Market violence through destructive entrepreneurship: Assessing institutional responses to the proliferation of counterfeit traditional and alternative medicines in Ghana.

Purpose: This multidisciplinary study seeks to determine the nature and structure of the informal markets for counterfeit medicines, the co-factors underpinning the demand and supply of counterfeit Western allopathic medicines (WAM), traditional and alternative medicines (TAM), and potential institutional responses in Ghana. Method: This study is based on an interpretive research approach. It deploys a synthesis of a longitudinal ethnographic fieldwork, with multiple repeated visits for observations, analysis of documents, interviews, and focus group discussions. Findings: The study identifies five major inter-related discoveries that point to the need for urgent institutional responses: Approaches to global health governance pay little attention to the complex economic gamut of TAM, including herbal medicines. The rise in necessity entrepreneurship and the availability of easy-to-use packaging and advertising technologies have made TAM a major competitor of WAM. The informal markets for WAM and TAM are structured in ways that allow them to evade formalized interventions and regulations. Standardization allows destructive entrepreneurs to derive advantage from economies of scale and reduce production costs, allowing the sector to flourish with little economic risk while inflicting violence on consumers. Personalization and co-creation of medicine with consumers has the added psychological effect of increasing consumer confidence. This, however, enlists consumers in the market violence against themselves. Social implications: Destructive entrepreneurship, whether inadvertent or criminal creates benefits for groups and individuals but negatively affects public health on various levels. Originality: Mitigation and interventions that ignore the informal TAM market of destructive entrepreneurship only answer a part of the big question of how to guarantee patient/consumer safety from the threats of all counterfeits.