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This paper deals with a topic heretofore largely neglected in studies of health and social policy, namely the challenge presented by the growing global trade in dangerous counterfeit medicines. Empirically, the scope and scale of this trade is assessed, along with its public health risks and impacts. Analytically, a range of social, political and economic processes are identified as contributing to this problem. These include the impact of on-going neo-liberal globalisation and the emergence of patent regimes that favour the developed over the developing nations. Current anti-counterfeiting policy initiatives, at both national and trans-national levels, are also critically examined. It is argued that such measures are unlikely to be effective unless combined with more radical challenges to the chronic lack of access to safe medicinal drugs in the developing world.