Deceptive Virility

By Mohammad Al Jadhafsi
Manama, Bahrain, Nov2016 (Alwasat) – Some traders take advantage of the absence of a law regulating the circulation of dietary supplements and herbal medications, selling chemical sexual enhancement products harmful to men searching for virility or embarrassed to visit a doctor to cure their impotence.
Finding mostly China-made tainted sexual enhancement products with chemical or herbal formulas that enter the country in suitcases carried by traders or are smuggled in, is no longer difficult in Manama.
In a shop that specializes in selling toys and electronics in downtown Manama, A, a young man, asked the vendor for a sexual enhancement product. Without hesitation, he opened a drawer and handed him the drug.
The sale and purchase process was conducted in a smooth way as witnessed by this reporter who accidentally happened to be there triggered the start of this investigative report into the world of illegal and unapproved sexual enhancement drugs in Bahrain.
He visited ten shops and found that they all sold illegal sexual enhancement drug, many of them harmful to consumers, according to several international organizations. This is taking place because of weak coordination among the Ministries of Industry, Commerce and Tourism and the incompetence of official inspectors, some of them with judicial power.
The most common drugs sold in Bahrain as tracked by this reporter are: “Yong Yang” and “Max man II capsules”. They are not licensed locally, according to Hisham Abullah Alawami, in charge of the laboratory for ensuring quality of medicines at the National Health Regulatory Authority.
Those herbal drugs are tainted. They are similar to those authorized to enter Bahrain and produced by international drug companies. They bear names that are close or similar to the original names arriving via transit trade. The World Health Organization had been warning for more than ten years about the flourishing trade of alternative drugs, so lucrative that producers of illegal drugs have joined what has become an organized, cross-border crime.
The danger of these products lies in the fact that they are industrially unregulated and may have varying results when used. According to the 2007 report by the American Food and Drug Administration (FDA) entitled: “Tainted Sexual Enhancement Products”, the FDA has identified an emerging trend where over-the-counter products, frequently represented as dietary supplements, contain hidden active ingredients that could be harmful. Medications for erectile dysfunction are used in these drugs in high doses to ensure stronger sexual performance while ignoring the their harmful side effects due to an imbalance in composition”.
Another report entitled: “Max Men Capsules: Capsules that pose a huge danger to the health and must not be used” and issued by the Therapeutic Goods Administration (TGA) in Australia in March 2014, also mentioned that the TGA had tested those capsules and found they contained an undisclosed ingredient of Viagra. All this despite the fact that the label on the product alleges it is made of 100% natural and safe material, and does not contain drugs . It advised consumers to choose safe medical products.

The same applies to capsules that are sold under the name “Yong Yang”. The TGA in Australia issued a special report on June 5, 2013 entitled: “Yong Yang Capsules pose a huge threat to your health and you should not use them”. It said that it had “tested the Yong Yang capsules and found that they contain an undisclosed medical formula of Tadalafil (Cialis). We don’t advise consumers to use it except upon a medical prescription”.
So, Yong Yang capsules did not receive good evaluation by TGA regarding quality, safety and efficiency, according to the Australian legislation. The location of manufacturing was not approved either . These warnings are related to unofficial products produced without licensing from the TGA.
The same warning was mentioned in a statement issued by the FDA on March 2, 2015 advising consumers not to buy or to use Max Man Capsules – marketed as a sexual enhancer.
FDA tests confirmed that the drug contains Sildenafil, the active ingredient in the medical drug Viagra. The report indicates that this undisclosed ingredient might interact with nitrates in some drugs such as Nitroglycerin and might lower blood pressure to dangerous levels. These nitrates are often found in medications for diabetes, high blood pressure, high cholesterol, or heart disease.
Similar to the Australian report, this report warns people against an increase in the market share of dietary supplements, with hidden drugs and chemical material. These products are usually marketed as enhancers of sexual abilities, and are often described as “100% natural” .
Hisham Alawami, from the laboratory for the quality of medications at the National Health Regulatory Authority in Bahrain, warns against negative effects of sexual enhancement products sold as unlicensed alternatives for original medical drugs available in pharmacies and sold against medical prescriptions.
Alawami says unlicensed and counterfeit drugs are mixed with large quantities of other drugs turning them into poisonous substances in most cases.
Alawami confirms that “Max Man and Yong Yang are officially banned in Bahraini and are not registered at the National Health Regulatory Authority. They are rejected by the FDA and the Public Health Agency of Canada. Their sale in Bahrain is illegal.”
He added: “The side effects of using unregistered sexual enhancement products cannot be counted. Their content must be fully tested in laboratories of the authority after registration and before they are permitted for use.” Alawami said authorities here did not test these products. Rather, they settled for frequent international reports issued by credible and competent parties. He also pointed out that “in the case of initial registration of medical herbs, health products and other supplements, the authority tests most brands at a laboratory to ensure the quality of drugs before registration and issuance of a registry certificate, except if it is not possible to do the analysis at the laboratory. In that case the authority relies on the analysis of the credible competent authorities.”

According to the owner of Al Hikma Pharmacy, Ahmad Al Alawi, the unofficial trade in medical herbs constitutes “a large percentage of the overall trade in the market of drugs and medications in Bahrain. Its illegal revenues might lead to ridiculous profits as a result of extreme weakness in legislation and regulation”.
Al Alawi, who had warned against that years ago, confirmed WHO estimates putting the size of trade in this market at $35 billion. Hence, this is not surprising when drug dealers turn to this lucrative trade .
The owner of Al Razi pharmacy, Hussein Abdul Aziz, said: “The release of Viagra was a revolution in the field of sexual impotence treatment. The drug was very demanded at pharmacies. However, as a result of the spread of alternative enhancement products and drugs, many people began buying them from other places at cheaper rates.”
Agents of three medical sexual drugs in Bahrain (Viagra, Cialis, Snafi) attributed this to the fact that consumers turn to buying alternative sexual products from unknown sources. Dr. Mohammad Abdul Menam, sales manager at the medical institute Bazhard, official agents of Snafi) confirms that sales of sexual drugs lead to a false competition with lower prices and higher accessibility. It is likely that the reason behind the spread of these products is that many people go to Asian countries for tourism where these products are found in the market for very low prices. They buy those products to sell them in Bahrain.
He said he found a clear discrepancy in the sale of the medical drug Sanfi over the past two years. He said he expected that demand for sexual drugs from pharmacies to increase. This view was also endorsed by pharmacy manager Youssef Mahmoud, the official agent for Viagra.
Dr. Walid Ali, counselor at Ibn Al Nafees Hospital, said patients do not go to doctors because they do not like to discuss their sexual impotence. They prefer to go to shops that sell unlicensed sexual drugs that are administered with no watch from doctors. However, the danger lies in the long and short-term side effects of those drugs.
For the young, it is also cheaper not to go to see a doctor, where they would pay an average of BD 100 ($265) for check-up and medical tests.
The price of 100 pills of Maxman is $21, according to information gathered by this reporter. One pill costs around 12.5 fils compared to that of authentic sexual supplement products are sold in packs. But shop owners who endorse this drug sell it by the pill, selling each three for one Bahraini Dinar ($2.6), while the price of the Yong Yang product (the most popular locally) can reach up to a dinar per a pill.
In comparison, the price of one Viagra pack (100mgs – 4 pills) is BD 9.890 BD ($26.224) – one pill is sold for BD 2.472 dinars ($6.556).

Table of prices for sexual enhancement products traded in Bahrain (disclosed and undisclosed)

Amidst the search for manufacturers of drugs like Maxman and Yong Yang, this reporter only found websites with an active email address. Pretending to be a trader of herbal products, he sent an email and a letter via registered mail to the addresses printed out on the packets of the two drugs. He called several distributors asking both for information/prices of the illegal drugs and how to import them into Bahrain.
He got no response to his email. The registered mail returned along with a phrase saying that it doesn’t include enough information or say if the address is incorrect. This means the company is using fake addresses.

To reach the source of the products in Bahrain, the journalist posed as a trader in medical herbs planning to import these drugs. He asked the local distributor for Maxman and Yong Yang capsuls about that and was told: “If you want to get the drugs at a small amount, you can get a counterfeit version from China. But I don’t sell the counterfeit version and this makes it more expensive.”
He added: “If you want to import the products, you will face two problems. The first one would be the shipping costs and the import tax. Then you have to deal with the import permit to get out the goods from the customs.”
This distributor opposed the plan of the journalist to import those capsules saying it is easier and better to buy the products from Bahrain instead of going through the trouble to buy the counterfeit drugs from China. Your loss might be bigger if you sell the counterfeit drugs here.”
According to official directions to obtain the agency of those products in Bahrain, a trader needs to have a commercial register and another one from the Health Ministry for buying and importing health products. Afterwards, one must bring samples of those products to be tested at the Ministry of Health in order to specify whether they are permitted or not before their distribution in the markets.
The distributor also said: “Getting a commercial register does not take very long, but the remaining procedures would take up to three years.”
This implies that most traders of these drugs buy them from major unlicensed local distributors who get them from “suitcase traders” arriving from Asian countries. The reporter was not able to get information on Bahrain’s total imports of the most popular medical sexual enhancers like Viagra, Cialis and Snafi.

On Aug. 16, 2015, Prince Salman Bin Hamad Al Khalifah, Bahrain’s First Deputy Prime Minister, ahrain, issued two decrees amending law number 18 of 1997 on organizing of the profession of pharmacists and pharmaceutical centers. The two decrees dealt with pharmaceutics and medicines. Violators will be jailed for at least three months or pay BD 10,000 in fines in addition to closing down the shop and confiscating material and equipment.
But the decrees deals with “medicines” and “pharmaceutics” and does not cover non-medical prohibited products which are not considered medicines and are not found at pharmacies in the first place but in shops that have nothing to do with medicine or health.
Dr. Walid Ali from the Ibn Al Nafees Hospital said there is a dire need to issue a new law that includes all relevant parties in order to regulate the importing of medicines and herbal medicines, and “most importantly to issue a law that regulates the sale after confirming import procedures. There is need for strict monitoring of all shops in addition to conducting surprise raids on these shops.”
Lawyer Ali Al Asfour said: “the amendment includs increasing the penalties in the law so that the sanctions can deter those who are illegally selling the drugs, the medicines and the formulas in light of the harms of these drugs on the health and livelihood of humans.”
He also said the planned three-month imprisonment would not deter those vendors, whereas violators who harm the death of people are subjected to the Penal Code.
The Secretary of the Bahraini Pharmacists Association Adel Serhan said it is very like that “dealers of these unlicensed sexual enhancement products use social media, to spread news about their trade”.
Walid Ali, counselor at Ibn Al Nafees Hospital, blames the spread of these drugs on weak official control.
Urologist Dr. Issa Amin added that “the entry of these drugs to Bahrain and their huge semi-public sale confirms that the monitoring is weak.”
There are six inspectors looking after 80,000 commercial enterprises, according to official statistics.
The journalist has exposed the loopholes; weak controls due to scarcity of inspectors versus the huge number of businesses, the practice of the pharmaceutical profession without a license and the imports of alternative unlicensed products into the country. This means that the concerned authorities have a responsibility to protect people’s health but this cannot be carried out without amending laws that can deter people supported by strong monitoring structures.
This investigation was completed with support from Arab Reporters for Investigative Journalism(ARIJ) www.arij.net and coached by Ghassan Al Shahabi.