March 5, 2008
In his weekend radio address, President Bush warned of rogue pharmacists making potentially dangerous prescription drugs readily available online.
"The Internet has brought about tremendous benefits for those who cannot easily get to a pharmacy in person," Bush said. "However, it has also created an opportunity for unscrupulous doctors and pharmacists to profit from addiction."
That's undoubtedly true, as are most observations that the Internet has become a hotbed of fraud and flimflammery. And I think we can all agree that patients should see doctors face to face, rather than via an online chat or survey, before receiving prescriptions for painkillers and other such meds.
But Dr. Bush is addressing a symptom and not the cause of one of the country's top medical problems.
Many Americans, including numerous seniors and people with chronic conditions, obtain prescription drugs from international sources not because they're scratching some itch for faraway places. The shameful reality is that they're looking abroad simply because they can't afford U.S. drug prices.
"The United States has the most costly medications in the world, and a large percentage of the population either lacks insurance or is underinsured," said Andy Troszok, who runs a Calgary, Canada-based, mail-order drug supplier called Extended Care Pharmacy.
Nearly all his roughly 30,000 customers are Americans, he said. And increasingly, the people seeking cut-rate meds aren't retirees on fixed incomes but working people in their 30s.
"They're the ones who can't afford the prices at their local pharmacy," Troszok said.
Aliso Viejo resident Philip Fleming doesn't exactly fit that profile -- he's 43 -- but he comes close. Fleming requires medicine for hypertension, and he found that prices in Canada were consistently about 30% or 40% below what he paid domestically.
"The drug costs in this country climb and climb and climb," he said. "I felt like I was forced to seek some kind of alternative."
Bush illustrated his concern about online drug sales with the story of San Diego teenager Ryan Haight, who died after overdosing on the painkiller Vicodin in 2001. Bush noted that "with only a few clicks of the mouse, Ryan was able to get a prescription from a doctor he had never met and have the pills sent to his front door."
The president didn't mention that Haight purchased the pills by faking his age, an ailment and a doctor's name.
In any case, a very sad story. But what about the thousands if not millions of other people forced to buy their meds online not because they're looking for a buzz but just to stay alive?
Forty-seven million Americans lack health insurance and millions more do not have coverage for prescription drugs.
Meanwhile, U.S. drug prices are as much as 50% higher than in Canada, Western Europe and Japan, where limits are placed on how much drug companies can charge patients.
"For people with specific needs for branded drugs, and who do not have health insurance, they can save hundreds of dollars by buying abroad," said John Rother, policy director for AARP, which supports people being able to import "safe and legal" prescription drugs.
That's the attraction of online pharmacies, and the main reason lawmakers need to step carefully in any crackdown on Internet drug sales. Simply put, we can't punish people for trying to make up for the shortfalls of the U.S. healthcare system.
In late 2005, the Bush administration instructed Customs agents to intercept prescription drugs crossing the border from Canada, resulting in about 40,000 packages being confiscated or delayed.
That policy ended about a year later -- just a few weeks before election day -- after politically powerful seniors made clear they weren't happy having their meds taken away.
In his radio address, Bush indicated he supported legislation introduced by Sen. Dianne Feinstein (D-Calif.) that would require a valid prescription for online drug sales. That prescription, presumably, would only be obtained directly from a doctor.
That's fine in theory. But it might be a little hard to enforce in light of shadowy drug suppliers plying their trade online from such far-off places as Thailand, China and Eastern Europe.
Then there's the matter of Americans seeking reasonably priced meds from our friends to the north. Canadian law requires that a Canadian doctor either issue or sign off on any prescription.
In other words, you can't just fax your U.S. prescription to a Canadian pharmacy.
Because relatively few Americans have the wherewithal to fly to Manitoba for a checkup, online diagnoses and prescriptions may be the only alternative open to many people in need of specific medications.
Any attempt to shut down such "illegal" online drug sales could result in cutting off medical supplies to Americans in need.
What's the answer? Clearly there need to be safeguards to prevent situations like what happened to Ryan Haight, as well as to protect people from possibly dangerous concoctions offered by fly-by-night pharmacies in Southeast Asia and elsewhere.
But until the U.S. can extend health coverage to everyone and limit drug prices to reasonable levels, many Americans will have no choice but to seek the best possible deal for their meds, and this will often require them to look beyond our borders, via the Internet.
"The pharmaceutical industry doesn't want us to do it," said Jack Hoadley, a research professor at Georgetown University's Health Policy Institute. "This administration doesn't want us to do it. But there are safe ways this can happen."
Since so many people already shop for prescription drugs in Canada, that's the obvious place to start. The Food and Drug Administration should be authorized to certify leading Canadian pharmacies as reliable suppliers of medications.
Pharmacies in other countries would be able to apply for certification as well, but they would be required to demonstrate safety standards that meet U.S. levels.
At the same time, U.S. and Canadian officials should negotiate a treaty that permits U.S. doctors to fax or electronically transfer prescriptions to Canadian pharmacies. This wouldn't necessarily solve the conundrum of uninsured Americans being unable to afford doctors' visits, but it would allow prescriptions to be more easily filled.
Unfortunately, millions of Americans have been priced out of the U.S. healthcare system and will do whatever is necessary, and face whatever risks, to remedy their medical woes.
Bush called on Congress to help "put an end to the illegal sale of highly addictive prescription drugs on the Internet."
But if all he's offering in return is business as usual, that patient's already dead.
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