Two weeks ago I brought you some highlights of the PhRMA-led Partnership for Safe Medicines (PSM) Interchange propaganda show, which was held on September 18th. Look over to the left. See that picture. Those logos of big pharmaceutical companies make it abundantly clear who is pushing the distorted message of PSM about personal drug importation and online pharmacies.
I’m not joking about the word “propaganda” applied to the PSM event. The online Merriam Webster dictionary provides the following definition for that word: “ideas or statements that are often false or exaggerated and that are spread in order to help a cause, a political leader, a government, etc.” In this case, as I see it, the “cause” of PSM is the commercial agenda of the pharmaceutical and U.S. pharmacy industries cynically couched behind terms of patient safety. A central message of PSM is that Americans are risking their lives buying medication online from other countries and that there is no way to do so safely. Those are false and exaggerated messages that are potentially leading lawmakers and regulators to overreact and scare Americans from a potential lifeline of affordable prescription drugs. Evidence shows that this has been PhRMA’s communications strategy for more than a decade.
Of course, during that decade, millions of safe prescription drugs were ordered online by consumers with valid prescriptions from their healthcare providers without safety problems. Without these online pharmacies, millions might have gone without needed medication. All one needs to do is listen to real people. Click that hyperlinked text and you’ll find about 2,000 comments by consumers, many of whom are essentially saying: “I can’t afford drugs in the United States. If I don’t have access to safe international online pharmacies then I will not be able to take medication prescribed to me.”
Now we introduced the leadership of PSM in a blog post several years ago but here’s a refresher to remind you that they are lieutenants and consultants for drug companies. The executive director is Scott LaGanga. When Mr. LaGanga is not running PSM activities to save Americans from lower priced medication, he is a vice president for the Pharmaceutical Researchers and Manufacturers of America (PhRMA). The president of PSM is Marvin P. Shepherd, PhD, Center for Pharmacoeconomics Studies, College of Pharmacy, University of Texas. Current or past clients of the Center for Pharmacoeconomics include Eli Lilly, GlaxoSmithKline and Pfizer [Duly note that Dr. Shepherd has done some good work to understand and improve pharmacy regulation, despite his affiliations]. When he’s not working to manage the finances of PSM as its treasurer, Thomas T. Kubic, president and CEO of the Pharmaceutical Security Institute, a non-profit group of the security heads of major pharmaceutical companies, is on the prowl to protect the interests of drug companies from drug counterfeiters, diverters (often meaning licensed pharmacies in other countries that sell lower cost medications to Americans), and thieves. Then there is Jim Dahl, formerly assistant director of the FDA’s Office of Criminal Investigations. Mr. Dahl has also worked for the pharmaceutical industry and is currently an independent product security consultant. All PSM board members appear to work for or be strongly tied to the pharmaceutical industry.
Last week I mentioned the misleading nature of some of the presentations about online pharmacies at PSM. However, there were a few things that happened in the Lion’s Den that were kind of creepy. First, recall that I had stood up at the conference to point out to the attendees that while, according to FDA’s data, almost one quarter of American adults may buy medication online, only 4% do so from websites that might be based outside the U.S.; meaning the overwhelming majority of online prescription drug purchases are domestic (i.e. at licensed U.S. pharmacies). In case any attendees were new to the issue, I didn’t want them to get the false impression that 25% of Americans are buying medication from rogue online pharmacies, or even safe international online pharmacies, an impression that could lead lawmakers and regulators to overreact.
After that panel someone from a global pharmaceutical company’s product security division approached me and asked, “Is this your website?” pointing to a price comparison page on PharmacyChecker.com on his iPhone. [I won’t mention his name or company because this person is not in a public role]. I said yes. Pointing to one of the verified online pharmacies he asked, “Isn’t that the website identified in that last panel as selling foreign medication to Maine residents.” I said no, that was a different one but that other one is in our program, too. Referring to my prior remarks on the FDA’s survey data, he said, and I’m paraphrasing, “What’s the difference if it’s 4% or 25% of Americans who are buying medication online from foreign sources. It’s like saying it’s only 200 homicides instead of 2,000 homicides.” I was stunned. I asked, “Did you just say homicide?” He did. I don’t know what type of Kool-Aid he had swallowed but I realized there was no end to how bizarre things could get in this Lion’s Den of misinformation and obtuse metaphors.
There was the keynote speech by the Mississippi Attorney General, Jim Hood. I had read about his efforts to pressure Google to do more to get rid of “rogue” online pharmacies – but those efforts seemed to include real and safe international online pharmacies, too – so I was really looking forward to not liking this guy. Sure enough he said Google is not doing enough because people can still find “illegal” and “legal” – meaning, and he said the word, “legitimate” prescription drugs doing a search on Google. Does that mean he wants Google to censor its search engine to remove information about legal and legitimate medications? We fought against the Stop Online Piracy Act to deter that very kind of censorship.
Now I actually liked Mr. Hood (the guy was just upbeat in this Southern way that New Yorkers think is kind of cool) and it’s possible that he is not be fully aware that many Americans benefit from, and in some cases need, lower priced medications sold online from foreign pharmacies. He did say, “I appreciate this type of organization that puts together people in groups that may not think alike but at least you’re able to talk about different issues.” Well, since I’m the only one who offered a different opinion he must have been referring to me! In fact, the PSM conference is eerily scripted to include presentations that do not deviate from PSM’s message.
What was most scary about Mr. Hood’s talk was his recounting of a certain meeting he attended about four years ago “at the White House or something weird like that,” he said. In attendance were banks and “rights holders…some of them who are here today.” By “rights holders” he meant intellectual property holders – in this case, drug companies. At this meeting, apparently the drug companies asked the banks to stop credit card payments to certain online pharmacies. Mr. Hood said, “What if we had a list from some independent outfit that identified a lot of these companies. What would you do? Would you stop payment to them? And they go, yes!”
So what is borderline nefarious about all of this? The White House held a meeting to ask banks to cooperate with drug companies in helping deny service to certain online pharmacies in the form of credit card processing. We have reason to believe that the “independent outfit” providing the list is LegitScript, which categorizes safe international online pharmacies as illegitimate [more on this in a future blog post]. If banks and credit card companies deny service to dangerous rogue online pharmacies then that’s good, but what I’m hearing is that drug companies are trying to make it so that Americans cannot use their credit cards when purchasing medication from safe international online pharmacies. That’s an attack on American consumers by drug companies and banks.
Finally, there was the participation of Daniel Burke, head of Cybercrime for the FDA Office of Criminal Investigations. Agent Burke said he was there as a private citizen, not in his capacity as an FDA agent. So I believe it’s OK to respond to the private citizen – with due respect for his official role as well.
Mr. Burke said a lot of things about protecting the public health by preventing them from obtaining fake, falsified for otherwise bad medication – or even real medication but without the appropriate medical supervision. I really liked one particular part of his talk. He invoked the Latin phrase “Caveat Venditer,” which means casting the responsibility for defects or deficiencies upon the seller of goods – to make that point that consumers deserve better than “Caveat Emptor,” which means “buyer beware” in Latin. Mr. Burke is saying “sellers beware.” I believe that’s a great point.
We started PharmacyChecker.com over a decade ago because Americans were buying medication online, often from Canada and didn’t know which sites were operating safely, less safely or dangerously. We figured that by providing information on important licensure and prescription requirements, we could help remove the “buyer beware” component for consumers looking online for lower cost medication. We were positively recognized for doing so, including acknowledgement from the FDA for our efforts. Some of those same Canadian online pharmacies partner with pharmacies in other countries and we verify their licenses as well.
In 2001, just before we started PharmacyChecker.com, the Commonwealth Fund reported that there were 29 million American adults, ages 19-64, who did not fill a prescription due to cost. That number skyrocketed to 48 million in 2010; and then to 50 million in 2012! No wonder Americans continue to look online for lower cost medication, including from foreign pharmacies.
What is so frightening about Mr. Burke’s talk is that his audience is the pharmaceutical industry and, as a collective, via PhRMA, that industry wants to shutdown foreign pharmacies that require valid prescriptions and sell real medications, ones that some Americans rely on because they can’t afford medications locally. His choice of words appeared directed at the safest international online pharmacies currently available to consumers, such as those approved in the PharmacyChecker.com Verification Program. He even implied that safe international online pharmacies are committing “fraud on the U.S. consumer”? Now that’s not quite “homicide” but the hyperbole and rhetoric itself seems a little deceptive.
Yes “Caveat Venditer! The responsibility should be on sellers of medication wherever they are. But medications sold by pharmacies approved in the PharmacyChecker.com Verification Program are genuine and work in the manner intended by the healthcare practitioners who prescribed them. Who are you really hurting by shutting down the sellers of safe and affordable medications? You’re hurting Americans who rely on them. Are those sellers all perfect? No, but neither are domestic pharmacies at which thousands of Americans have received the wrong medications and suffered illness and death over the last decade.
Mr. Burke says that “the bulk of our investigative resources” seek “to bring to justice to those that operate large online pharmacy networks, most of which operate outside the United States.” These are an estimated “30,000-50,000 illegal” such websites “active at any one time.” There are about 50 international online pharmacies approved in our program in a universe of tens of thousands. Why doesn’t the FDA focus the bulk of its investigative resources on shutting down the 99% that are truly dangerous? Are they afraid that there would only be safe international online pharmacies but without any rogue ones for big pharma to conflate them with?
There are indeed some global sellers and makers of medication committing “fraud on the U.S. consumer” and they include rogue online pharmacies and wholesalers who pass off medication as FDA-approved when it’s not. But they are not the only fraudsters. Fraud is defined as “a deception deliberately practiced in order to secure unfair or unlawful gain.” Does the pharmaceutical industry secure unfair gain when they spend billions of dollars lobbying members of congress and FDA officials, including on the issue of drug importation and online pharmacies to the disadvantage of consumers and taxpayers? How about when they ask the FDA to launch programs that warn Americans who are struggling with their finances to “only buy from U.S. pharmacies” but not to buy medication from any international online pharmacy on the pretense that it’s not safe when they know that’s not true? Who else might be committing fraud? Look into the Lion’s Den.Counterfeit Drugs, daniel burke, FDA, Interchnage, laganga, Mississippi AG hood, OCI, Partnership for Safe Medicines, phrma, PSM
I concur STRONGLY with your general comments but bristle against the insinuation about Dr. Shepherd just a bit.
I have read some of his Center’s reports (through this site’s link.) Though I disagree with many of the ultimate conclusions drawn, they strike me as being conducted with academic rigor.
Unfortunately, groups with an interest in the product of academic research tend to financially support that research. That doesn’t mean the outcome of the research is ultimately shaped by the source of its funding. Being aware of the source of funding is a totally valid and wise thing for any reader to consider and weigh, but doesn’t mean the integrity of the author should be discounted for that reason alone.
Thank you for your comments. Since you are obviously someone “in the know” about pharmacy issues, regulation, safety, etc., I would like to know who you are so feel free to contact me to discuss these issues further.
Regarding Dr. Shepherd: I was clear to point out that I know he has done excellent work in tackling issues of pharmacy regulation and safety. As it happens, he has also criticized the U.S. pharmacy industry for their failings. And while I don’t really know him, he seems like a good guy.
I agree with you that academic inquiry supported by the private sector can be done with complete integrity and objectivity, but too often the process is corrupted due to the inherent conflicts of interest.