title: Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health.
abstract: BACKGROUND
  Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted.
  
  
  CONCLUSIONS
  Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established.
  
  
  CONCLUSIONS
  Effective global "eHealth Governance" focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence.
authors.affiliation: Institute of Health Law Studies, California Western School of Law, 350 Cedar Street, San Diego, CA 92101, USA. tmackey@ucsd.edu.
authors.forename: Tim K
authors.initials: TK
authors.lastname: Mackey
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Liang
mesh_terms: D003415:Crime; D004345:Drug Industry; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D006801:Humans; D007391:International Cooperation; D038622:Internationality; D020407:Internet / Q000331:legislation & jurisprudence; D035846:Law Enforcement; D040541:Marketing; D061214:Patient Safety; D010594:Pharmacies / Q000331:legislation & jurisprudence; D011634:Public Health