Phil, I think the claimed safety “issue” of importing drugs from Canada to US is not whether Canadian drugs are inherently unsafe.

The argument is that there’s inadequate assurance that the drugs being imported are really from Canada, have been handled & stored properly, etc.

It’s still a lousy reason to oppose (re-)importation, but it’s not quite as ridiculous as claiming that Canadian drugs are unsafe per se.

I’m going to have to strongly disagree that inadequate preventive efforts against the flu are “no crisis.”

There are several issues and you only address one of them.

First, the flu kills nearly as many people annually as automobiles and firearms (or people wielding firearms anyway) do. In the current prevention paradigm, we only vaccinate high-risk individuals and therefore the rest of the population provides an adequate reservoir for routine transmission to take place. It’s true that there is substantial antigenic drift and that the vaccine is not perfect, but there is still a chance you can die in a car accident while belted. I hope that if automobile manufacturers suddenly stopped making cars with seat belts, it would be a “big deal” to you.

If the CDC and local health departments put their weight behind flu vaccines like the military does (annual flu shots are mandatory for active duty personnel, I wonder why) and if the vaccinated portion of the public was closer to 80-90% then the virus would have a much lower likelihood of spreading from an index case and the actual burden of suffering would be substantially decreased. To argue otherwise seems at best question-begging to me.

Beyond that, your statements are all based on the idea that the only threat from influenza is annual epidemics, but this ignores the evidence from the 1918 flu pandemic, which killed at least 20 million people worldwide.

To argue that a disease that has the potential to wipe out 20 million people in one season is not a “crisis”, and that a government that casually brushes off known threats of this magnitude while focusing on eradicated diseases like smallpox and screening mother’s breast milk before they get on an airplane is laughable.

Tell someone (there are many still alive today) who lost most of their family to influenza in 1918 that there is no “crisis” when the government’s contingency plans to manage a predictable annual event are slipshod.

What sort of confidence are we to have in our ability to handle bioterrorism if we can’t handle influenza?

Money is what the shortage comes down to. Why would a company produce these vaccines when the past 5 years have shown net economic loss? I think Wyeth alone has lost $50M in discarded flu vaccines since 2000.

I understand that price controls were imposed to make the vaccine affordable to anyone who needs it. However, the government cannot expect pharmaceutical companies to shoulder the burden of this “benevolence”. To prevent similar shortages in the future, perhaps the government should institute a buyback policy – where vaccine-producing companies would be reimbursed for losses. Or, the government could remove price controls and allow free markets to work.

On the sidenote, isn’t it interesting how you couldn’t pay people to take the vaccine last year, but this year its become a greater issue this winter than oil prices?

Aaron,

I agree that the safe handling argument is mostly specious. I wasn’t trying to defend it at all.

I was just pointing out to Phil that people who argue against re-importation from Canada aren’t really arguing that legitimate Canadian drugs are unsafe per se. They’re arguing that there’s insufficient oversight to assure proper sourcing, handling, etc.

Again, it’s a dumb argument, but if one wants to refute a dumb argument, it helps to know what the argument really is.

A public health epidemiologist? Glad to know you, brother.

With which half of my comment did you disagree? Vaccinating kids? That idea is not my own…

BEFORE SHORTAGE OF FLU VACCINE, MANY WARNINGS
The New York Times
Sunday, October 17, 2004

Dr. Robert B. Belshe, director of the center for vaccine development at Saint Louis University, said many experts in infectious diseases and vaccination believe that ultimately, the only way to control influenza will be to vaccinate nearly all school-age children every year.

If the medical profession does make that recommendation, and the public follows it, there will be a greater need than ever for vaccines — and possibly a more stable market to tempt manufacturers.

The received wisdom is supposed to be that Canadian drug inspection programs are as stringent as US standards.

I would agree, if I were dealing with a brick-and-mortar pharmacy on a street in a Canadian city, selling drugs to Canadians or anyone else who walked in the door.

I am not sure that the Canadian inspection regimen applies to businesses in Canada that act as conduits, shipping all their product back to the USA.

http://www.fda.gov/fdac/features/2002/502_import.html

“……if a Canadian company is selling drugs only for export to the United States, and not to Canadian citizens, Health Canada may not regulate the drugs or the company at all. Drugs coming to the United States from Canada may be coming from some other country and simply passing through Canada……..”

How accurate this is, I don’t know. It’s from the FDA site. As the pharmaceutical firms are putting the screws to the Canadians, limiting their imports to reflect Canadian domestic needs, and no more, or enforcing reimportation agreements, the Canadian pharmacies are going to other countries to get product to sell to the USA.

They have used the usual Commonwealth countries, Australia, New Zealand, etc., where that Lipitor pill gets more flyer miles than I have. But they are starting to go further afield for product, Pakistan, etc. Maybe I’m a bigot, but my personal tolerance of this starts to erode as the shipping labels move out of the English language and out of the Roman alphabet.

So…….caveat emptor, as usual.

As the re-importation movement gets bigger and bigger, I am starting to feel LESS secure about the whole thing.

And, speaking of Canadian pharmacies, make sure you really are dealing with a “Canadian” pharmacy in the first place. I’ve already stopped a couple of elderly patients who brought in literature on “Canadian” pharmacies, where close inspection showed they clearly were not Canadian. Anyone can set up a 800-number or a “.ca” Web site and work out of a boiler room in Jakarta. Usually, one of the tactics they use is to get the doc to sign on, accept delivery of the medicine on behalf of the patient……in other words, find ways to make the doctor a liability target.

What a surprise.

We need to preventing flu vaccines shortages in the future.

The flu vaccines should be manufactures in the United States to protect our citizens. Sure the flu vaccines is manufacture in Liverpool, England it produce very little flu vaccines especially with the swine flu is H1N! outbreak every should be vaccines against the H1N1.

The CDC should push harder that includes Home Land Security to push the Magnifications to speed up the process of flu vaccines that will nucleate every populations against the swine flu 2009-2019 flu seasons.

Salem, New Hampshire