The myth of drug “re-importation”

July 13, 2009

Peter Pitts — Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own. —

On Thursday, as part of the Department of Homeland Security funding bill, the Senate voted to make us less secure by allowing Americans to purchase prescription drugs from Canada over the Internet. The measure is now headed to conference, where House and Senate lawmakers will hammer out a final piece of legislation.

When he introduced the measure to his fellow Senators, Louisiana Republican David Vitter described it as a “re-importation amendment.” And over the next few weeks, as lawmakers deliberate on this, you’re likely to hear that phrase quite a bit. Supporters of foreign drug importation believe that such wording makes this policy more palatable to the American public.

After all, the implication of the term “re-importation” is that once the ban is lifted, U.S. manufacturers will export their drugs to foreign distributors, which will, in turn, sell back those exact same drugs to us.

Brand-name pharmaceuticals found abroad tend to be significantly cheaper than they are in the States, largely because foreign governments impose stringent price controls on most drug sales.
Advocates claim that “re-importation” will allow American patients to benefit from this price disparity.

But “re-importation” doesn’t actually describe what will happen if foreign drug importation is legalized. Using the term is an act of linguistic misdirection — or outright chicanery, if you’ve got a cynical streak.

Importing drugs from Canada is exceedingly dangerous for a number of reasons. For starters, many Internet pharmacies based up North are stocked with drugs from the European Union. And while many wouldn’t hesitate to take medicines purchased from countries like France and Great Britain, there’s plenty of risk involved.

The EU currently operates under a system of “parallel trade,” which allows products to be freely imported between member countries. This means that any drugs exported from the U.K. to Canada could have originated in an EU country with significantly less rigorous safety regulations, like Greece, Portugal, Latvia, or Malta.

Just last year, EU officials seized over 34 million fake pills in just two months. And in May, Irish drug enforcers confiscated over 1.7 million pounds of counterfeit and illegal drug packages. So if American customers start buying drugs over the Internet from Canadian pharmacies, they could easily wind up with tainted medicines of unknown European origin.

It’s also important to note that drugs from anywhere in Europe aren’t even legal for sale in Canada. So, when politicians say we can get “the same drugs” that Canadians get, they’re just plain wrong.

Even more worrisome is outright fraud — many “Canadian” pharmacies are actually headquartered somewhere else.

A 2005 investigation by the Food and Drug Administration looked at 4,000 drug shipments coming into the United States. Almost half of them claimed to be from Canada. Of those, a full 85 percent were actually from countries such as India, Vanuatu, and Costa Rica.

As part of another investigation, FDA officials bought three popular drugs from two Internet pharmacies claiming to be “located in, and operated out of, Canada.” Both websites had Canadian flags on their websites. Yet neither the pharmacies nor the drugs were actually from Canada.

As an FDA official told Congress, “We determined there is no evidence that the dispensers of the drugs or the drugs themselves are Canadian. The registrants, technical contacts, and billing contacts for both web sites have addresses in China. The reordering website for both purchases and its registrant, technical contact, and billing contact have addresses in Belize. The drugs were shipped from Texas, with a customer service and return address in Florida.”

And in laboratory analysis, every pill failed basic purity and potency tests.

Right now, American patients that head online to buy drugs are motivated by the cut-rate prices they see on the web. Health insurers could help patients avoid this temptation by reducing co-pays for drug purchases, particularly for low-income patients. If drugs become more affordable in the States, patients won’t feel the urge to look for a bargain abroad.

Dropping drug co-pays would also help patients stick to their prescribed treatment regimes. All too often, people skip a dose, don’t get a refill, or stop taking their drugs prematurely in order to save money. In the long run, though, not adhering to a drug regimen leaves patients less healthy — and increases national medical expenses by an estimated $300 billion annually.

Calling foreign drug importation “re-importation” is a clever way to sell the idea to the American people. But the term simply doesn’t fit with the facts. In reality, Americans would end up jeopardizing their health by purchasing unsafe drugs made in foreign countries.


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Or drug companies could charge less for their products. But then who would pay you to preach, my good sir?

Posted by Patrick | Report as abusive

Peter J. Pitts, everybody needs to make a living but calling EU-made drugs unsafe sounds awfully contrived.

Let’s see:
-Bayer (Germany)
-Novartis (Switzerland)
-LaRoche (Switzerland)
-GlaxoSmithKline (UK)
-Sanofi-Aventis (France)
-AstraZeneca (Sweden/UK)
-Boehringer Ingelheim (Germany)

I would like to point out the fact that if you go to a pharmacy/chemist in Europe, it’s not to buy a pair of flip-flops and a Mars bar, a t-shirt for the kid, some potting soil, a calculator, develop some pictures, buy some pistacchios, milk, sandwiches, cookies and ice-cream. I forgot the canned soup, candles, air freshener, card games, plastic toys, cheap perfume, bad hair care products and my favorite: cigarretes and chewing tobacco. And pet food.

I am sure the quality of the drugs produced and sold in Europe are of the highest standards, and the doctors are far more conservative in their prescriptions too. The EU standards are upheld far better than the US standards at all levels. I’m thinking the really bad quality aspirins available everywhere in US dollar stores, supermarkets and 7/11’s. You see, the high European standard is upheld not only in the manufacturing but also in maintenance of good conditions on the shelves. And there are no guarantees any US store will keep the pills at the appropriate temperatures, or keep from selling damaged packages.

Yes, it’s a fact that the prices of medical drugs in the US needs to go down. And they will one way or another. Regardless of how much the US drug lords pay their mouthpieces.

Posted by SGarrett | Report as abusive

What a crock! American drugs aren’t even made here – they are made all over the world. I have been buying my drugs from Canada since 2000, long before it was fashionable. And no one I know in Europe is dropping dead by filling an Rx.

Americans are going abroad for a reason. How about lowering the price of US drugs instead of supporting CEO bonus’ and shareholder profits?

Posted by Petunia McIntyre | Report as abusive

hogwash, Mr. Pitts.

Posted by Denver | Report as abusive

This argument takes the debate the wrong direction. The simple truth is that although high drug prices may mean a CEO makes a lot of money, that is but a fraction, far less than 1%, of the what consumers are paying for. So if you say to yourself “It’s OK to “re-import” because it all goes to the CEO anyway”, you are lying to yourself. What is really being bought are the hundreds of thousands of employees working on pharmaceutical development in the U.S. every day.

Our friends that buy their drugs from “Canada” are just freeriding off those that don’t and not paying their share of drug development costs. The result will luckily not mean a lower quality of life because the development has been done already, but future development will lessened. In other fields of medicine, such as hospitals or doctor’s price controls will have a more immediate impact on quality of life.

Posted by Jeremy | Report as abusive