One of the more complex problems I have encountered centers on the purchase of prescription drugs from Canada. A recent caller asked how I would advise her son who wanted to purchase her medicine from the Internet using a Canadian pharmacy. Because he was concerned about her prescription drug costs and he was able to save about $50 on each prescription, he saw this as a good deal but wanted my opinion.
I tried to put myself in his shoes. There are a number of approaches that I could have taken in response to this question. The easiest is to recognize that, although the FDA does not police the importation of drugs for personal use, it is an illegal practice. Therefore, I could have suggested that he not do it just because it violated US law. The law specifically states that importing these drugs is illegal, subjecting individuals to $250,000 fines and the potential of 10 years in prison. I could have played on his sympathy by saying, although this law is not being strongly enforced, if the FDA started to, what would he think of his mother being hauled off to jail?
Second, I could have raised the concern that, although some of these pharmacies providing drugs do provide quality drugs often manufactured in the United States, there is mounting evidence that some drugs being sent to the United States from Canada do not meet our standards for quality. The US Customs Service has testified at various times about drugs with expired dates, some products not containing any medication, or questionable ingredients, including controlled substances when none was supposed to be present. Because Canadian law only regulates products sold in Canada, not those for export, individuals who are trying to make money through the importation of Canadian drugs might be willing to use products manufactured in third world countries.
Although fake or substandard pharmaceuticals have been reported in many other countries, it has only recently become a problem in the United States. The FDA has investigated 71 cases of counterfeit drugs since 1996. The problem could increase significantly as more drugs are imported and bypass the traditional drug distribution network. I could have said to the son that, although only a small percentage of drugs may be adulterated, suppose that your mother got a prescription containing bad drugs? I could have tried to take a more long-term view by suggesting that, although drugs are more expensive in the United States, it is because most drug development occurs here and is supported by drugs sold in the United States. If we continue to try to restructure pharmaceutical economics by importing drugs from countries where they have price controls, we may be damaging the pharmaceutical industry and could in fact prevent the development of the next breakthrough products. By buying drugs from Canada, he may in fact be keeping himself or his wife from having a drug treatment that will really help in later years.
I could have tried to prick his conscience by suggesting that purchasing drugs this way was bypassing his community pharmacist and undermining the business in his local community. More importantly, he would not have access to the services that the local pharmacy provides the patient when a prescription is filled. This may be especially critical for elderly patients because drug interactions or drug overdose could be more harmful to them. Therefore, the value of a pharmacist monitoring a patient?s total drug regimen becomes very important. Also, the ability to pick up a phone or stop at the prescription counter to get questions answered can be very helpful.
I will let you guess what I told my friend. This is a complex question that will not easily be resolved because there are many aspects to consider. Simple solutions to complex problems often create more problems later. I am concerned that this may occur here as we try to reduce the cost of drugs to the consumer. Most solutions seem to sidestep the traditional system that has gotten reasonably priced drugs to patients at the community level?neighborhood community pharmacies. Let us hope that it does not lead to their demise, because they would be missed.
Women with abnormal vaginal microbiota showed no difference in efficacy of daily oral PrEP compared to women with normal vaginal microbiota.
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