls it out of a plastic bag with three red stripes that was once the inner lining of an envelope, and lays it down between my face cream testers. She says she has heard I could take a look at it. Her cousin in Lyon told her the injections were four times as expensive in Switzerland, and that it was the same product anyway.

That is usually where stories of this kind begin. With a cousin in Lyon. With a sister-in-law in Schaffhausen who knows someone. With a video in which a woman in the USA claims to have lost eight kilos in a month. With a website that has Swiss-German-sounding names, a .ch ending, a Swiss telephone number, and absolutely nothing to do with Switzerland.

The pen looks almost right. The label is correct in its layout, the colours are fine. But the serial number on the carton does not follow the Swiss format, the package leaflet is in English and folded in a way I have never seen before, and the pen is — the detail I only notice on the third look — not quite cleanly sealed on the underside.

I do not know what is inside.

In 2024, one hundred confiscated samples of erectile dysfunction products were analysed in the official Swissmedic laboratory. Thirty-two per cent contained two to four times the dosage authorised in Switzerland for those active substances. With counterfeit Ozempic pens, about which Swissmedic has warned repeatedly since 2023, there have been hospitalisations in Switzerland for acute hypoglycaemia. In one documented case, a pack sold as Ozempic actually contained an insulin pen.

An insulin pen that looks like an Ozempic pen can put a patient into a coma within hours. That is not a question of price. That is a question of content.

Mrs S. knows none of this. She knows she has saved money. She knows the packaging was attractive. She knows the first two injections seem to have worked, because she felt less hungry. She does not know that this impression of an effective medicine also arises when you believe the label and convert that belief into an effect.

The geography of the matter changed in 2025. Six thousand six hundred and forty-seven illegal medicine consignments were intercepted in Switzerland last year by the Federal Office for Customs and Border Security; that is seventeen per cent more than the year before. Three years ago, nine per cent of them came from western Europe. Today it is forty per cent — from France, from Germany. That is the new form: not the dubious shop in Hyderabad, but the website that looks like a Swiss pharmacy, with a Swiss cross, a .ch domain, an address that does not exist in the land register, and three advisers who do not exist either.

I explain this to Mrs S. as well as I can. I explain that I do not know what is in her pen, and that she does not know either. That the pharmacy is not an expensive detour between her and the active substance. That the pharmacy is the place where someone can say: this substance you are injecting is the one printed on the pack — because I can trace the supply chain, because the label connects to the carton connects to the batch connects to the manufacturer, and because if something is wrong, I know whom to call.

Mrs S. takes the pen away with her again. I cannot force her to return it. All I can tell her is that it would not be her fault if something happened; that it is her body nonetheless; and that a consultation with her GP on Monday costs around one hundred and fifty francs and, in the matter at hand, is worth more than the two hundred she saved online.

She looks at me as though I had said something personal. In a certain way, I have.

She makes an appointment.