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Getting the truth about Online Pharmacies

The economist and drug safety expert Roger Bate, PhD, affiliated with the American Enterprise Institute, published a short article this week, the title of which says it all: “Credentialed online pharmacies are so safe that peer review literature is no longer interested in results showing it.” The gist is that he and colleagues have been testing medications for several years, since 2008, as mystery shoppers ordering online domestically here in the U.S. and internationally for import. The research shreds the myths of the drug companies by presenting peer-reviewed data to derive what are called “facts” about the Internet and importation. The main fact proved is that importing medications, ones ordered online, can be equally safe as U.S. pharmacies.

In the studies from 2008-2016, 822 online medication orders were tested: 275 medications from 22 international online pharmacies verified by (12 of which are also verified by the Canadian International Pharmacy Association); 127 medications from eight U.S.-only online pharmacies verified by the National Association of Boards of Pharmacy and/or, and the rest from websites with no verification.

Verified U.S. pharmacies sold zero counterfeits but one (out of 127) order of generic Cipro was substandard. Verified international pharmacies sold zero counterfeits but one (out of 275) order of generic Cipro was substandard. On a percentage basis, the websites performed best (but that’s nitpicking). And for those of you thinking, well, one was substandard…that same medication is available at your local Walgreens or CVS. Read the research.

In contrast, online pharmacies with no verification (Dr. Bate calls it “credentialing”) sold eight counterfeits and 16 substandard drugs (out of 332 tested).

How about prices? When it came to brand name drug prices, the studies showed that credentialed international pharmacies were about 60% cheaper.

These results do confirm FDA warnings about online pharmacies, a majority being foreign sites, but they also confirm that warning Americans never to buy medication internationally over the Internet is really bad advice, which is what FDA advises. In fact, the research is so convincing that academic journals are not interested in continuing to publish new results, which is why Dr. Bate refers to buying medications over the Internet from credentialed international pharmacies as “so safe.”

Who funded this research? Foundations and think-tanks generally viewed (wrongly or rightly) as supportive of the pharmaceutical industry’s positions.

The Searle Freedom Trust and Legatum Institute through grants to the American Enterprise Institute funded:

  • 2008 (results published in 2010). Bate, Roger; Kimberly Hess. (2010) Assessing Website Pharmacy Drug Quality: Safer Than You Think? PLoS ONE 5(8): e12199. See
  • 2010-2011 (results published in 2012, 2013). Bate, Roger; Ginger Zhe Jin; Aparna Mathur. (2013) In Whom We Trust: The Role of Certification Agencies in Online Drug Markets. NBER Working Paper No. 17955 March 2012, Revised January 2013, Revised July 2013.

American Enterprise Institute funded

In his post, Dr. Bate say’s that “insiders” in the Trump Administration and FDA say the pharmaceutical companies believe the studies’ sample sizes are too small. He concludes: “Essentially, the medical and economic literature broadly accepts that credentialed pharmacies are safe, but politically this is irrelevant.”

Have a good weekend.


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