International online pharmacies process orders for prescription drugs that are mailed across borders. That’s a simple definition for myriad websites, good, bad and in between, that can be found selling medicine on the Internet. Patients looking online for affordable medicine from another country want to know they will receive a lawfully-manufactured medicine that works. At PharmacyChecker, we believe we’ve developed a system of standards, rules and policies, for evaluating such websites to determine if they are safe and the businesses involved properly licensed. Those online pharmacies that are not only eligible but also willing to accept our monitoring and oversight are verified in our Verification Program. Verified means that an online pharmacy meets our online pharmacy standards of practice and agrees to our monitoring and oversight protocols. PharmacyChecker-verified online pharmacies are eligible to publish a PharmacyChecker seal on their websites and list their pharmacy information and prices on our website.
A new organization, the Center for Safe Internet Pharmacies (CSIP) – safemedsonline.org – made its debut yesterday. Unfortunately, the group seems more focused on keeping its big corporate members in the good graces of the pharmaceutical industry and government than on helping American consumers. In fact, its actions may endanger public health.
The Center for Safe Internet Pharmacies has two main activities. The first is to educate, or more accurately, “scare,” the public away from using “illegal” pharmacies, which appear to include licensed and safe pharmacies outside the U.S. which sell genuine but lower priced medicine to Americans. The second is to work with the U.S. government to “shut down” chosen online pharmacies by blocking their ability to appear in online searches and to accept payments.
CSIP has handed over the job of deciding which online pharmacies are okay to LegitScript, which has its own suspect past and intentions. All non-US online pharmacies are branded “not approved” by LegitScript on the basis that it’s technically illegal to personally import most medications – even though the government, in its wisdom, has permitted it. Moreover, it appears that LegitScript is essentially a private sector extension of the FDA as evidenced by its $2.6 million government contract.
As part of its launch, the Center for Safe Internet Pharmacies produced a scare video showing a caring, young woman go online to research and order lower-priced medication online for an elderly relative. The relative then falls ill and the young woman worries that the medicine may have been fake or even “rat poison” and, through the miracle of video, the clock is rolled back, the medicine is never ordered, and all is somehow well without the medicine.
This far-fetched horror flick is far more likely to scare people away from affordable medicine than keep them safe. It’s an indisputable fact that for more than a decade millions of Americans, many of whom have trouble paying for prescription medication in the United States, have safely filled their prescriptions, at much lower prices, through online pharmacies in Canada and other countries. Independent research has also shown that medicine ordered from sites approved by PharmacyChecker.com or the VIPPS Program is genuine. If CSIP’s well-funded public relations team could have found a person who was actually injured by ordering medicine with a prescription from an online pharmacy, they would not have had to create a fictitious character and story.
There are plenty of rogue pharmacies out there which CSIP can help root out – ones that sell fake medicine and don’t require prescriptions. We hope CSIP decides to focus all of its attention on these real dangers. If not, the real horror story could turn out to be CSIP itself when its actions increase the number of people who go without needed medication or are left impoverished due to prices at pharmacies of which CSIP “approves.”
On May 14th, an article appeared in ForeignAffairs.com called “Dangerous Doses: Fighting Fraud In The Global Medicine Supply Chain.” Authors Tim Mackey, Bryan Liang, and Tom Cubic simultaneously report on the counterfeit drug threats and tragedies experienced globally while deceptively attempting to link safe international online pharmacies to this problem. Our vice president, Gabriel Levitt responded in Telling the whole truth about online pharmacies. His response is published below.
Over a decade of experience and empirical studies [See “Unveiling the Mystery of Online Pharmacies: an Audit Study” in National Bureau of Economic Research] have shown that credentialed international online pharmacies sell safe and affordable medication, not counterfeit drugs, to Americans who otherwise might cut back or not take their medications at all. These credentialed websites work with licensed pharmacies that require a prescription and meet high safety standards for mail-order pharmacy. They just happen not to be located in the United States, which explains their low prices. They are not a part of the counterfeit drug threat but the authors of this article would like you to think that they are
So why do these authors take this position? Although not well disclosed, the two senior authors are directly affiliated with pharmaceutical corporate interests. Pharmaceutical companies in the U.S. do not want their sales undercut by lower cost imports of the same exact medicines they sell here because it negatively affects their profits. No one disputes this. Bryan Liang maintains a leadership position with the Partnership for Safe Medicines (PSM), which is largely funded by pharmaceutical companies and is currently led by the Deputy VP of Public Relations for the Pharmaceutical Researchers and Manufacturers of America (PhRMA). Thomas Cubic is head of the Pharmaceutical Security Institute (PSI), an organization of pharmaceutical company members. I believe the two entities share an office in Virginia.
The pharmaceutical industry has focused a lot of its lobbying muscle against drug importation laws that could help millions of Americans obtain needed medication. The pharmaceutical industry position is advocated on many levels through Liang’s Partnership for Safe Medicines and Cubic’s PSI, as well as through PhRMA and the National Association of Boards of Pharmacy with the goal of preventing non-US online pharmacies from selling to Americans even if they are safe. A careful reader would certainly find their position in this article.
The authors here accurately acknowledge that a majority of the world’s counterfeit drugs and the subsequent sickness and death they cause are found in countries with weak drug regulations and/or enforcement of laws. But they try and equate huge tragedies in developing countries where counterfeit drugs kill hundreds of thousands with the real but different dangers posed by the Internet.
Let’s just make one thing clear: The counterfeit drug problems found through online pharmacies in the rich countries are real but miniscule compared to the tragedies reported about in poorer countries. In fact, examples provided in this article perfectly reflect the sharp dichotomy in the numbers of counterfeit drug victims in the United States and in poorer countries. Eleven years ago one young American named Ryan Haight, 18, tragically died from an overdose of pills purchased online, which he should have never received. But it’s worth noting that the drug, Vicodin, was real – not counterfeit. In this case, the problem was dispensing medications without proper medical supervision – not counterfeit drugs. The people who sold him the Vicodin went to jail. In Niger, a much larger tragedy occurred – 2,500 people died out of 50,000 who were inoculated with bogus medication. Of course this had nothing to do with U.S. drug importation or online pharmacies. One might have expected the authors to mention the 238 Americans who died after ingesting fake Heparin, which was circulating thorough the legal U.S. drug supply in 2007 and 2008. This, too, had nothing to do with online pharmacies but exceeds in victims any reported incidents having to do with the Internet.
The authors would like you to believe that CanadaDrugs.com, a credentialed international online pharmacy, is a part of the counterfeit drug problem so as to foster actions that could block access to such sites. They state that one of its suppliers is responsible for the counterfeit Avastin in the United States. They fail to mention, however that the counterfeit Avastin had nothing to do with online pharmacies, safe or otherwise. As it happens, many pharmacies in the United States have at one time or another unintentionally sold counterfeit medication – including CVS and Walgreens, which is not a reason to shut them down.
The source of the most recent large scale problem with intentionally sold substandard medications distributed in the United States is in fact GlaxoSmithKline. They were fined $750 million for intentionally distributing millions of substandard pills all across the country. These products were manufactured at their facility in Puerto Rico. U.S. Marshalls confiscated $2 billion of products from the plant in 2005, the largest such seizure in history and worth at least four times the value of all drugs imported by Americans from Canada each year.
There is no doubt that companies and people operating websites that purposefully sell fake drugs or even real drugs without a prescription need to be shut down, and in many cases criminally prosecuted. Victims of bogus online pharmacies certainly go underreported and the problem is very serious. But it’s a different problem from the large scale counterfeit operations that are killing hundreds of thousands of people in poorer countries – a crisis that demands immediate action to prevent the next massacre. The UNDOC may in fact be a better venue for international enforcement efforts, as the authors point out, because police actions may exceed the WHO’s mandate. Interpol’s enforcement work in Operation Pangea definitely took out a lot of bad guys – more such efforts are needed. Certainly working in concert, tapping their respective strengths, UNDOC, Interpol, WHO-IMPACT can bring us to a better place where the counterfeit drug threat goes on the decline.
But when it comes to the American pharmaceutical market, we find 48 million Americans not filling a prescription each year due to cost – an underreported crisis from which many die. Some of these Americans seek affordable and genuine medication online from Canada and other countries to acquire needed medication.
To directly address the core of Foreign Affairs readers, we must not allow our foreign policy and multilateral actions to disadvantage American consumers who are struggling or can’t afford prescription medication. So as we ramp up our efforts to stop criminals from infesting the world with fake drugs let’s not enact policies that will block the access of Americans to life saving medications simply because it improves our corporate balance sheets.
Gabriel Levitt
Vice President
PharmacyChecker.com
President
United Nations Association Brooklyn Chapter
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