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3/21/2004

Canadian cure

By Tony Kindelspire
The Daily Times-Call

LONGMONT — She doesn’t look like an outlaw.

But that’s exactly what the sprightly 85-year-old with the lively eyes is: someone blatantly and knowingly violating federal law.

This Boulder woman, who asked that her name not be used, buys her prescription drugs from a Canadian pharmacy — a definite no-no, as far as the Food and Drug Administration is concerned.

How does she sleep at night? Very well, thank you.

“I’ve always been a person to follow the law, but at this point I’m not sure that this is a good law,” the woman said. “And I know that it’s there because of the lobby of the pharmaceuticals.

“Some of us don’t have that kind of lobbying, so I think our voices need to be heard. So far, they really haven’t heard us.”

The woman said she used to purchase her drugs at RxCanada on Arapahoe Avenue, a store where people could go to buy their prescription drugs straight from a Canadian pharmacy, saving, in this person’s case, about a third of the cost.

But RxCanada was shut down last fall as part of a nationwide crackdown by the Feds against such storefront operations.

Now, while she won’t be specific, she says simply, “they come to me from Canada.”

_ _ _

Just as health care in general figures to be a prominent issue in this fall’s presidential election, the issue of purchasing drugs from Canadian pharmacies serves as an illustrative microcosm of the much larger problem.

The FDA says no, it’s against the law. Pharmaceutical companies — rightly so, in some cases — scream of the dangers consumers can face. And caught in the middle are people like our 85-year-old, who is defiantly unapologetic.

“At one time I did have some insurance (through a group plan). There was a $50 deductible that you paid and they would pay 50 percent of your prescription up to $1,000.”

However, the insurance company carrying the group plan dropped the coverage. A new plan picked them up, but it offered no prescription drug coverage at all.

Her AARP card provides her with 10 percent to 15 percent off the price of her drugs, but that’s weak compared to the 33 percent savings she found at RxCanada.

She first went there about a year ago, and then when the storefront was shut down — something she had expected to happen following news reports, she said — she found another way.

Whatever her exact method is, she would rather not say.

“It comes in a package directly from the pharmaceutical producer,” she said. “It’s in a blister-type thing, and it has all the packaging and wrapping of the pharmaceutical.

“I don’t personally know there are other people that are (buying their drugs from Canada), but I’m sure that there are others — I’m not the only one in the county.

“RxCanada wasn’t staying in business just to serve me.”

_ _ _

According to the Baltimore Sun’s Cyril Zaneski, who wrote a piece on this topic last month, Americans spent $184 billion on prescription drugs last year, a 13.4 percent increase over the year before.

Spending on prescriptions, Zaneski found, has been increasing at approximately twice the rate of inflation for the past decade.

An Associated Press poll released last month found that almost a third of Americans say paying for prescription drugs is a problem in their families. Nearly two-thirds say the government should make it easier to buy cheaper drugs from Canada and other countries.

The problem has led to entire states openly defying the FDA law banning Canadian drug imports.

In Illinois, an elderly couple has filed suit in U.S. District Court in Washington, saying that the law prohibiting them from purchasing drugs at a lower price from Canada is unconstitutional. The couple’s lawsuit has been endorsed by Governor Rod Blagojevich, a Democrat.

Meanwhile, in Minnesota, Republican Gov. Tim Pawlenty told the Washington Post that “The high cost of prescription medicines in the United States is unsustainable, plain and simple. In Minnesota, we are moving ahead with an innovative approach to enable our citizens to bring those costs down.”

Specifically, the Post reports that Pawlenty sent his own state health regulators to check out two Canadian pharmacies. After his inspectors gave their approval, the Republican governor officially endorsed the two pharmacies as being safe to buy from.

In Wisconsin, Democratic Gov. Jim Doyle has set up a Web site, www.drugsavings.wi.gov, to help people buy drugs from Canadian pharmacies that his inspectors have checked out.

Locally, Liz Keating has been an outspoken critic of the government’s policy against Canadian imports.

Keating launched www.rxsavingsguide.com “to help people find free and discounted prescription drugs.

“Sometimes you can get the drugs for free. I’ve found over 300 programs out there. People just don’t know about it — they’re hard to find,” said Keating, who lives in the Denver area and runs an Internet company for a living.

Many seniors, however, such as our 85-year-old, don’t meet the income limitations needed to obtain free drugs. Those people, Keating said, get steered north of the border.

“I actually went to a Canadian pharmacy in August, and I was more impressed by the safety of these pharmacies than almost anything I’ve ever seen,” said Keating.

While it should be noted that there are many, many disreputable outfits purporting to offer Canadian drugs on the Internet, Keating said the Canadian pharmacies she recommends on her Web site have a solid reputation.

“I would not ever order from a company that didn’t require a prescription, or say they’ll write the prescription for you,” said Keating.

As for the FDA’s ban against such imports, Keating calls it “a scare tactic.”

Her Web site is a subscription site, she said. For $300 per year, or $25 a month, subscribers will find a comprehensive collection of different options, Keating said, adding that she refuses to accept advertising.

“Liz’s site also lists all of the discounts that drug companies offer,” said John Riggle of Boulder Senior Services. “They’ve had those for years, but it’s not something the drug companies have really promoted.”

Riggle said he invited Keating to speak to a group of seniors recently, and feels she is performing a valuable service.

“We already knew of seniors locally who were buying drugs at RxCanada,” Riggle said.

Given the touchiness of the subject — federal laws are, after all, federal laws — Riggle said his organization doesn’t blatantly promote Keating’s site, but his group “gives the password to people who request it.

“We don’t push anything,” Riggle said. “Some of the seniors we know, who are really having a hard time being able to pay for their drugs, they can come in and get their password and access the site as often as they want.”

If all of this sounds like a wink-and-a-nod approach, it is. When your adversaries are the federal government and the powerful pharmaceutical lobby, you had best tread lightly.

But while they may not be the Medellin Cartel, there is a large network of people — some underground, some above ground — who continue to look for solutions to the problem, law or no law.

“If it’s a last resort as far as saving on their medication, we steer them to Canadian pharmacies,” said a woman who works with seniors at a prominent Denver hospital. She also asked not to be identified.

“Their medications are much, much cheaper, and I have not heard of anyone who’s gone through a Canadian pharmacy and had any kinds of problems with them,” she said, although she, too, stressed the importance of going through “reputable” Canadian pharmacies.

_ _ _

As far as the FDA and the pharmaceutical industry is concerned, there is apparently no such thing as a “reputable Canadian pharmacy.”

“In light of recent terrorist attacks, the risk of tampering seems to be one of great significance,” shouts a paper put out this month by the National Association of Boards of Pharmacy.

Wanda Moebius, a spokeswoman for the Pharmaceutical Research & Manufacturers of America — or PhRMA, an industry lobbying group — likens buying prescription drugs online to “finding a needle in a haystack,” saying that “it’s totally unfair to ask a senior citizen ... to distinguish between a legitimate, safe source of prescription drugs and a bad actor.”

PhRMA backs the FDA’s ban on the importation of drugs, and blames price controls in other countries for the high price of prescription drugs in the United States.

“There is definitely a squeeze on patients, because the American consumer is carrying an unfair share of the research burden because Canadians and Europeans are taking a free ride,” said Moebius.

The solution? “We can do a better job of working with our trade representatives and ensuring free trade. We just need to make sure that there’s fairness,” she said.

A report issued last June by Ralph Nader’s organization, Public Citizen, said the drug industry hired 675 lobbyists in 2002 — almost seven per U.S. Senator. Asked about the number, Moebius said, “I don’t know, I know it’s a lot,” adding, “It’s also a global industry.”

According to the report, the pharmaceutical industry spent $91.4 million on lobbying activities in 2002, an 11.6 percent jump from the previous year.

“I think we’re one of the most heavily legislated and regulated industries in the world,” said Moebius.

Asked about a 2003 Kaiser Family Foundation study that found direct-to-consumer advertising by the pharmaceutical industry had jumped from $800 million in 1987 to $2.7 billion in 2001, Moebius emphasized the education component of that advertising.

“It’s a personal and subjective call if the industry is doing too much advertising,” she said, noting that some ads had been taken off the air by the FDA for not having enough of an educational component.

And the ads are there for a reason: they work. The Kaiser study found that in 2000, for every dollar the drug companies spent on D-T-C advertising it got back $4.20 in increased drug sales.

According to Public Citizen, in 2002, the top 10 largest drug companies reaped nearly $36 billion in profits, five-and-a-half times the median for all industries in the Fortune 500.

But Moebius defended the companies, citing the expense and risk inherent in what they do. It takes an average of $800 million and 10 years to bring a new drug to market, and anywhere along the way, things could go wrong and the drug could fail.

“It is totally fair to talk about profits and research because the two are inexplicably linked,” she said. “The profits do drive research and innovation.”

_ _ _

“With the high cost of prescription drugs, it is natural for Coloradans to explore other options,” said Attorney General Ken Salazar, in a statement his office has issued on the subject of importation. “I sympathize with this dilemma; it is unconscionable that in the wealthiest country in the world, citizens are having to make decisions between adequate housing and food and medicines because of the medicines’ high cost.

“I understand the need to seek out alternative and hopefully cheaper sources of prescription drugs. My concern is that, in their haste to obtain cheaper prescription drugs, Coloradans may be harmed by the dispensing of adulterated or inappropriate drugs from Internet and/or foreign pharmacies without adequate legal resource or protection.”

Our anonymous 85-year-old outlaw would respectfully disagree with the AG. Seemingly excessive cost versus seniors on a limited income — something has to give.

“I would hesitate going to Mexico and getting anything from there,” said the woman, who said she only began needing such drugs in the last five years. “But I don’t have any qualms about getting them from Canada, when they’re as supervised as they are.

“It’s a risk when you go into the pharmacy and hand them a prescription; there’s a risk that it won’t get filled out correctly. I don’t think there’s any more of a risk here.

“I think that until we’re able to get prescriptions, and people can get them for a price we can live with — this just isn’t fair. If (the pharmaceutical companies) can send it to Canada, and Canada can send it back to us at a price we can afford, why can’t they sell them directly to us?

“After all, we’re their citizens — we’re the ones keeping them in business.”

Tony Kindelspire can be reached at 303-776-2244, Ext. 291, or by e-mail at tkindelspire@times-call.com.