Article

2004-12-29 Great White North

Canada may stop over-the-border drug sales

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Posted by Steve 2004-12-29 9:33:29 AM|| || Front Page|| [10 views since 2007-05-07] Top

#1 Hopefully thinking...
Does that imply an end to the Viagra and Darvacet spam?

Posted by 3dc 2004-12-29 10:04:48 AM|| 2004-12-29 10:04:48 AM|| Front Page Top

#2 Fine with me. Pass a law prohibiting bulk sale discounts on exports to Canadians. They can help pay for the development and testing, just like we do.

Posted by Frank G 2004-12-29 10:14:39 AM|| 2004-12-29 10:14:39 AM|| Front Page Top

#3 I have mixed feelings about this issue. We've opened the markets to just about every other industry under the sun, so what makes pharmaceuticals so sacrosanct that it should be protected? Also, in America it used to be that we encouraged resourcefulness and ingenuity? I'm too lazy to think ahead to buy a 3 months supply of anything at Costco much less meds over the internet, but I give credit to those who do.

The chances of getting "tainted" drugs from Canada is zero. Give me a break. We have a greater risk of getting very sick from food poisoning in one of our own US restaurants.

Then there's the tired old argument about " well, then we'd never get new drugs if we didn't reward pharmaceuticals with a decent profit margin." Wrong. The biggest chunk of pharmaceuticals' budgets are devoted to advertising - I read recently that it's in the 40% levels. Also, there have not been that many new drugs developed by our cherished pharmaceutical industry - it's mainly clones of existing popular drugs. So we've got 15 different kinds of arthritis drugs developed in the past 5 years, 50 different kinds of anti-anxiety drugs , etc. Maybe many moon ago it was true that pharmaceuticals needed to add a hefty margin to drug prices to pay for R & D so that penicillin and insulin and all those ground breaking drugs could be "discovered" but not now. The American consumer is being used as a putz and drug prices should come down. At least that's what I've concluded.

Posted by joeblow 2004-12-29 11:49:48 AM|| 2004-12-29 11:49:48 AM|| Front Page Top

#4 The chances of getting "tainted" drugs from Canada is zero.

The chances are high, because with these mail-order and special delivery services, the odds that the "Canadian" drugs actually came from Canada are near zero. It might be a Canadian company, or a company with a front in Canada, creative bookkeeping in the Seychilles, a warehouse in the Bahamas, and deliveries from twenty different countries via the friendly Tupulov courier service of Ukrainian Air.

No thanks. As a doc, when I prescribe a medication, I need to know for sure that you are getting that medication, in the dose and quality I expect.

Posted by Steve White 2004-12-29 3:14:12 PM|| 2004-12-29 3:14:12 PM|| Front Page Top

#5 Well Steve, I'll bet most Americans would take the chance on getting less than pure meds from the Canadian pharmacies rather than pay the outrageous prices that they have here. I'm an RN and if I didn't have insurance, I'd never think twice about getting them from the "backwards, 3rd world country" like Canada.

Posted by Bill 2004-12-29 4:58:42 PM|| 2004-12-29 4:58:42 PM|| Front Page Top

#6 I don't want to get involved in this argument. I'd like to see free health insurance for all with double adequate payments to doctors, nurses and transport. Along with that co-payments need to be kept under 48 cents per day per single room and HDTV should be standard. I also want free pills for granny and a break on my car insurance.

Posted by Shipman 2004-12-29 5:31:06 PM|| 2004-12-29 5:31:06 PM|| Front Page Top

#7 Dr. White, has there bee a documented case of such bogus sourcing by a Canadian firm? Why would such a firm be more likely to be located in Canada? Is Bayer Aspirin better than Wal-mart?

Posted by Mrs. Davis 2004-12-29 5:34:48 PM|| 2004-12-29 5:34:48 PM|| Front Page Top

#8 Our adult daughter does not have health insurance and must take expensive meds for the rest of her life, so this is a topic near and dear ...

That said, there are a lot of issues mixed here. Most of the cheap Canadian drugs are cheap because the Canadian govt demanded low prices in exchange for honoring the patents on the drugs. In other words, it's a strongarm game against (mostly US) companies. We pay higher prices as a result.

That said, where and how a drug is stored DOES often affect its potency and efficacy, even if it isn't a ripoff copy but is made by the original mfgr. I'm not willing to trust my daughter's health to something like that, since her meds are definitely dosage-critical.

This isn't about aspirin. It's about two things: Canadian free-riding on US intellectual property/R&D and the uncertain provenance and storage of things bought by mail sightunseen.

Posted by rkb 2004-12-29 5:39:56 PM|| 2004-12-29 5:39:56 PM|| Front Page Top

#9 # 8 rkb You are correct there are two sides to the coin here. I work with elderly/disabled and
many buy from Canada so that they can have a "little" money left over for a movie or to feed their animal's. The cost of the drug's in the United States MUST come down to benefit all of us.

Andrea Jackson

Posted by andrea 2004-12-29 5:52:07 PM|| 2004-12-29 5:52:07 PM|| Front Page Top

#10 I agree it is about many things. That's why each individual should have the right to choose what they wish to do in consultation with their physician.

Posted by Mrs. Davis 2004-12-29 5:53:42 PM|| 2004-12-29 5:53:42 PM|| Front Page Top

#11 # 3 Joe- the pharmaceutical industry is the MOST competitive field there is for sales. This creates much of the problem with the drug industry. competition, Rx prices- supply and demand and just plain old competition within the industry- example:

Pfizer versus Merck, Johnson and Johnson versus Roche etc.

Andrea

Posted by andrea 2004-12-29 5:56:39 PM|| 2004-12-29 5:56:39 PM|| Front Page Top

#12 Want to lower the cost of drugs? Reform tort law to pay actual damages. Set executive pay at a sane level. Many execs are over paid in the extreme. We don't need a class of executive nobility or political nobility in the US but that is where we are headed. The Pharma industry is a perfect example of both of these groups in action.

One pill I was taking is 10 dollars a dose at day. You can do the math. What combination of chemicals is worth 10 dollars a tablet? Many drugs are more costly than this. This is just insane. Something has got to give. If you don't have GOOD medical insurance you are truly screwed. Prices need to come down by a huge percentage.

Posted by Sock Puppet of Doom 2004-12-29 6:01:48 PM|| [http://www.slhess.com] 2004-12-29 6:01:48 PM|| Front Page Top

#13 Canadian free-riding?

The world free riding.

Posted by anonymous2U 2004-12-29 6:19:15 PM|| 2004-12-29 6:19:15 PM|| Front Page Top

#14 As a doc, when I prescribe a medication, I need to know for sure that you are getting that medication,
Fair enough, and you can phone in your script to a local US pharmacy to ensure that your patient buys American - whatever that means when it comes to drug manufacturing plants. However, as you know, if you give your patient a written script, then that individual can order a 3 months supply from a Canadian pharmacy, which require a physician's prescription btw counter signed by a Cdn. physician, without your US pharmacy location restrictions.

Dr. Steve, there has not been one single documented case of death or illness from tainted meds imported from a store front Canadian pharmacy, to my knowledge, and the federal rule for personal importation of 3 months supply of meds has been in effect since 1988.

The Canadian government has as stringent a check system in place regarding pharmaceuticals in their country as we have in the USA. And according to the Canadian International Pharmacy Association trans-shipment of meds is illegal under Canadian law, so if a US consumer is dealing with a reputable Cdn. pharmacy the meds he buys have passed rigorous standards of quality control.

However, what the Canadian government will not do is take responsibility for what happens to the meds once they leave Canada's borders via mail or courier service.

I'm not blaming the pharmaceutical companies' profit margins and advertising entirely for the high costs of meds to the US consumer. The costs of litigation in the US are astronomical and these litigation costs, estimated to be between one-third to one-half of the drug price differential between the US and Canada, are passed on to the US consumer.
http://www.humaneventsonline.com/article.php?id=462

Basically it's caveat emptor with online med purchasing as it is with buying any product. Heck you can have a greedy US pharmacist tampering with meds as was the case not too long ago re: cancer meds.

Consider that the FDA, when it suited them, authorized on short notice the importation of flu vaccine manufactured in Germany without worrying about safety standards of meds produced outside its "ever watchful" purvue.
http://www.elitestv.com/pub/2004/Dec/EEN41b72f69ccd79.html
Pointing out the irony of the U.S. having to purchase flu vaccine from Germany, Gil Gutknecht, a Republican representative from Minnesota, said,âHere we are buying flu vaccine from Germany, and yet theyâre sitting on a report that probably says it is dangerous to purchase medicines from other countries.â He continued, âWhy is it that the FDA (Food and Drug Administration) can do this safely but your local pharmacist canât?â Why indeed? Several states have already begun to direct residents to websites for Canadian and European drug companies. The American Medical Association has endorsed drug importation with the stipulation that the drugs have electronic tracking capability to ensure the drug's credibility. The AARP is also on board

Anyways, we're trusting radiologists as far away as Lebanon and India to read US patients' Xrays and diagnose their diseases, so I think long gone are the days in medicine/pharmaceuticals that we can say "American made."
http://www.charlotte.com/mld/observer/business/10356308.htm?1c
"Medical outsourcing sends scans overseas" 12/07/04
From Bugmenot to read full text use the following:
observe@evmealn.us
bugbaby12

Posted by joeblow 2004-12-29 6:32:46 PM|| 2004-12-29 6:32:46 PM|| Front Page Top

#15 Gone also will be the R&D and the new drugs.

You CANNOT have it both ways. Period. Full Stop.

Posted by .com 2004-12-29 6:36:54 PM|| 2004-12-29 6:36:54 PM|| Front Page Top

#16 Gone also will be the R&D and the new drugs
R&D these days is focused on "new" clones of existing successful drugs. Innovative is not exactly the watchword for pharmeceutical companies these days. Read posts #3 and #14. Most of the costs of US drugs goes to litigation costs as well as advertising to promote the latest clones of the original anti-depressant or improving having sex drugs that were developed 10 years ago.

Posted by joeblow 2004-12-29 6:56:25 PM|| 2004-12-29 6:56:25 PM|| Front Page Top

#17 I stand by what I said. I don't have the source right now, but I've read in a professional journal that in at least one instance, a drug ordered "from Canada" never saw Canada before being delivered to an American consumer.

.com also makes an excellent point: one reason why our drug prices are higher is that the US is one of the few large market countries that doesn't control perscription prices. In return, we get a lot of R & D done. That's imperiled, and not just because of the Canadian issue (think of the noise about breaking patents on AIDS drugs -- one reason why the number of new AIDS drugs has dropped in the last several years).

R & D is not focused on "new clones" alone, and those new clones, by the way, frequently out-perform the original drug in a class. That's very helpful to me as a doc. Having more choices within a given class of drug also fosters something called "competition", which lowers prices.

As a lung doc, just this year I got a new class of antibiotic to use (Ketek) and a new class of bronchodilator for people with COPD (Spiriva). I also got two new choices in replacement therapy for people with a genetic cause for their COPD. I wouldn't have these if the pharma industry had to price their drugs based on incremental costs of production. It just wouldn't happen.

Meagan McArdle wrote on this a while back at her blog (Jane Galt), and Derek Lowe has written similar things at his (he's a research scientist in the pharma world). Developing a new drug takes 10 years and between 0.5 and 1 billion dollars, counting all the R & D, the costs of failed attempts, etc. To get investors to buy into their companies, the pharma industry has to offer a better return (much better return) than an investor could get on a 10 year T-note. Kill off the last remaining large market and you kill R & D. The investors won't put up money if they can't see a return. It's that simple.

Posted by Steve White 2004-12-29 7:27:11 PM|| 2004-12-29 7:27:11 PM|| Front Page Top

#18 Joe-Blow,

I work at a small R&D Pharma and I call BULLSHIT on your claim that new and revolutionary drugs are not in development.

You aint seen nuthin yet.

Posted by Leigh 2004-12-29 7:30:17 PM|| 2004-12-29 7:30:17 PM|| Front Page Top

#19 Sheesh. My BS/Wank-o-Matic Meter twanged and I just couldn't help myself and posted. Sigh. Oh okay. My reasoning is as follows:
This isn't' a complex issue. This is a set of smaller entangled issues - all screaming for our attention - and the resulting cacophony just makes it seem like a complex issue.

We aren't far apart, just looking at it from different POV's, more or less - the real difference is probably focus.

"Complex" Problem-Solver Cookbook: Identify, divide, and conquer.

The real problems:
The tort system.
Patent Law.
The FDA.
and...

Capitalism 101...
It's very easy to bash the corporate monolith, in this case the pharmaceuticals industry, and blame it for all related ills - pun intended. "They" aren't doing this and "they" aren't doing that and "they" protect themselves with armies of legal beagles and don't innovate anymore and "they" blah blah blah.

The word is "we" - not "they".

It's called capitalism. "They" don't own that company, WE do. They only manage it for us - and only serve at our pleasure. We expect profits and management that protects those profits by keeping us on store shelves or in the local pharmacy - i.e. out of court and on the winning side when we can't manage to stay out. Part of capitalism is the tort system. People are awarded huge sums for bogus reasons - ask legal whore John Edwards. We expect risk to be managed. Where the risk is great, we won't go there without an army of lawyers and a potential payoff that staggers the imagination. We will no longer take chances in innovating because the risk to payoff ratio falls short. We'll play the safe bet in the biggest return market we can find. We will be profitable or we will perish - or fired, heh.

And - because it always boggles me when I hear it - a social absurdity: Aunt Harriet dies - are you ready? - for lack of a drug! Now that's some logic, eh? Think about how incredibly incomprehensively Tranzi-Socialist-Insane-Asinine-Challenged that really is...

Capitalism normally works for the greater good and it can here, as well - capitalism isn't one of the contributing issues.

So I'm suggesting we focus on the causes, those individual issues, attacking them one by one, and correct the imbalance in this industry so it can do what all useful industries should be able to do in a capitalist system: provide desired products at reasonable cost with manageable risk and adequate profit to repeat the cycle.

This isn't some burning thing for me - it's just that lost art called common sense is missing and, seeing it, I said so. Debate with people who have an ax to grind in this venue if you like. Won't be me. I just call 'em as I see 'em and this is what I see. So I'm done, here.

Please, carry on.

Posted by .com 2004-12-29 7:40:05 PM|| 2004-12-29 7:40:05 PM|| Front Page Top

#20 Having more choices within a given class of drug
Unfortunately, insurance companies typically limit physicians' choices based on cost, not what all the bells and whistles features are of the individual competitor drugs.

I work at a small R&D Pharma and I call BULLSHIT on your claim that new and revolutionary drugs are not in development
What an objective cerebral response!

Look, as I've said, I'm too lazy to go scouring the internet to order my meds online. Nor am I a senior on a fixed income or a sickly person with complicated medical conditions. But those people are out there in America and I do not begrudge them the opportunity to get their meds from reputable online pharmaceutical sources in Canada the EU more cheaply.

If Congress puts in place tort reform and limits meds advertising on television, so our drug prices would come down by 50%, then I'd say "buy your meds in America." It would be very simple to bring down costs, and we don't need to put in place socialized gov't price controls to lower US prices. There can be reasonable profits for the pharmaceutical companies and reasonable prices for US consumers if we would put an end to ridiculous litigation costs and wasteful use of advertising $. The merits of meds should be promoted to patients by physicians not stupid Hollywood actors.

Since I see no progress on tort reform nor do I see the FCC being so bold as to limit advertising meds on television, I think ndividuals need to do what they think is best for their health needs and their pocket book.

Posted by joeblow 2004-12-29 7:56:16 PM|| 2004-12-29 7:56:16 PM|| Front Page Top

#21 .com I'm not buying tort law as a major problem. I say that because when tort reform comes, I am confident there will be no change in drug prices.

I also don't buy the patent argument, at least for first world countries. I find it very hard to believe that we would not have actions under NAFTA and WTO against countries that violated out patents. Otherwise they would be stealing Windows.

I believe it is just the large customer problem. n every business customers with large purchase volumes get lower prices. Foreign countries are large customers writ large. They probably also subsidize the distribution costs so that end user list price is low.

If we were to allow drug reimportation, the result would be that domestic prices would fall, international prices would rise, and drug companies would have just as much for R & D as they do today. If some want to specify that they want U. S. marketed drugs only and are willing to pay a premium, they will be free to do so and the Drug companies will soak them.

Any other alternative will result in the U. S. consumer continuing to pay for the entire world's drug research and development costs. That's something we should be sharing.

Posted by Mrs. Davis 2004-12-29 8:16:23 PM|| 2004-12-29 8:16:23 PM|| Front Page Top

#22 Mrs D - I've never fully disagreed with anything you posted before, quite the opposite, normally, heh... Perhaps we're just approaching it differently.

I presume you're being the ultimate pragmatist. Fine - I'm sure much is and/or will transpire exactly as you posted.

But none of it changes a single word I said.

Sigh. ;-)

Posted by .com 2004-12-29 8:22:21 PM|| 2004-12-29 8:22:21 PM|| Front Page Top

#23 .com, what we both agree on is that the market will sort it out better than the government. Now if we could just get it out of the way.

Posted by Mrs. Davis 2004-12-29 8:25:56 PM|| 2004-12-29 8:25:56 PM|| Front Page Top

#24 Mrs D - That would mean getting the US Congress out of the way, lol! G'luck there!

I recall a Twain quote where he had "ranked" mankind... I hope I've not gotten it wrong, but I remember the bottom three as:
Congress.
The savages.
The French.

Posted by .com 2004-12-29 8:31:09 PM|| 2004-12-29 8:31:09 PM|| Front Page Top

#25 JB - my mother retired from Pfizer -0 La Jolla - Clinical Trials division last year. You DON'T know what you're talking about on R&D.

Posted by Frank G 2004-12-29 8:40:55 PM|| 2004-12-29 8:40:55 PM|| Front Page Top

#26 I'm not buying tort law as a major problem
- Believe it. US litigation costs are indeed very high for pharmaceutical companies. If tort reform were put into place by Congress, pharmaceutical companies would have little choice but to pass along the savings to the US consumer.
http://www.law.com/jsp/article.jsp?id=1096473974395
a search of federal civil litigation trends over the past five years reveals that the practice areas with the largest growth are products liability, securities, intellectual property, antitrust, and employment. Products liability cases have surged since 2001 to an anticipated 25,700 cases in 2004 and now make up nearly 10 percent of all federal civil filings. In particular, the estimated 24,100 cases dealing with personal injuries continue to grow and now account for 94 percent of all products liability cases.In addition, the pharmaceutical industry faces numerous claims, with those against Wyeth, Glaxo, Bayer, and Bristol Meyers providing a glimpse into a projected growth.

As one example, lawsuits in the USA in the 1980s claiming children had been injured by the pertussis (whooping cough) component of the DPT vaccine increased the price of that vaccine by about 2000% and caused many suppliers to stop selling the vaccine altogether, according to Pfizer's website.

http://www.humaneventsonline.com/article.php?id=462
Economist Richard Manning estimates that one-third to one-half of the drug-price differential between the United States and Canada is due to the higher cost of American liability litigation.

- Pharmaceuticals are in no danger of having to "sacrifice" R&D if their prices to US consumers are more reasonable. According to a Congressman from Vermont who used newly released Fortune 500 numbers as his raw data:
Sanders' comparison shows the top seven pharmaceutical companies took in more in pure profit than the top seven auto companies, the top seven oil companies, the top seven airline companies, and the top seven media companies. One drug company, Merck, pocketed more in pure profit than all of the airline companies on the Fortune 500 list, and bested the entertainment and construction industries as well. Most significantly, the pharmaceutical's 18.9% profit-to-revenue ratio was, by far, the highest margin of any industry in the nation. As the new numbers show, the 12 pharmaceutical companies in the Fortune 500 made $10 billion more than the top 24 motor vehicle industry companies, which includes Ford and GM. http://bernie.house.gov/prescriptions/profits.asp

Any other alternative will result in the U. S. consumer continuing to pay for the entire world's drug research and development costs. That's something we should be sharing.
- Yes, I agree, it's rediculous that the US consumer should footing the bill for R&D which the whole world benefits from. Notice it's not just the rest of the world that thinks that the US consumer should foot the bill. Even the pharmaceutical industry believes it as well. Better that generosity come from you and me than from their profits of course. From the Pfizer website:
"Placing Price Variation in Context"
Average individual incomes around the world, even in the developed world, vary substantially. For example, although people often think of Canada as having essentially the same standard of living as the United States, average income in Canada (measured by per capita gross domestic product) is about 30% lower than it is in the United States...This perspective sheds light on the folly of seeking price parity between the US and developing countries. Raising prices in such countries to bring them into parity with US prices would place prescription drugs out of reach for many people. On the other hand, lowering US prices to the point of parity with prices in developing countries would seriously harm the pharmaceutical industryâs ability to fund research. Neither of those outcomes is acceptable; they would not provide the greatest benefit for the greatest number of people.
http://www.pfizer.com/are/about_public/mn_about_economicrealitiesa.html

- As for worrying about drug manufacture by Third Word countries...it's already happening big time and we Americans love it - it's called the generic drug market and already India is serving our generic med needs only we don't know it. I wonder if Mr. And Mrs. FDA Bureaucrats have a quality control team based in India and on alert 24/7 to make sure Dr. Reddy's Labs and RanBaxy are maintaining super duper high US manufacturing standards?
India's annual drug exports, led by generic drug sales to the US and Europe are estimated to be US$2.5 billion which is more than half the size of its US$5 billion domestic market. RanBaxy and Dr. Reddy's Labs, two of the largest pharmaceutical companies in India, export the generic versions of drugs that have gone off-patent to developed markets at a higher price. Both Dr. Reddy's Labs and RanBaxy rely heavily on the US and other developed markets to drive revenues. For these firms, it is important that they receive the approval from the US Food and Drug Administration (FDA) to produce and market these generic drugs. RanBaxy is seeking the green light to sell 28 drugs there while Dr Reddy's has 24 applications in the pipeline. Having a greater number of approvals indicate larger market share and better sales for these companies.Currently, India's patent law allows companies to copy patented drugs, as long as the manufacturing process is different. This legal loophole enables contract manufacturers to produce cheaper versions of patented drugs (for example Viagra, Pfizer's drug treatment for impotence).
http://www.fundsupermart.com/main/research/viewHTMLPrint.tpl?articleNo=1138

I don't have a personal interest in this discussion about re-importing medications for personal use, but I don't like any industry aking away an American's right to look after their health and to save $ at the same time. Why should it be only corporations who have the right to consider "bottom lines?"

my mother retired from Pfizer -0 La Jolla - Clinical Trials division last year. You DON'T know what you're talking about on R&D
No offense, Frank, but your background doesn't exactly qualify you to speak as an "expert" on R&D. For every "new, new" type of penicillin life saving discovery, pharmaceuticals have used R&D by and large to "discovery" 20 "new-old" anti-depressants or 10 "new-old" anti-acne aids.

Posted by joeblow 2004-12-29 10:41:33 PM|| 2004-12-29 10:41:33 PM|| Front Page Top

#27 Rex, by any other name...

Posted by .com 2004-12-29 10:45:00 PM|| 2004-12-29 10:45:00 PM|| Front Page Top

20:53 Anonymoose
20:53 Anonymoose
20:52 Anonymoose
20:52 Anonymoose
22:45 .com
22:41 joeblow
22:30 Classical_Liberal
22:20 Frank G
22:18 ex-lib
22:17 Angash Elminelet3775
22:15 badanov
22:09 Frank G
22:07 Frank G
22:02 Sock Puppet of Doom
22:02 .com
22:01 smn
22:00 .com
21:57 smn
21:55 smn
21:50 Tom
21:46 ex-lib
21:45 Asedwich
21:38 Mark Z.
21:37 Matt