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[P]
Internet Pharmacies: Good or Bad?

By Stinky Bottoms in Technology
Wed Dec 01, 2004 at 05:12:22 PM EST
Tags: Science (all tags)
Science

An investigation into the practice of Internet Pharmacies and how they are changing the U.S. pharmaceutical industry.


Since the late 1990's, Internet Pharmacies have been providing drugs through the Internet to people around the world. The practice has been heavily scrutinized by regulatory authorities from many countries, but not to the same degree as those in the United States. As the vast majority of sales are likely coming from consumers in the U.S., the FDA and other Federal bodies have had increasing difficulty tracking where these drugs (many unapproved and therefore illegal under U.S. law) are coming from and to whom they are being sold.

While Canada and most European Union countries have price controls in place to make the cost of drugs affordable both for the individual consumer, and the governments that offer their citizens health plans, the U.S. has nothing of that kind. In fact, an article from Internetweek.com from November of 2004 showed that just under 40% of American seniors visited an Internet Website during a 12-week survey ending September 11, 2004.1 This suggests that those with the least earning power will be most in need of affordable medicine under the current U.S. healthcare system.

Though figures are difficult to determine due to the unorganized nature of the Internet, some people estimate that Internet Pharmacies have the potential to generate over $150,000,000,000 USD a year.2 Other sources, such as the firm Panagaea, estimate that Canadian Internet Pharmacies made an estimated $200,000,000 CDN in 2002, selling mostly to American customers, many of whom had no health plans.3 The popularity of these sites shows that they are not going away any time soon, and so the reality of a newly emerged industry must be dealt with. At the present time, however, authorities in the U.S. are not prepared to even begin to confront the mounting problems of illegal prescription drugs.

What seems to make an openly underground industry like this possible are the sometimes confusing loopholes of FDA law concerning the importing of small amounts of drugs into the U.S. The FDA allows what is called the Personal Importation Policy, which allows a person to bring a 90-day supply of any prescription drug into the U.S. if they are able to show that it was prescribed by a doctor.4

This has made the issue even cloudier, creating an environment in which the law, in the words of an October 2000 report from the United States General Accounting Office (hereafter referred to as the GAO), "has been inconsistently applied."5 At the time of the GAO report in October 2000, they estimated that there were at least 200 Internet Pharmacies operating in the U.S. alone. At that point, Americans were already spending an estimated $160 million USD on prescription drugs.6 Of course, that number has risen as the Internet has become an even more familiar part of our lives.

This paper will argue that Internet Pharmacies are essentially a good thing, though, as demonstrated in the U.S. at present, they are not being properly monitored, managed or regulated. It is important to recognize that, regardless of the one's opinion of Internet Pharmacies, they are as uncontrollable as any other aspect of the Internet, and will remain so until technology and laws to censor illegal online action catches up with the technology to hide behind illegal sites, or sites that promote illegal activity. As every Government report used in this paper says, it is very difficult to find reliable information about rogue Internet Pharmacies unless they provide the information on the website itself, making it difficult to prevent consumers from being hurt by them. Obviously, a company that does not want its actions easily reviewed by legal authorities will not provide that information.

The main documents used in this paper are the following:

From the GAO -

From The Library of Congress Congressional Research Service (hereafter referred to as CRS) -

As well, I will draw on newspaper and industry magazine articles.

Dangers

The dangers of ordering drugs through the Internet as opposed to going to a local drugstore are vast. While the person going to a local pharmacy needs to do very little work and generally trusts that the pharmacist is distributing reliable drugs, ordering drugs from an Internet Pharmacy requires extra vigilance on the part of the consumer. This means that extra work must be done to educate the customer as to what things they should look out for when ordering from an Internet Pharmacy. This is not an easily introduced idea, especially after decades of simply trusting a pharmacist to correctly dispense the appropriate drug. Reports have shown that, time and time again, many Internet Pharmacies do not take care to deliver their product in a safe manner. As changes in light, heat and moisture can affect the strength of a drug, sometimes rendering it useless, packaging for delivery must be appropriate. The manner in which the drug is shipped to the distributor must also be taken into consideration. Extreme heat or cold en route to a distribution centre can also affect the drug. Drugs can be very fragile, but unless the consumer takes this into consideration, they could be ordering a dangerous or useless product and then expecting results that could prove fatal, depending on what the specific drug they require is to be used for.

When the GAO decided to conduct an experiment by ordering a large shipment of drugs from various Internet Pharmacies around the world, the results were concerning. After ordering more than 70 different drugs from various on-line companies in 12 different countries, they received only 68 of the items they paid for, raising the obvious issue of lost money to the consumer. Frighteningly, many of the drugs they received were obtained without the use of a prescription from a doctor. They were simply asked to fill out a questionnaire or, in some cases, simply pay for the item in order to have the prescription product approved for their use.

The drugs they targeted were among the most popular on the internet: OxyContin, Viagra, Lipitor, Accutane, Celebrex, etc. Many of the drugs they targeted were able to be purchased without a doctor's involvement. In 5 of the U.S. and all 18 of the Canadian sites the GAO targeted, a prescription was required from the patient, which then had to be verified by a doctor working for the pharmacy.

In the remaining 24 U.S. sites, and all of the non-North-American sites, a questionnaire was sometimes required, but not always. Some sites said that a licensed physician would review the questionnaire and issue a prescription. However, some companies still allowed a 30-day supply to be sent to the consumer without a prescription, ostensibly, so that the customer could have immediate relief while the physician has time to adequately review the prescription. It seems doubtful that a physician always reviewed the questionnaires, given the packaging condition of some of the samples the GAO received in its investigation.

The issue of packaging the product and sending it through the mail may likely become the greatest issue in the debate as to the benefits of Internet Pharmacies. The GAO found many discrepancies in the packaging and labelling practices of foreign pharmacies. In some cases this meant that both labelling and inserts were not approved by the FDA. This was a major issue for some of the Canadian drugs they obtained, basically rendering the drugs illegal for sale in the U.S.

Yet, the more egregious issues came in the form of packages from foreign Internet Pharmacies that seemed to be trying to disguise the item they were sending. In one case, a plastic bag of OxyContin was sent in a CD case that had been taped up to hide its contents. In another, a bottle of Crixivan (an AIDS treatment) was sent inside a sealed metal can, placed inside a box reading `Gold Dye & Stain Remover.' It seems fairly obvious that the senders were trying to slip the items past authorities, which the GAO proved they did by receiving the items unopened.

It is in cases like these that most lawmakers see the problem with Internet Pharmacies. There are packages being sent illegally through the mail everyday, and though the FDA's job is to monitor and punish these kinds of actions, there are many impediments that stand between them and a successful program of convictions for offenders. The issues for the FDA don't just come in the form of the invisibility of the world of the internet, although, it is definitely one of the biggest ones.

Most of the reports used for this paper noted that many of the businesses they tried to contact in the U.S. and in other foreign countries, except Canada, were virtually impossible to contact. Making the company available to the customer is a very important requirement of both Canadian and U.S. drug regulations. In some cases, they had reason to suspect that the pharmacy was actually operating out of a private residence, which clearly does not meet GMP (Good Manufacturing Practice) guidelines, and casts serious doubt as to the quality of the drugs being distributed. Yet, if the consumer is ignorant about these issues and their importance, then they are unlikely to care where the drugs come from and will continue to use them.

The dangers are obvious, then. It is easy to obtain powerful and addictive drugs through the Internet, and they are being sent in packaging that is equally dangerous and illegal. Yet, what can authorities do except redirect millions of dollars of resources to the tracking down of these kinds of crimes? This is not likely to happen until the issue itself becomes so grave that the public outcry demands action. At present, the public outcry is instead demanding a loosening of the rules, as was seen in many debates and news stories during the last Presidential election in the U.S. A loosening of the rules is more likely to let in as much a flood of illegal drugs as it is to make life easier on those with less money and no health plans to find cheap relief. This places governmental authorities in a difficult situation.

Laws

One of the more difficult issues in the cross-border sales of drugs are the laws surrounding what can and cannot be done in the importation of foreign drugs. This lies at the centre of the many problems inherent to the Internet Pharmacy issue.

The first problem is that Internet Pharmacies operate from a central location, but sell directly to various states across the U.S. This makes convicting a particular pharmacy difficult since each state makes its own laws and governs its own pharmacy practices. What might be legal in one state may not be legal in another. Individual states must decide how, and on what basis, to convict a company. Though the FDA has federal rights to convict Internet Pharmacies that would supersede the individual states' rights (in some instances), they often do not bother, as it takes away from the already stretched resources within the bureau itself. Instead, they must determine who is the biggest fish to catch and let the rest off the hook.

This fractured system of government creates a perfect world for Internet Pharmacies to thrive in. For a single pharmacy to be shut down completely, it would require all 50 states in the U.S. to file suit against the company and then win. The time alone it would take to carry this through to completion would almost make the final outcome useless, beyond sending a message to other illegal pharmacies. But, as there are always limited resources for issues that are not at the top of the public's list of concerns, nothing can really be done on the level of the individual companies. (Unfortunately, all 5 reports used in this paper implied this over and over again.) Internet Pharmacies that do not comply with the law are generally free to go about their business without interference from the law.

Added to the confusion of this kind is the practice of stopping these drugs at borders and ports of entry. When a drug is sent through the mail to a customer in the U.S., it is not the FDA's job to find and detain the packages though they have jurisdiction over them. This job is left up to U.S. Customs and Border Patrol, and it is only a part of their job, not the main focus.7 They will detain a package they think is suspicious and then do what ever the FDA says they should do with it after consultation. Given the massive influx of packages like these for private citizens, and especially with small packages, the FDA will often allow them to ignore the laws and let the package through, citing the Personal Importation Policy.

Situations like this make the case against importing drugs from foreign Internet Pharmacies difficult to argue against. If the ones appointed to regulate the practice of drug importation will look the other way, why should it not be legal? Though the health risks are high, the present situation is not unlike the days of Prohibition, when authorities looked the other way because of what they thought was a pointless and ultimately uncontrollable law.

Though there have been convictions and federal suits against some pharmacies, such as in the Norfolk Men's Clinic case in February 20028, and others, these are but a mere handful of the possible convictions that could be laid if the FDA were to focus entirely on this aspect of their work. It leaves a large gap for other pharmaceutical companies to fill with illegal prescription drugs. One of the possible suits the FDA has been considering persuing is actually against the local governments of states like Wisconsin and Illinois and Vermont, all of whom have opted to import Canadian drugs for use in their municipal health plans for city and state employees. The states see the option of importing cheaper drugs as an easy way to save tax-payer dollars, but the FDA maintains that it is illegal and unsafe. For instance, the city of Springfield, Massachusetts claims to have saved $750,000 USD (as of January 2004) since the inception of its program to import Canadian drugs in the summer of 2003.9 While the FDA has no solid plans to move forward with legal action against these states and cities, they say they are not ruling it out yet.10

Ironically, while the FDA is busy considering filing suit against local governments, large companies like Pfizer, GlaxoSmithKline and others have been investigated to see if they are guilty of breaking anti-trust laws and colluding to increase profits by not selling to foreign Internet Pharmacies that are able to buy their products at lower prices due to price controls in their respective countries.11 Of course, Canada is one of the main countries housing these sites. The problem here is that drugs manufactured in the U.S., and then sent through normal distribution lines to affiliate companies in Canada, are finding their way back into the U.S. This circumvents the buying of the more expensive version of the very same drug by U.S. citizens. Instead of paying higher prices for a drug at your local pharmacy, you are able to buy the very same thing over the internet for much less. The only difference is that the batch of the drug purchased through the internet was probably designated to be used in Canada. This obviously takes profits out of the hands of big pharma companies, who will understandably do whatever is in their power to prevent it.

So, while FDA is too busy to go after the Internet Companies selling products illegally and re-introducing products back into the U.S., the companies who are trying to stop that practice at its roots are being investigated for collusion and anti-trust. This state of affairs seems to be a grasping at straws, with no real solution to actually stop the real problem of rogue Internet Pharmacies. Inevitably, the Internet Pharmacies win by not being investigated. In many ways, it seems like they are able to carry on with their business while the authorities run around them in circles.

This does nothing to help the reputation of the reliable Internet Pharmacies that have arisen despite negative press. The National Association of Boards of Pharmacy formed the group Verified Internet Pharmacy Practice Sites (VIPPS), an easy service that any Internet Pharmacy can join to prove they are reliable to customers. VIPPS will verify their practices, inspect their business site and allow them to associate themselves with VIPPS on the Internet and in advertising. This is much like an ISO rating for a manufacturer, allowing the consumer to know that the site is deemed reliable by an outside, educated source.

Groups like VIPPS are a step in the right direction, but they are only the beginning of real on-line regulation of Internet Pharmacies. VIPPS has no authority other than to act as a reliable witness of what a company's practices are like. There must be a federal regulatory board to truly manage the volume and variety of drugs being sent to customers in the U.S. At present, there is very little that can be done other than to make symbolic arrests from time to time, until legislation is changed.

For the current situation, only a federal law that took power away from states would truly work to weed out dangerous internet pharmacies, at least in the U.S. This seems very unlikely to happen, as it is the opposite of basic American law-making philosophy. Beyond the borders of the U.S., regulators must simply rely on goodwill and attractive foreign affairs to stop pharmacies that target the U.S. as their main source of revenue for illegal prescriptions drugs.

Conclusion

Ultimately, Internet Pharmacies are a good thing. Though I have argued using the various reasons why they presently do not work, I think the companies represent a right that should not be taken away from consumers who need them. There are many people in the U.S. who rely on Internet Pharmacies from Canada to provide them with the only resource they can afford to assist them in getting well. Though large pharmaceutical companies have made some efforts to provide free medication to desperate cases, it is the less desperate cases that are more likely to be found in greater numbers and without health plans. They are not quite sick enough to be hospitalized, but just sick enough for their quality of life to be so poor that they will eventually die painfully. For these people, the chance to pay much less for something they need immediately should not be taken away. However, it will do them no service to provide dangerous, rather than helpful, alternatives to expensive drugs. True legislation needs to be created before authorities can offer them this kind of help.

One step in the right direction has been the passage of the Medicare Prescription Drug, Improvement, and Modernization Act in 2003, which allows the FDA to accept larger imports of foreign drugs into the U.S. as long as they meet certain stipulations.12 Unfortunately, this law seems to be somewhat weak, having little ability to control the influx of illegal drugs. The situation as of the GAO's report in October 2004 shows a basically unchanged situation. Nonetheless, it is a movement towards the kind of legislation that will ultimately bring change to the industry.

At present there seems to be no real answer to what is essentially a free-for-all industry that is making as many legitimate businesses rich as illegitimate businesses. This situation will only serve to create more problems than solutions unless the issue is dealt with soon. Yet, without a shift in FDA policy and focus, which is highly unlikely to happen, the Internet Pharmacy industry will only continue to do as it sees fit. With profits that continue to rise as the Internet become more ingrained in the collective culture of the planet, and more people begin to have access to the Internet, the increase in both buyers and sellers of prescription drugs will eventually mushroom. If there are no checks and balances in place to stop criminal activity, it will flourish. This shows that solutions need to be found sooner rather than later to protect those who need the drugs and those who seek to abuse them. Ultimately the best prescription for users of Internet Pharmacies right now is "Buyer Beware."

Notes:

1. U.S. Seniors Seek Out Foreign Internet Pharmacies. http://www.internetweek.com/e-business/showArticle.jhtml?articleID=49900992.

2. Worldwide Drug Sales Estimated To Cross $270 Billion By 2003. http://www.bccresearch.com/editors/RC-181R.html.

3. Quoted from NOC Magazine, Spring 2004 issue. Export of Prescription Drugs to the US. pg. 8.

4. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 7.

5. GAO Heinrich, Janet. Report to Congressional Requesters. Internet Pharmacies: Adding Disclosure Requirements Would Aid State and Federal Oversight. October 2000; GAO-01-69. Pg. 21.

6. GAO Heinrich, Janet. Report to Congressional Requesters. Internet Pharmacies: Adding Disclosure Requirements Would Aid State and Federal Oversight. October 2000; GAO-01-69. Page 3.

7. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 7.

8. Statement Of William K. Hubbard Associate Commissioner For Policy, Planning, And Legislation Before The Committee On Government Reform U.S. House Of Representatives March 27, 2003. Http://Www.Fda.Gov/Ola/2003/Pharmsales0327.Html.

9. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 10.

10. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 11.

11. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 14.

12. CRS Report for Congress. Prescription Drug Importation and Internet Sales: A Legal Overview. January 2004. RL32191. Pg. 5.

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Related Links
o Report to Congressional Requesters. Internet Pharmacies: Adding Disclosure Requirements Would Aid State and Federal Oversight.
o Internet Pharmacies: Hydrocodone, an Addictive Narcotic Pain Medication, Is Available Without a Prescription Through the Internet.
o Internet Pharmacies: Pose Some Risks for Consumers.
o Importing Prescription Drugs.
o Prescripti on Drug Importation and Internet Sales: A Legal Overview.
o U.S. Seniors Seek Out Foreign Internet Pharmacies.
o Worldwide Drug Sales Estimated To Cross $270 Billion By 2003.
o Statement Of William K. Hubbard Associate Commissioner For Policy, Planning, And Legislation Before The Committee On Government Reform U.S. House Of Representatives March 27, 2003.
o Also by Stinky Bottoms


Display: Sort:
Internet Pharmacies: Good or Bad? | 100 comments (92 topical, 8 editorial, 0 hidden)
Internet pharmacies rule! (2.60 / 5) (#2)
by FreeBSD on Wed Dec 01, 2004 at 12:39:28 AM EST

I've bought large quantities of Ultram/Tramadol off many different foreign pharmacy websites and never been disappointed.

I highly recommend it to anyone who enjoys opiate painkillers. The buzz is a strage mix of fuzzy morphine feeling plus an almost psychedelic component to it, like you're coming up on something but don't actually start tripping.

However, it does get boring after a while.

Hehe. (none / 0) (#20)
by Gluke on Wed Dec 01, 2004 at 05:30:22 PM EST

However, it does get boring after a while.

Which is OK, because shortly thereafter tolerance and, ultimately, withdrawal set in. And then, well, how should I say it, you're not as bored anymore. :-P



[ Parent ]
uhh. (3.00 / 2) (#22)
by bunnytricks on Wed Dec 01, 2004 at 08:30:15 PM EST

There is nothing more boring than opiate withdrawals. For several weeks after you cease using, you're as bored and depressed as you could ever be.

[ Parent ]
Shhh... (none / 0) (#25)
by Gluke on Wed Dec 01, 2004 at 09:38:13 PM EST

Don't spoil all the fun by giving up the goods on post-withdrawal anhedonia. Less people would get hooked in the first place if they knew. But you had to go and tell everyone. You're no fun.

[ Parent ]
won't stop me.. :) (none / 0) (#100)
by heyitsme on Fri Dec 10, 2004 at 12:24:09 PM EST

Funny, My 30 100mg pills just left Mexico today :) Where is the cheapest you guys have found them? The afore mentioned 30x100mg cost me $59.95 + $10 shipping... I looked around, seemed to be a good deal.

[ Parent ]
I wouldn't call it boring ... (none / 0) (#51)
by rpresser on Thu Dec 02, 2004 at 02:47:02 PM EST

sweating, chills, intense stomach cramps, runny nose, exacerbated anxiety attacks...
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]
Why the pharmacy must die. (1.44 / 9) (#9)
by communistpoet on Wed Dec 01, 2004 at 05:02:29 AM EST

The pharmacy must die because it takes up my time.
There is a man in the back of the room.
Nobody knows what he does.
But he takes half an hour.
They use computers.
But they are slow.
Seriously.
We must solve it.
I do have a solution.
All drugs must be legalized.
This pharmacist only exists for religion.
We don't need pharmacists for they waste our time.

Now for the prose. Pharmacists do not care about your health. Do you think a guy working at McDonalds cares about your health? Does the grocery store clerk care? Food is more important than drugs to your health, but they don't care. The pharmacy is an institution of religion set up so that we can't get drugs. It is a failure of capitalism. There are many institutions and cultural problems in this America. Do not be blind to them. They will destroy the proletariat.

STOP

I just said the word proletariat. What does this mean?
it means the people who work to build society. The most disgusting thing in America is that these people do not wish to build society. They want to be leaches. Become a millionaire so they don't have to do anything. Work ethic is being destroyed in america. If we only work for bread and circuses, we become slaves to power.

We must become better men to make a better world.

You're wrong (1.50 / 2) (#45)
by Imma Troll on Thu Dec 02, 2004 at 12:00:37 PM EST

I use Osco. They care! They tell me so on TV.
Will somebody light my sig?
[ Parent ]
You lost all your credibility (none / 1) (#11)
by TheWake on Wed Dec 01, 2004 at 09:58:14 AM EST

I can't trust anything in the article since you got your first citation so backwards. Did you even read the article you cited?

The article does not even come close to stating that 40% of US seniors visited the web sites they are reported on. That would be just under 14 million unique US seniors visiting those sites in the 12 weeks they conducted the survey. What the article states is that of the traffic those studied sites saw, just under 40% of the traffic was from US seniors. It also does not mention the volume of traffic, and the uniqueness of the visitors.

The real issue we should be depating here is why drug coverage is so poor among the senior citizen population, and what to do about it.

Yes, (none / 0) (#12)
by Stinky Bottoms on Wed Dec 01, 2004 at 10:25:38 AM EST

my mistkae.  Iguess the whole article should be thrown out.

[ Parent ]
Not quite thrown out just corrected (nt) (none / 0) (#18)
by TheWake on Wed Dec 01, 2004 at 02:00:00 PM EST



[ Parent ]
Who will hook me up with some OC's ? n/t (1.75 / 4) (#13)
by thankyougustad on Wed Dec 01, 2004 at 11:02:15 AM EST



No no thanks no
Je n'aime que le bourbon
no no thanks no
c'est une affaire de goût.

I love that show!!!!!!![nt] (none / 1) (#14)
by Stinky Bottoms on Wed Dec 01, 2004 at 11:11:08 AM EST



[ Parent ]
Prescriptions and Quality (2.75 / 4) (#15)
by Rich0 on Wed Dec 01, 2004 at 12:11:12 PM EST

Obviously market efficiencies are a big reason to allow internet pharmacies - just like they are good for books, music, etc.

There are two main problems with Internet pharmacies:

  1.  Lack of prescription enforcement.  
  2.  Potentially dubious quality (including counterfeit drugs - not even mentioned in the text above).
The first is up for debate.  Honestly, I'm not sure why we require prescriptions to use medication - if I want to self-diagnose and kill myself in the process that should be on me.  We let people cram all kinds of herbal stuff down their throats - and those don't have half the data or testing that any prescription drug has.

The second is a potentially big issue.  In the USA there are regulations called the Good Manufacturing Practices which dictate how drugs are manufactured, packaged, shipped, tested, and dispensed.  They are the reason that a vendor can recall a specific lot and be assured of being able to find out every person who received so much as a single pill from that lot.  These rules are necessary since you can't determine the quality of a drug simply by tasting it.  

When you get a drug from xyz's discount website - how do you know what is in that pill?  There have been cases of just about every white substance known to man being compressed into tablets and sold fraudulently.  It usually takes a $50,000 HPLC and an analytical chemist to determine what is in the pill, and whether it is safe to take.  And of course, the testing is destructive, so the only way to be safe is to order 10% more than you need and test 1/10th of your pills to make sure that they are consistently good.

Note that mail-order pharmacies are not illegal in the USA.  In theory the FDA could host an official list of all registered web pharmacies which follow safe practices.  However, any pharmacy that follows FDA regulations wouldn't be able to offer the low prices that seniors are looking for on the web.  Those pharmacies at the very least need to reimport product from overseas to take advantage of price controls.

In any case, allowing reimportation won't really fix much.  If the US market were threatened with reimportation then drug companies would either strictly ration drugs overseas (so that none are left to reimport), or they would refuse to sell any drugs for less than the US price.  Foreign countries are likely to adopt compulsary licensing, but the US is unlikely to allow patent-violating medications to be reimported into the USA.  If they did it would probably end the patent-drug industry as we know it - nobody would spend $800 million to discover a drug that nobody will pay money for...

So you're saying.....? [nt] (none / 0) (#16)
by Stinky Bottoms on Wed Dec 01, 2004 at 01:40:41 PM EST



[ Parent ]
Why you need prescriptions to get medication (2.00 / 2) (#26)
by mjfgates on Wed Dec 01, 2004 at 11:14:17 PM EST

'Cos you don't want me to be able to pick up some Thorazine, feed it to you without your knowledge, and then drag you off for a weekend of Happy Fun Butt. Besides which, unprescribed use of antibiotics is the reason why we have antibiotic-resistant bacteria. All those millions of people in Brazil, taking one or two penicillin whenever they get a cold... twenty years later, there isn't a single bacterium in the country that's vulnerable to the stuff.

[ Parent ]
drugs online (2.66 / 3) (#17)
by fourseven on Wed Dec 01, 2004 at 01:47:28 PM EST

yes, but what we really need is for the local dealers to go online and peddle coke hash and heroine off their cousin's website. and go into joint venture with the pizza delivery guy. that would be something.

I'd do it, but (none / 0) (#19)
by Stinky Bottoms on Wed Dec 01, 2004 at 02:12:26 PM EST

I don't have the start-up capital.  Ohh, well, back to salt mines for me, I guess...

[ Parent ]
Common problem (2.00 / 6) (#21)
by cdguru on Wed Dec 01, 2004 at 07:15:18 PM EST

The principal problem with "Internet Pharamcies" is the same as with nearly anything else that is "Internet" - it is a consequences-free zone. If Amazon wanted to start shipping wads of used toliet paper instead of books (and still pretending to sell books), how long would it take before they were stopped? A long time is the right answer.

Because of the Internet being a "consequences free zone", someone can sell fake medicine from their basement and they stand a very small chance of being caught. If they take the elementary precaution of not shipping stuff from their mailbox, the chance of being actually stopped from doing this is near zero. Similarly, if someone rips you off on eBay, how many other people can they do this to? A lot is the right answer - because, after all, who is going to stop them? eBay? Hardly.

Want to make some easy money? Set yourself up as a spammer or a web site selling OEM software. Or, if you want to be anti-establishment, set up a warez web site. If it is hosted in another country, it will not be taken down. Consequences for doing any of this? None.

So, what is the answer? The Internet was conceived of as a place where people could be relatively anonymous and be trusted to not violate the trust that was placed in them. After all, they were students or government employees. Opening this up to the public at large changed the rules somewhat. You can now assume that there are indeed people that want to do you and your computer harm. They want to steal all your money or sell you useless crap. They will sell you fake medicines or dangerous drugs that can kill you if taken improperly. How is this different than stealing your money or identity? It isn't. This leaves the "rulers of the Internet" (if only there were some!) to decide to change things such that the original implicit trust in using the Internet is restored, or that this trust is impossible and the structure of the Internet must be changed to correspond to this new reality.

In many ways, the structure of the Internet is changing because of this lack of trust. How long will an unprotected computer last on the Internet without being compromised? Can you actually read email and open attachments with any degree of confidence? How about running your own web server? How about useful little services like finger - do you even know what that is anymore?

The problem is that people still believe a "vendor" has some kind of responsibility and if they violate the trust of their customers "something bad will happen to them." In truth today, nothing is ever going to happen to the guy that steals from you on the Internet. Nothing is going to happen to the spammer that fills your inbox. Nothing is going to happen to the script-kiddie that sent out a trojan to steal your password or credit card number. Can we fix this? Or, do we have to assume that no one can be trusted?

Duh? (3.00 / 4) (#23)
by ubu on Wed Dec 01, 2004 at 09:21:18 PM EST

If Amazon wanted to start shipping wads of used toliet paper instead of books (and still pretending to sell books), how long would it take before they were stopped? A long time is the right answer.

Huh? What? Are you stupid, or do you think we are?

If Amazon.com shipped toilet paper instead of books, it would take up to 4 days along the UPS Ground Route for their customer base to notice. At that point, the Internet would be flooded with conversation on the topic, and Amazon's sales would drop to nothing within hours if no explanation were forthcoming.

If Amazon.com's sales slipped by even a tiny fraction during that period, it would have warranted a comment in their next quarterly SEC filing. If Jeff Bezos couldn't explain the incident his entire staff would be investigated for an enormous array of potential claims on behalf of the major shareholders of the company.

"Consequences-free zone"? No.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
[ Parent ]
Internet flooded? (none / 1) (#52)
by cdguru on Thu Dec 02, 2004 at 02:56:34 PM EST

OK, just how many Amazon customers read K5? Or Slashdot? Or Usenet?

The "voice of the commons" isn't there on the Internet. It would last until the major media picked it up, at least. This would then start to affect their sales outside the "Internet geek" community. Oh yes, it would take only hours for the bloggers to know about this. The other 99% of the population would wait for 60 Minutes.

[ Parent ]

No (none / 0) (#54)
by ubu on Thu Dec 02, 2004 at 03:28:26 PM EST

You're wrong. An ever-increasing percentage of adults get their news from the Internet, send and receive emails daily, and make use of instant-messaging networks. The figures are significant: well over a majority of American adults use the Internet and email, and somewhere between a third and a half of American adults use the Internet as their primary news source.

Connect this group with word of mouth and subtract all those non-Internet users who wouldn't be ordering off of Amazon.com in the first place. The result is probably that a vast majority of users would be aware of the problem well before their next Amazon.com purchase.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
[ Parent ]
Not only K5, Slashdot, Usenet (none / 0) (#59)
by kisielk on Thu Dec 02, 2004 at 06:29:45 PM EST

What, you think something as big as this wouldn't be on CNN.com? BBC.co.uk? Plastered over every news site on the web? A *lot* of people read news online. Once it raised enough commotion online, it would no doubt be on television soon afterwards.

--
Talk, talk, it's only talk. Arguments, agreements, advice, answers, articulate announcements. It's all just talk."
- Elephant Talk, King Crimson


[ Parent ]
umm (none / 0) (#60)
by mpalczew on Thu Dec 02, 2004 at 06:32:41 PM EST

the same people who would shop online would also probably read news online.  Or at least do something online besides shopping.
-- Death to all Fanatics!
[ Parent ]
Good point but (none / 0) (#65)
by m a r c on Fri Dec 03, 2004 at 07:14:01 AM EST

Amazon is not anonymous. I believe that the above post is valid in that because the internet is anonymous and people who cannot be identified can get away with a lot. A known corporation cannot because it survives on public perception of it. Maybe the news of it being dishonest would start on a blog, etc but it will filter its way into main stream media and at that stage it's all over.

So the really interesting point is how we are using this medium known as the internet for something it was not indended for, namely secure information exchange between identifiable parties. Prehaps the solution would be a logical overlay network considing of nodes that had been identified. If there can be a way to definitively identify an idividual that is using the computer then this might be possible. When i log into my net banking I have to provide a client number and password. Would it be possible to log into a subnet of the internet where every user has to log in with this mechanism so they are all identified?
I got a dog and named him "Stay". Now, I go "Come here, Stay!". After a while, the dog went insane and wouldn't move at all.
[ Parent ]

Yeah (none / 0) (#82)
by ubu on Fri Dec 03, 2004 at 10:36:53 PM EST

Would it be possible to log into a subnet of the internet where every user has to log in with this mechanism so they are all identified?

Of course, and you already see this with VPNs. My expectation is that in the future most of our high-level network traffic will be mobile agents travelling from site to site delivering and gathering data for their users. We'll probably have to spend some time figuring out how to regulate this traffic in order to prevent abuse. But necessity is the mother of invention, and I'm sure we'll figure it out.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
[ Parent ]
Question? (none / 0) (#24)
by carb0n on Wed Dec 01, 2004 at 09:27:44 PM EST

Perhaps I'm missing something, but instead of having to import drugs from countries (such as my own) that have cheap drugs (due to price controls), why doesn't the United States follow a similar pattern?

I know the current administration is all wet about 'free markets' and all that, but clearly some regulation is in order, no?  (So much for competition bringing _lower_ prices :)

Because (none / 0) (#27)
by jeremyn on Wed Dec 01, 2004 at 11:30:30 PM EST

The testing regulations in the US are more stringent than for example that of Canada. Larger profits fund innovation to create better drugs. The smaller profits that is made on (less effective and often generic) drugs in price controlled countries can't cover the research that will really benefit everyone.

[ Parent ]
umm, the drug companies sell teh same drugs (none / 0) (#28)
by modmans2ndcoming on Thu Dec 02, 2004 at 01:14:19 AM EST

to canada as they sell to the US. the US just pays the research fees.

[ Parent ]
actually (none / 0) (#31)
by tantrum on Thu Dec 02, 2004 at 03:26:28 AM EST

you don't pay the research fees at all. The current implementation of price control in europe and canada is to prevent companies acting as monopolies (yes, I know that there is patents and stuff, so the meds are different from company to company).

Pharmaceutical companies have one of the highest ROI rates in modern business.

You do not pay for their research, you pay more because of monopolitic competition.



[ Parent ]

For American companies, yes, essentially (none / 0) (#62)
by Stinky Bottoms on Thu Dec 02, 2004 at 06:50:06 PM EST

But it's not like they aren't making money. Otherwise they wouldn't bother selling to countires like Canada.  To have the drug approved for sale in Canada is too expensive to just do it at a loss.

[ Parent ]
Testing Regs (none / 0) (#38)
by Stinky Bottoms on Thu Dec 02, 2004 at 07:51:28 AM EST

are EXACTLY the same in Canada and the U.S.  In fact, because of the lack of volume in Canada, the quality of drugs made here is probably better.  It's just that the market in the U.S. began with the prices they have for drugs and they stay at those prices.

[ Parent ]
because (none / 0) (#29)
by emmons on Thu Dec 02, 2004 at 01:16:26 AM EST

In a nutshell: Pharmaceuticals need to make large profits in order to make up for the large risks they take by investing billions of dollars in developing the drugs in the first place. If we were to take away those profits we'd remove the incentive for them to develop new drugs.

Competition does bring lower prices once the drugs' patents are up. Witness the current prices for generic Claratin. Drugs that are under patent are expensive though- the companies that own the patents keep the prices high in the US (the only country they can) in order to make up for both the cost of development and the risk that the money they invested could have been lost had the drug turned out to be useless. Vioxx is a recent example of this.

One way that we could reduce drug prices in the US would be by refusing to export drugs to countries that implement price controls and therefore forcing them to remove those controls, thereby spreading development costs more evenly throughout the world. But I don't see this happening anytime soon.

---
In the beginning the universe was created. This has made a lot of people angry and been widely regarded as a bad move.
-Douglas Adams

[ Parent ]

Industry lobbying BS (2.00 / 2) (#33)
by jotango on Thu Dec 02, 2004 at 03:53:40 AM EST

"In a nutshell: Pharmaceuticals need to make large profits in order to make up for the large risks they take by investing billions of dollars in developing the drugs in the first place. If we were to take away those profits we'd remove the incentive for them to develop new drugs."

Pharmaceuticals have margins over 30% a year, AFTER R&D expenses. They could lower their prices by quite a bit, and still be able to fund their R&D. A big Pharm. company like Merck is so diversified, the risk is systematically reduced.

Your argument is BS.

[ Parent ]
oh (none / 0) (#53)
by emmons on Thu Dec 02, 2004 at 03:13:58 PM EST

They why did Merck's stock do this: http://finance.yahoo.com/q/bc?s=MRK&t=3m ?

Developing and selling drugs is a risky business. Not only has Merck lost out big on the research dollars they've put into Vioxx, they'll now be sued by thousands of prople for the harm the drug caused. Merck's investors are getting hosed.

Investing in such a risky industry certainly isn't something I'd want to do unless I thought there was a chance for a high rate of return.

---
In the beginning the universe was created. This has made a lot of people angry and been widely regarded as a bad move.
-Douglas Adams

[ Parent ]

No. (none / 0) (#84)
by Empedocles on Sat Dec 04, 2004 at 06:20:55 AM EST

Merck hosed their investors by rushing a questionable product to market. The FDA failed the public by allowing it to happen.

---
And I think it's gonna be a long long time
'Till touch down brings me 'round again to find
I'm not the man they think I am at home

[ Parent ]
ughh (none / 0) (#63)
by Armada on Thu Dec 02, 2004 at 09:38:40 PM EST

It's the testing.

When you have an overarching government entity like the FDA constantly rejecting your studies or requiring you to wait in line 5 years for approval, price controls are admantly rejected.

This is not the competition of a free market. To suggest such, you would have to remove the FDA from the picture.

[ Parent ]

i was wonder where all these cheap quad bars were (none / 1) (#30)
by auraslip on Thu Dec 02, 2004 at 01:46:30 AM EST

coming from.
124
Why would you buy drugs off the Internet? (none / 1) (#32)
by gordonjcp on Thu Dec 02, 2004 at 03:39:04 AM EST

It's not like they're difficult to get hold of. Unless you live in the middle of nowhere, you can go to a place called a "Pharmacy" and just buy them.

The other thing I don't understand about drug spam is, why do they always say stuff like "NO EMBARRASSING DOCTOR VISIT! NO PRESCRIPTION NEEDED!"? What's the problem with visiting the doctor, if you're ill? And why would I want drugs if I hadn't been prescribed them?

Not only that, but many of the drug spams start off with "CAN'T AFFORD THE PRESCRIPTIONS YOU NEED?" - who the hell can't afford prescription medicine?

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.


Yeah quite (none / 0) (#34)
by GenerationY on Thu Dec 02, 2004 at 04:41:36 AM EST

It wouldn't be so bad if they were offering stuff cheaper than the price of a prescription, but they never do. How strange is that! Who are these people throwing their money away for the hell of it?

[ Parent ]
Read the story (none / 0) (#37)
by Stinky Bottoms on Thu Dec 02, 2004 at 07:48:24 AM EST

In the U.S. it is cheaper to buy drugs from the Internet because the "Pharmacy" (or "Chemist") charges up to 8 times the price for the drug you just purchased from "Canada."

[ Parent ]
In the UK... (none / 0) (#47)
by gordonjcp on Thu Dec 02, 2004 at 01:17:39 PM EST

... every prescription costs £6.40 - unless you're unemployed or an old-age pensioner.

Doctors still prescribe antidepressants like they were M&Ms, though.

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.


[ Parent ]
Because doctors suck (none / 0) (#46)
by Noexit on Thu Dec 02, 2004 at 12:34:54 PM EST

I have no problem going to the physician for any reason. But I've yet to find one in my small town that will write for Xanax, which I once had a long standing "all you can eat" type script for. So, occasionally I go to Mexico to get what I can't get here, and will gladly buy off the internet once I find a site that I trust (yes, I see the conflict in that statement). It's not a question of embarrassment, or price, it's all about the availability: I have to go where I can to get what I want and need.

[ Parent ]
You do realise that .... (none / 0) (#76)
by Pxtl on Fri Dec 03, 2004 at 01:10:07 PM EST

... at this point, your need for Xanax has probably crossed the line from treatment to chemical addiction, don't you?

[ Parent ]
Probably not... (none / 0) (#77)
by Noexit on Fri Dec 03, 2004 at 01:34:47 PM EST

...since I take about 1mg a week, if that much. Take your assumptions elsewhere, won't you?

[ Parent ]
Sorry, not everybody is in your position (none / 0) (#50)
by rpresser on Thu Dec 02, 2004 at 02:43:13 PM EST

who the hell can't afford prescription medicine?

Do you realize that I spend over $500 per month on prescription drugs? That's with an employer-sponsored health plan, for which I pay another $1000 per month in premiums (self + spouse).

Admittedly, my wife & I aren't the healthiest people. But we're not that rare either.

And my mother, who is age 72 and on fixed income, spends over $1500 per month in drugs.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

What, pray tell, do you take? (none / 0) (#55)
by skim123 on Thu Dec 02, 2004 at 03:36:08 PM EST

I recently read that 44% of US citizens take at least one perscription drug. Crazy. Looks like another fat bonus for CEOs of pharamsuticals...

Money is in some respects like fire; it is a very excellent servant but a terrible master.
PT Barnum


[ Parent ]
What we take (none / 0) (#56)
by rpresser on Thu Dec 02, 2004 at 03:50:45 PM EST

Myself: Wellbutrin, fluoxetine, allopurinol, Diovan HCT, Actos, Glucovance.

My wife: Wellbutrin, Xanax, Bextra, Avinza, Diovan HCT, Nexium, Levoxyl, and at least 3 others I'm forgetting.

That's what we take daily. There are a whole lot of as-needed or rarely-needed drugs sitting around the house. One more reason why it's best that we're childfree.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

Holy Crap. (none / 0) (#57)
by killmepleez on Thu Dec 02, 2004 at 05:31:29 PM EST

Either you're absurdly overdrugged because you've bought into the idea of the Self and its corporeal accompaniment as a bag of chemicals, or your lives truly are a nearly unbearable hell.

All those meds.... personally, I'd prefer suicide.

__
"I instantly realized that everything in my life that I thought was unfixable was totally fixable - except for having just jumped."
--from "J
[ Parent ]
hmm. (none / 0) (#61)
by mpalczew on Thu Dec 02, 2004 at 06:41:58 PM EST

There are some people that have severe imbalances.  Now I used to not believe in it.  If you ever see someone change into a different person overnight you may realize that it ain't that simple.
-- Death to all Fanatics!
[ Parent ]
How is that not covered by what I said? (none / 0) (#68)
by killmepleez on Fri Dec 03, 2004 at 09:11:15 AM EST

no tautology

__
"I instantly realized that everything in my life that I thought was unfixable was totally fixable - except for having just jumped."
--from "J
[ Parent ]
Oh my God (none / 0) (#80)
by Stinky Bottoms on Fri Dec 03, 2004 at 06:29:22 PM EST

did you just say "tautology"?

[ Parent ]
No. (none / 1) (#85)
by Empedocles on Sat Dec 04, 2004 at 06:21:15 AM EST

I'm pretty sure he wrote it.

---
And I think it's gonna be a long long time
'Till touch down brings me 'round again to find
I'm not the man they think I am at home

[ Parent ]
I apologize for shocking you. (none / 0) (#87)
by rpresser on Sat Dec 04, 2004 at 11:24:12 PM EST

But thankfully, I did not ask your opinion, nor anyone else's.  My life is my own, thank you, and your judgement shall be duly ignored.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]
Yes you did. (none / 0) (#93)
by killmepleez on Mon Dec 06, 2004 at 04:21:29 PM EST

By posting your thoughts on a public web-based discussion forum of which I am a longtime member you are indeed asking for my opinion and the opinion of every person with read/post priveleges herein.
But nice dodge attempt anyway.

__
"I instantly realized that everything in my life that I thought was unfixable was totally fixable - except for having just jumped."
--from "J
[ Parent ]
Nice try. (none / 0) (#94)
by rpresser on Mon Dec 06, 2004 at 09:18:59 PM EST

I answered the specific question "What, pray tell, do you take", posed by the user skim123, which was asked in a remarkably polite manner. Of course I was aware that I was posting to a public forum. I also had a good hunch that many would take advantage of the opportunity to make themselves feel more important by telling me how stupid / unfortunate / lazy / etc. I am. This happens whenever I post anywhere, because 99% of the Internet-using world wants to hurt people.

So, in a word, begone.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

Be ye moderate. (none / 0) (#96)
by killmepleez on Tue Dec 07, 2004 at 06:34:33 PM EST

Look, I've been on a couple of those drugs as well as others appropriate to my particular dysfunctions, and I had the extra 25 pounds, constant drowsiness, reduced "desire", etc., that so often goes along with them.

To be on more than four maintenance medications in addition to other "as-needed" stuff around the house, well... doesn't that seem a bit excessive to you? I suppose I'm going on the assumption that K5ians are not, as a rule, older than fifty, which is when most people begin to need constant medication to fight the effects of biological entropy. If you're older than fifty, I rescind all comments made to you and pray thee to carry on medicating as long as your body's molecules will hold together.

It is precisely because I recognize, from experience, that people can change instantly due to electrochemical reactions in the neuro-hormonal system that I provided you with two alternatives. Namely, you are either overmedicating [my value judgement] because you [or your physician[s]] place pills at the top of the list of potential therapies, or all of the conditions those drugs claim to moderate are so debilitating that you do indeed require medical maintenance just to acheive minimum daily functioning, in which case your life truly must suck [and I mean that empathetically]. Further, if *my* mind/body were causing me that much trouble, and I found no other remedy [because I have somewhat been able to moderate my own conditions with a combination of philosophizing, diet/activity/lifestyle changes, a little CBT habit-replacement, and good old fashioned luck] than a psychiatric cocktail which comes loaded with side effects universal to drug combinations... well... I'd kill myself. Which is what I tried to do before I learned how to be okay with not being okay.

That's the way I framed my original statement, and I stand by it insofar as it is reasonable to stand by a snap assessment made of a stranger's medical history based on the flimsiest of data filtered through a weblog going through its own collaborative identity crisis.

Fair enough?

__
"I instantly realized that everything in my life that I thought was unfixable was totally fixable - except for having just jumped."
--from "J
[ Parent ]
Hmm... (none / 1) (#69)
by Fon2d2 on Fri Dec 03, 2004 at 09:17:04 AM EST

Anti-depressants, high blood pressure, and diabetes medication. How do people end up on so much medication?

First off, I would be very wary about taking any SSRIs. If you haven't done so already, you should read a book such as Prozac Backlash. It is very well researched and informative.

As for high blood pressure and diabetes, how do so many people develop these types of problems? Is it just from a bad diet and a lack of exercise. Can't people stay in shape?

I hope I never have to take any of these drugs. Seriously, $1500 a month? That's just all the more incentive to keep exercising. It is way cheaper. And if any doctor ever prescribes SSRIs, I will be very skeptical. Sorry, but I simply do not trust Eli Lilly or any of the other pharmaceuticals.

[ Parent ]

Never understood that (none / 1) (#74)
by skim123 on Fri Dec 03, 2004 at 11:38:54 AM EST

You're right, a lot of these problems are problems a person brings on themselves with their diet and lifestyle. And not only is it a toll on your body, lifespan, soul, and psyche, but on your pocketbook as well, as evidenced by needing $1,500+ dollars of drugs / month. Insane.

Exercise, eat healthy, and live a simple life. It might not be the path of instant gratification, but that's not so hot a path anyhow.

Money is in some respects like fire; it is a very excellent servant but a terrible master.
PT Barnum


[ Parent ]
Hoping the best for you (none / 0) (#88)
by rpresser on Sat Dec 04, 2004 at 11:26:35 PM EST

that you are lucky enough not to have to take medicines.

However, while I understand your disapproval of my pharmaceutical regimen, I don't particularly care that you disapprove.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

Fuck Mary! (none / 0) (#89)
by bob6 on Mon Dec 06, 2004 at 09:36:19 AM EST

That's serious! I hope both of you will get through...

Out of curiosity, does the budget figure you mentioned (1500$ iirc) includes consultation fees like quacks, shrinks and such?

Cheers.
[ Parent ]
44% (none / 0) (#72)
by Cro Magnon on Fri Dec 03, 2004 at 10:08:51 AM EST

I can believe it! Several of my cow-orkers are on multiple meds, and they're not that old! I hate to think about how much they'll be taking after they retire.
Information wants to be beer.
[ Parent ]
Over 25% of people under 18 take at least one... (none / 0) (#73)
by skim123 on Fri Dec 03, 2004 at 11:35:20 AM EST

... perscription drug. Scary.

A Brave New World is here. I am ready for my Soma.

Money is in some respects like fire; it is a very excellent servant but a terrible master.
PT Barnum


[ Parent ]
I'm under 18 (none / 0) (#81)
by Mystess on Fri Dec 03, 2004 at 09:06:58 PM EST

Does the pill count as a perscription drug? Cos if so, thats why its 25%

"Don't worry, You're better than somaudlin." - stuuart
[ Parent ]
Why are you on the pill? (none / 0) (#86)
by Stinky Bottoms on Sat Dec 04, 2004 at 04:49:21 PM EST

Your 18!!!!  And yes, the only way you got it was to go to a doctor, so it's prescription.

[ Parent ]
Wow. (none / 0) (#91)
by Pxtl on Mon Dec 06, 2004 at 02:09:27 PM EST

Are you naive.  Surprised that 18 y.o. is on the pill?  I didn't think that the Amish had computers.

Props to MystesS for taking good care of herself.  Still, make the boy wear a rubber anyhow, you don't know where its been (and given the way most teenaged boys act, there's a chance he doesn't either).

[ Parent ]

I'm surprised that an 18 y/o is on the pill (none / 0) (#92)
by Cro Magnon on Mon Dec 06, 2004 at 04:17:49 PM EST

If my school was any indication, they just let themselves get knocked up.
Information wants to be beer.
[ Parent ]
I'm on the pill because... (none / 0) (#97)
by Mystess on Tue Dec 07, 2004 at 10:35:42 PM EST

I've been going out with my guy for a year...

I don't want to wreck my life at the moment by having a kid....

We enjoy sex...

"Don't worry, You're better than somaudlin." - stuuart
[ Parent ]
Even if I went private... (none / 0) (#71)
by gordonjcp on Fri Dec 03, 2004 at 09:57:05 AM EST

... it would cost me a fraction of that here. Why do you need to take three different kinds of antidepressants? Maybe your life is broken, and you need to fix that first.

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.


[ Parent ]
Who are you talking to? (none / 0) (#75)
by Gallowglass on Fri Dec 03, 2004 at 12:07:08 PM EST

I ask, because your message asked "Why do you need to take three different kinds of antidepressants?"

I looked at the parent to your post, and the parent of that, and neither mentioned antidepressants.

[ Parent ]

See this post... (none / 0) (#83)
by gordonjcp on Sat Dec 04, 2004 at 06:13:33 AM EST

Here.

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.


[ Parent ]
I don't ... (none / 0) (#90)
by rpresser on Mon Dec 06, 2004 at 01:46:27 PM EST

... take three kinds; I take two kinds: Wellbutrin and fluoxetine.  Diovan is for hypertension; Actos and Glucovance are for diabetes; allopurinol is for prevention of gout.

I also don't think it's your place to make recommendations. I didn't ask your opinion; I just responded to a gracious "What, pray tell, do you take" question.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

Internet Pharmacies: Stupid (2.00 / 2) (#35)
by GenerationY on Thu Dec 02, 2004 at 04:51:59 AM EST

How can a private company undercut a multi-Governmental bulk purchase deal that makes the  big drug companies cry like babies? I further don't see how they can then sell, say, a £100 net cost medication below £6.40 (or less if I buy a PPC) to be worth bothering with.

The whole premise is fucked. This stuff either gets made in people's garages or is stolen probably. A ban would be a good idea to protect public health. Although if you are stupid enough to go in for something like this perhaps you deserve all you (may or may not even) get?

I guess for people in poor countries it might be a good idea, but then again, they should be getting subsidies, grants and NGO donations anyway.

You're looking at it (none / 0) (#36)
by Stinky Bottoms on Thu Dec 02, 2004 at 07:46:59 AM EST

from an entirely British perspective.  In the U.S. they do't have what you have in health care, so it's often cheaper to go online for your drugs, unless you are buying them from U.S. pharmacies.

[ Parent ]
Whats health insurance for then? <nt> (none / 0) (#39)
by GenerationY on Thu Dec 02, 2004 at 08:05:09 AM EST



[ Parent ]
England has price controls on (none / 0) (#40)
by Stinky Bottoms on Thu Dec 02, 2004 at 08:34:34 AM EST

their drugs.  You might pay out of your pocket, but you pay a LOT less than they do in the States.  Health insurance covers the rest of the cost that the government didn't already.

[ Parent ]
Thats not what I meant (none / 0) (#41)
by GenerationY on Thu Dec 02, 2004 at 09:46:23 AM EST

but I'm assuming I must have this wrong.
I've been told many times in the past the US has a superior medical provision because employers fund health insurance for their employees. I wasn't aware this didn't include free drugs.

[ Parent ]
No,it's true (none / 0) (#42)
by Stinky Bottoms on Thu Dec 02, 2004 at 10:04:24 AM EST

that employers do fund health insurance, but where the Internet Pharmacies come in is for the millions of people who don't have health insurance: elderly, poor, illegals, etc.  Basically, ther are millions of people who don't have jobs or don't good enough jobs to get health insurance.  They have to pay out of their pockets and if you're old or poor, it's difficult.

[ Parent ]
Eek. that sucks then (none / 0) (#43)
by GenerationY on Thu Dec 02, 2004 at 10:08:08 AM EST

You have to have price controls on medicine because the normal rules of supply and demand don't apply. That the drug companies have a higher profit margin than banking, financial services and even tobacco is a bit of a hint.

I'm surprised people haven't stormed the White House with pitchforks over this.

[ Parent ]

After paying for the drugs (3.00 / 3) (#44)
by Cro Magnon on Thu Dec 02, 2004 at 11:52:04 AM EST

we can't afford pitchforks.
Information wants to be beer.
[ Parent ]
It took 230 years (3.00 / 2) (#58)
by killmepleez on Thu Dec 02, 2004 at 05:46:55 PM EST

...but America has finally homogenized and pacified all the disgruntled post-feudal peasants, religious wackos, political agitators, and criminals who originally took over this continent. Now we're just criminally religious disgruntled wackos whose lack of real political agitation will soon turn us all back into post-feudal peasants.

__
"I instantly realized that everything in my life that I thought was unfixable was totally fixable - except for having just jumped."
--from "J
[ Parent ]
That's not why it's better (none / 1) (#48)
by smithmc on Thu Dec 02, 2004 at 02:36:08 PM EST


I've been told many times in the past the US has a superior medical provision because employers fund health insurance for their employees. I wasn't aware this didn't include free drugs.

I'd be surprised if anyone actually told you with a straight face that the US healthcare system is better. I certainly wouldn't say that. I do believe, however, that the health care available in the US is the best in the world.

[ Parent ]

Very seldom free (none / 1) (#49)
by rpresser on Thu Dec 02, 2004 at 02:38:46 PM EST

It is very rare to have a healthplan that provides drugs at zero cost.  

Some plans provide no prescription drug coverage.

Other plans have a flat co-pay for prescriptions, often $5, $10, $15, etc. per 30-day supply. Often the copay is lower for generic drugs and higher for name-brand drugs.

Other plans (such as the one I have now, alas) will only pay for a percentage of the drug cost (this is called coinsurance), and sometimes only after a deductible is met. Again, the percentage funded may be different for generic drugs and for name-brand drugs. My plan pays 60% for generics; 50% for name-brands where a generic is not available; and 40% for name-brands where a generic is available, but where the name-brand is prescribed by the doctor as medically necessary.  These plans are becoming more and more common as costs go up and companies can no longer afford premiums.

Finally, nearly all plans have a "formulary" - a list of drugs which will be funded. If your drug is new, it will not be funded. Other drugs may only be funded for certain conditions -- my plan will not pay for Bextra for my wife because she does not have rheumatoid arthritis.

It's all the drug companies' fault IMHO. They claim they need to recoup research costs, but research costs are themselves inflated because the drug companies are able to pay them because drug prices are kept high. If the US had drug price controls, research would still get done; it would just be less disgustingly profitable.
------------
"In terms of both hyperbolic overreaching and eventual wrongness, the Permanent [Republican] Majority has set a new, and truly difficult to beat, standard." --rusty
[ Parent ]

England != UK (none / 0) (#70)
by gordonjcp on Fri Dec 03, 2004 at 09:55:07 AM EST

en tee

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.


[ Parent ]
patent violation (none / 0) (#78)
by Rich0 on Fri Dec 03, 2004 at 04:59:04 PM EST

How do you make money selling a $10 drug for $2?  Simple - you violate patents.

A drug which sells in the USA for $80 probably sells in England for about $10.  The same drug probably costs about 50 cents to manufacture.

An Indian generic manufacturer will violate the patent rights and sell their pills for just a few dollars.  India does not enforce drug patents, so there is no fear of prosecution.  Quality is generally good if this is in fact the source.  (Some online medicines are made in garages though - these are quite dangerous.)

The problem with drugs is that it costs $500 million to develop one, and 25 cents to produce them.  Unlike software, most of the costs cannot be eliminated with an open source model.  (Open source contributors use $500 PCs to do their work - not $100,000 lab equipment.  Open source beta testers are not taking their lives into their own hands by testing software - I doubt there would be many volunteers for open source HIV vaccines.)  

The $500 million has to come from somewhere.  Right now the model is that the company recovers it by pricing the pills at a very high cost.  Another model might be to have R&D done at government expense, and then release the manufacturing process into the public domain (pills would be very cheap then).  One problem with either approach is fairness - why should the R&D cost of a medicine that benefits the entire world be borne by a single country (either via overpriced US drugs, or US-sponsored drug research)?  

[ Parent ]

Fairness and Business (none / 0) (#79)
by Stinky Bottoms on Fri Dec 03, 2004 at 05:44:15 PM EST

Nary the two shall meet.

The thing that is good about the IP's is that they are forcing the issue of an open marketplace.  Research costs are high, in some respects for no reason other than that they are high.  They began with inflated costs and continue with inflated costs.

In truth, as countries outside the U.S. have proven, you can develop drugs at a much lower costs if the market allows.  For instance, to simply file for a drug to be approved in the U.S. costs 5 or 6 times a mucg as it does in Canada.  Yet, the quality of the drug that results is absolutely the same.

So, we are now seeing an industry shift as it becomes an open, wider market than it used to be.  They were riding the wave of an optimum consumer market size, one which did not really grow or shrink for quite a while.  In that environment, without price restrictions, the companies inevitably command profits.  But, when the need for drugs explodes like it has in the past few years, the price has to be driven down as the market shifts to accomodate it.

[ Parent ]

Bullshit (none / 0) (#95)
by GenerationY on Tue Dec 07, 2004 at 06:04:23 PM EST

All the drugs I have in the house were manufactured in the USA or under license in the EU. If you looked into it instead of making things up, you'd know we in Europe have stricter quality controls than the FDA does. Indeed, in sum, the FDA allows the prescription of a great many drugs that are banned throughout Europe. There are neglible instances of the reverse being true.

The reason US drugs are cheap here is because there is a European pricing agreement. The notion we violate patents etc. is utter bollocks and I defy you to produce evidence for this. There are binding international agreements on Intellectual Property. Last I checked we weren't part of the Third World just yet.

I'm sorry, but you've bought into a very simpleminded explanation of how they do business and the conditions under which that business is transacted. It simply isn't true if you look at the numbers and ignore their spiel.

This disparity is only 24 billion to 17 billion Euros anyway. From the way you write its like you believe the US is the only place with scientists.  Having being entertained before now at the largesse of a major drug company I find these argument hilarious. They have money to burn, far more than bankers or sharebrokers or anyone in any other business sector. Put simply, for all their whining, they have bloated profits beyond any other industry, with business run at somewhat less risk than is run by either the financial or manufacturing industries.

There is significant ill feeling on this issue in the American press about Europe "free rides" on the back of Americans. Just shows some people would rather get angry than learn how to read the financial pages.

Personally I don't go to bed at night feeling sorry for Pfizer, Glaxo and their pals and neither should you. Might be an idea to wonder why you Government won't deal with them on your behalf though.

[ Parent ]

Internet Pharmacies: Insider's Look (2.80 / 5) (#64)
by bg on Fri Dec 03, 2004 at 02:36:02 AM EST

I used to work for a "company" that runs internet pharmacies. I suppose it's a normal enough business.

They are based in a country other than the US. All medications (which are legit and not stolen, btw) are sourced from various countries. As you can imagine, almost all sales are to the US.

When I first started working there I was under the impression that everyone who ordered from us was using the drug for legit (non abusive) purposes. I quickly learnt that was almost never the case. The girls that process the orders would get emails like: "Please don't send me any more Xanax or Stilnox or anything, please. Even if I place an order. I am an addict! Please don't send any drugs!" Unfortunatley our Customer Relations Management system (coded by yours trully) didn't have a checkbox on the customer page called "Addict" so the guy probably ordered and received more of his poison.

Actually, on each of the sites there is a page right before the checkout page that asks a number of medical questions, such as: Do you have a history of heart disease? Are you pregant? Have you ever abused drugs? You'd think that perhaps noone would ever tick "Yes" to the last question, but to tell you the truth I'm not sure. The doctor doesn't look at the medical information before approving each order. I don't know if he even approves orders any more. That medical information is just a waste of MySQL tablespace.

The people that run the business are nice enough. The job saw me travel around the world setting things up. It was a different working environment to most places I've worked. I was allowed to smoke weed at my desk. My boss bought me speed when we were approaching a deadline. The only problem was I found myself in a psychiatric ward, repeatedly, throughout the year with drug induced psychosis.

If anyone has any questions...

Now... to the beer dispensary unit!

- In heaven, all the interesting people are missing.

and then there was copyright (none / 0) (#66)
by m a r c on Fri Dec 03, 2004 at 07:46:40 AM EST

just when you thought copyright was only a problem for record labels.... Ok so some drug company has a patent for drug X. No other company can produce this drug otherwise it will get its ass sued under patent law. But what about some other company in a far country producing the drug and selling it as a knock off for the real one back to US citizens. Even assuming perfect drug quality I can't see how this kind of activity is not going to obviate US drug patents.
I got a dog and named him "Stay". Now, I go "Come here, Stay!". After a while, the dog went insane and wouldn't move at all.
Yeah that was in the article. (none / 0) (#67)
by Stinky Bottoms on Fri Dec 03, 2004 at 08:31:14 AM EST

The main problem with Canadian imports, who have the highest and most reliable standard for Internet Pharmacies, is that they are selling generic versions of drugs that have not been approved for sale in the U.S.  Other countries do this as well.

Even if the drug is bioequivalent, it isn't approved, making it illegal to sell in the U.S.

[ Parent ]

The thrid option... (none / 0) (#98)
by curunir on Wed Dec 08, 2004 at 10:03:06 PM EST

This article seems to take for granted that there are two ways for consumers to get drugs, traditional pharmacies and internet pharmacies. There is a third distribution model that is currently growing at a tremendous rate and deserves at least some attention in your article.

The Prescription Benefits Management (PBM) industry, while working with traditional pharmacies to some extent, is pushing their mail-order business as an almost complete replacement of the traditional pharmacy. PBMs already lower the cost of prescriptions for their clients by negociating bulk prices with the drug manufacturers and their mail-order fulfillment programs lower prices further. There's a lot of issues with mail-order dispensing of drugs, but I truly believe that the majority of prescriptions will be filled in this manner within the next 10 years.

For one, the pharmacist has traditionally been the last line of defense in catching drug interactions. With the time crunch that many doctors are feeling these days, they often prescribe a drug without first ensuring that it won't interact with something the patient is already taking. There are so many new drugs on the market that it is hard to keep up with the interaction warnings. Pharmacists are often much more up-to-date on these kinds of things. Mail-order business will catch drug interactions missed by doctors, but only if both prescriptions are being filled by the same vendor. Since there is no human-human interaction, the patient cannot be questioned as thoroughly. I used to work for a PBM and part of my job was programming the drug interaction checking.

Anyways, not that it changes the fact that internet pharmacies can get away with selling drugs illegally over the internet, but PBM's mail-order business (legit internet pharmacy, if you will) is much more of a competitor to these new internet pharmacies and deserves some attention in your piece.

This would be a great option (none / 0) (#99)
by Stinky Bottoms on Thu Dec 09, 2004 at 10:08:17 AM EST

when it becomes combined with the internet.  I don't think we will see any real change, though, until U.S. law creates a system where the Internet is a safe place to obtain prescription drugs.  The Internet is not going way, so the answer lies in controlling the vehicle of access, not the method of distribution.

Regardless, as I work in the drug industry, and read over 300 hundred pages of material with no mention.  Mind you, these were government documents and think-tank papers, so you'd assume they might be mindful of viable options to Internet Pharmacies acting illegally.

Anyway, thanks for the tip.

[ Parent ]

Internet Pharmacies: Good or Bad? | 100 comments (92 topical, 8 editorial, 0 hidden)
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