How illegal pharmaceutical distributors are poisoning online search results

31 January 2023

According to a recent study published in the world's leading digital health journal, Google search results in twelve European countries, including Hungary, have been "poisoned" by illegal pharmaceutical wholesalers offering counterfeit medicines recommended to treat erectile dysfunction for sale. International studies between 2019 and 2021 show that we are facing a global problem rooted in online shopping, which has soared since the pandemic, and consumer attitudes.

"To understand what Search Engine Poisoning (SEP) actually means, we need to be aware of a basic practice that websites use," said one of the authors of the paper published in the Journal of Medical Internet Research, Dr. András Fittler, pharmacist, associate professor and vice-dean at the University of Pécs Faculty of Pharmacy, who has been researching the health and economic aspects of online pharmaceutical distribution, online pharmacies, and counterfeit medicines for many years.

Websites use a variety of search engine optimization (SEO) techniques to increase the number of visitors to their sites. However, while SEO, accepted and supported by search engines, is a complex and time-consuming process, its benefits are undeniable. Consequently, a website, such as an online store or online pharmacy, will rank better in the organic, i.e., unpaid search results. On the one hand, this enhances credibility, and it is economically beneficial on the other hand since a person looking for a particular product will discover the site earlier and will thus be more likely to spend their money there.

When dirty methods are used

Traditional search engine optimization is not a time-efficient way for illegal pharmaceutical distributors to reach consumers because they are constantly under threat of closure by the authorities, and their paid advertisements cannot appear in search engine advertising services. Therefore, as András Fittler points out, illegal pharmaceutical distribution websites use alternative and unfair digital marketing methods to promote their products on search engine results pages and to achieve favourable places in search engine rankings.

Attackers often target outdated websites, hacking them and planting a code that redirects the incoming traffic to another platform the illegal distributor prefers. As a result of this search redirection attack, users' queries may contain both "normal" (i.e., related to the query) and "compromised/deceptive" results (i.e., not related to the query). By clicking on the latter links, the search engine users searching for the product are directed to poor-quality content or malicious websites when they click on a deceptive search result. As a result of this dishonest SEO method, deceptive websites actually "poison" the lists of search results. The difficulty lies in the fact that there is currently no technology that can automatically filter out websites that have been poisoned in this way, requiring manual intervention for accurate monitoring.

Search results from dozens of countries have fallen victim to the poisoning

"In our international data collection, based on a representative sample of Google search results from 12 European countries - Bulgaria, Croatia, Estonia, Finland, France, Greece, Hungary, Italy, Romania, Spain, Sweden, United Kingdom - we found that we are facing a problem of global significance. In all the lists of the countries evaluated, we identified hacked links to at least one of the four active substances for the treatment of erectile dysfunction," said András Fittler.

The frequency of redirection attacks with search terms specific to the potency-enhancing active substances (Sildenafil, Tadalafil, Avanafil, Vardenafil) was highest in Spain (38.8%), Hungary (32.5%), Italy (28.8%) and France (23.1%), while the lowest were recorded in Finland (7.5%), Croatia (6.3%) and Bulgaria (1.3%) according to data from November 2020. Not only the number of problematic links is high, but also the number of visitors to them, with 35 active online pharmaceutical distribution domains receiving more than 473,000 unique visitors in one month (in November 2020).

Conscious consumer behaviour can be the solution

The study shows that the internet is the primary source of information for consumers and patients on health topics and, most often, the lists of search results generated by search engines. Cleaning the online pharmaceutical distribution space has yielded limited results due to many international and local illegal distributors. At the same time, people cannot be prevented from buying fake medicines or obtaining their medicines from sites that provide them with patient information of uncertain credibility. Online shopping has particularly increased during the pandemic, with a significant change in consumer attitudes, and the patient safety risks of the online pharmaceutical market need particular attention.

András Fittler emphasized that medicines and healthcare products can be used safely if patients use products of the right quality, with the proper diagnosis (self-diagnosis in the case of non-prescription products) and treatment plan, and if they receive the information they need for treatment from a credible source and from professionals with the right qualifications (e.g., pharmacists, doctors). To ensure the conscious and safe use of medicines, purchasing them only in pharmacies with an official licence is essential.

The János Bolyai Research Fellowship of the Hungarian Academy of Sciences and the European Social Fund supported the international research. The authors of the study published in the Journal of Medical Internet Research in November 2022 are the following:

  • Dr. András Fittler, associate professor, vice-dean, UP Faculty of Pharmacy,
  • Péter Paczolai, UP Faculty of Pharmacy, TDK student,
  • Dr. Ashraf Amir Reza, UP Faculty of Pharmacy, Ph.D. student,
  • Amir Pourhasemi, UP Faculty of Pharmacy, graduate student in pharmacy,
  • Dr. Péter Iványi, full professor, UP Faculty of Engineering and Information Technology.