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Politics and drug importation

Kerry Faults Bush Over Opposition to Drugs From Canada

Hitting hard on an issue of deep concern to older voters, Senator John Kerry on Wednesday promised an overhaul of the Medicare prescription drug law, saying President Bush had personally “stood in the way” of importing drugs from Canada, which advocates say would significantly reduce costs.

“George Bush stood right there and said, ‘Nope, we’re not going to help people to have lower cost drugs in America, we’re going to help the big drug companies get a great big windfall,’ ” Mr. Kerry said.

He said of the president’s opposition to legislation to reimport American-made drugs from Canada, passed by the Senate: “I thought these were the people who believed in the marketplace, in fair competition. This isn’t fair competition, it’s a monopoly, and it’s been put in place by George Bush and his friends, and it’s costing you a whole bunch of extra money, and it’s wrong, it’s fundamentally wrong.”

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Republicans responded Wednesday with a strong condemnation not only of Mr. Kerry’s plans for importation and bulk purchasing of drugs, which they denounced as costly and unrealistic, but also of what they described as blatant and base politicking. Representative Bill Thomas of California, the chairman of the Ways and Means Committee, told reporters that Mr. Kerry lied and “made up stories” about health care quagmires and “was AWOL through the entire process” of negotiating the drug plan.

So who is right? I have ranted about drug importation in the past. Some patients do benefit financially from importing drugs. Others really save little money.

As usual one must examine unintended consequences. What impact would a massive drug importation have on new drug development? One can easily claim that research will continue unabated, but perhaps not. As much as I love to criticize the pharmaceutical industry for their marketing practices, they are responsible for a plethora of new important drugs.

Would the pipeline slow if we import more Canadian drugs?

What impact would this policy have on Canada? How would the pharmaceutical industry retaliate against Canada? How would this effect Canadian citizens?

But neither party will engage in real debate concerning this issue. Our political process may ask tough questions, but rarely addresses the tough answers. Kerry will use this claim, as on the surface is “plays well in sound bites”. But we should think more carefully to understand his claim. I believe his argument good politics but suspect policy.

18 Responses to “Politics and drug importation”

Drug importation from Canada will never legally occur.

The Pharmaceutical industry is THE most powerful industry, whose lobbyists are in thick cahoots with the Bushies.

2. Any attemp to legalize importation will only cause the drug companies to severely cut back manufacture in Canada. In fact, they have already openly and directly threatened the Canadians on this.

3. A solution will never be forthcoming until the administration is accountable to the people, not Big Money. and these days, this is a bit to much to hope for in the good ol US of A.

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This type of modernization is a big part of Kerry’s healthcare plan. It provides incentives to encourage providers to upgrade.

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Sorry. I posted to the wrong article.

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The FDA has a very good point when it worries about the safety of reimported drugs. Look at it this way:

Canada manages to get cheaper drugs by basically extorting the drug company for lower prices via threats to invalidate their patents. As a result, the company only sells as many prescriptions as are needed to Canada (it’s a financial waste for them, they’re not making much profit from the sales, why boost them?).

So the first problem is that Canada will face a prescription drug shortage if reimportation is legalized. Oddly enough, this shortage will last for only a brief time.

The drug companies won’t be picking up the slack though. Instead of getting drugs from the United States, Canada will begin getting drugs from un-named manufacturers in Thailand, Pakistan, Morocco, etc.

The big problem with this is that none of these manufacturing plants are regulated, and are often churning out fake drugs. If the FDA cannot keep a tight grip on drug manufacturers, the US consumber becomes vulnerable to buying drugs with little, no, or harmful amounts of effective ingredient.

There is no recourse in the case of fake drugs. You can’t sue the legitimate drug company, they didn’t make the pill. Try to sue the Canadian pharmacy that sold it to you, they’ll tell you to call the company from Pakistan (or wherever) that they bought it from. Good luck bringing a lawsuit against a counterfeit drug maker halfway around the world.

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Prozac (fluoxetine) used to cost about $250-$300 for a three-month supply.

I looked in the Henry Schein catalogue, a hundred pills is now less than twenty bucks.

Similar drops for tramadol, lisinopril, loratatidine.

About a 90% price drop when the patent was dropped.

One “simple” way to deal with a big part of the problem. Rationalize the patent system.

The drug’s patent lasts from point “A” to point “B”.

Period. No longer.

No junk lawsuits over patenting the metabolites and all the other games they play. They drag these patents out forever. The price stays up, they make enough money during the litigation to justify a team of lawyers.

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loratadine

I can spell……….

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“No junk lawsuits over patenting the metabolites and all the other games they play. They drag these patents out forever.”

Not forever. At most they can get back part of the time lost to the approval process. (Because the formulation or whatever patent has to be granted before they can start the last stretch of FDA approval.)

Oh, and some drugs dissolve about as well as sand does. Try taking multiple injections every day and then see if you still complain about formulation patents.

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What we’re going to end up with as a result of all of this BigPharma bashing is fewer new drugs. I know that the drug companies are greedy, avaricious, powerful, autocratic, and self-interested. So is every other large corporation in this world. The difference is that these evil corporations literally save lives with their products. The antiretroviral drugs changed AIDS from a guaranteed death sentence to a chronic management problem. The development costs were in the billions, with no assurance that any of them would ever be sold. Now the Pharmas are being extorted to give them away. Bayer spent hundreds of millions developing Cipro, again with no guarantee that it could ever sell a single pill (Pfizer spent similar $ on Trovan, only to have to take it off the market due to liver problems). I’ll bet many of you forgot the way Bayer was demonized when it declined to give Cipro away during the anthrax panic in 2001. The only way these companies are going to make any money is to make stuff that nobody really, really needs, because if someone really, really needs something, anyone who has it is obligated to give it to him with no profit allowed. Why would any compnay risk big money on development of a drug to, for example, cure diabetes? It might have to charge thousands for a course of treatment, and there would be endless demonstrations to demand free treatment, especially “for the children” who are stricken with diabetes, who are condemned to a life of injected insulin but can’t afford the new treatment, and the company is morally obligated to give it away, at least “for the children.” No company wants this headache. If there is a possibility of spending that R&D money on topical Viagra cream, that’s where it will go, and nobody’s diabetes will be cured. You might scoff at this; but hope that your sugar stays low.

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jb is right. This is a tough pill to swallow, but inevitable should Kerry nd others become successful in pushing health care as a “right”. (If he wins the presidency)

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Reimportation is little more than political cover for those who want to create the appearance of being responsive to the financial plight of citizen consumers but who lack the political will to legislate meaningful cahnge. It’s not an accident that drugs are cheaper in Canada and elsewhere: those countries have price controls. Reimportation has the effect of borrowing another country’s price controls because our leaders are too beholden to drug companies to create our own. Unfortunately it introduces a whole slew of safety risks by creating an unregulated delivery chain.

The idea that we need to pay through the nose for drugs to ensure the steady advance of pharmaceutical development is laughable. We already fund a huge portion of the research costs through the NIH. I realize that drug companies incur a substantial cost in bringing drugs from the bench to the pharmacy and need to have an opportunity to recover their investment and make a profit for their shareholders. But drug companies waste a lot of money too (and physicians are partly to blame). Here are my modest proposals:

1. Empower the FDA to create price controls. Work through the WTO to create equitable international price controls for the developed world (higher than current prices in Canada and elsewhere) and lower price controls for the developing world (at or near cost). Offering drugs at cost to the developing world (e.g. sub-Saharan Africa) does not truly deprive drug companies of any profit because those countries don’t currently have the financial resources to actually constitute a market.
2. Eliminate non-print drug company marketing to and “education” for health care professionals. When a patient sees a physician write a script for the same drug that’s emblazoned on the pen that spills the ink, the physician comes off as a drug company whore, rightly or wrongly. Nevermind all the meals, lecture-mercials, etc. Replace nitwit sales reps with a scholarly-run, pharmaceutical industry association supported, educational institute that provides fair and balanced (but not according to the Fox News definition) continuing education on drug classes that describes comparability and highlights important differences in efficaciousness and side effects.
3. Eliminate direct-to-consumer non-print drug company marketing. Let the same educational institute create community outreach programs designed to instruct the public about benefits, risks, and proper use of pharmaceuticals. Removing the hype, perhaps patients will stop thinking that pills are always the answer (antibiotics for the flu, Ritalin for children with discipline problems, antidepressants for every relationship break-up).

I am confidant that by relieving drug companies of their enormous marketing cost burdens (think SuperBowl ads are cheap?) they will still manage to make a profit and conduct effective R&D under a system with price controls. And their executives will surely sleep easier knowing they are no longer driving retirees on chronic meds into the poor house.

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Price controls, marketing restrictions, concern about the sleeping habits of BigPharma executives??? This will encourage people to invest in pharmaceutical companies? This type of system has been tried elsewhere on a larger scale, with disastrous results. There is almost no pharmaceutical development being done outside the US. What will we do for new drugs when we have to depend on the collected research output of Europe and South America? Even the minimal output from Europe and Japan that makes it to market depends on the US to provide the profits to justifythe development costs. There is no free lunch. The real reform that needs to be passed is for other wealthy countries to pay their own way. That way prices in the US may become more competitive. It’s not for you or me to decide that the drug companies “waste” money; it’s their money to spend as they see fit after they earn it.

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jb has another good point. We can sit here and cry about how the drug companies charge us too much, but I think it would be more beneficial if we attacked the root of the problem: other countries extorting lower prices out of the drug companies. Its a very difficult problem to solve. It would require a global enforced legislation, which is a near impossible feat. All a company needs is a chemist to break a patented drug down and make a knock-off. Any suggestions on how to protect the interests of the pharmaceutical companies?

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To respond to jb:

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“Price controls, marketing restrictions, concern about the sleeping habits of BigPharma executives???”

My concern for the executives was facetious. You’ve got a keen eye for sarcasm.

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“This will encourage people to invest in pharmaceutical companies?”

Pharmaceutical companies aren’t struggling to attract investors. They’re even part of the president’s portfolio.

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“This type of system has been tried elsewhere on a larger scale, with disastrous results.”

Tell us more. If, as you say, domestic and foreign drug companies are so utterly dependent on jacked-up pricing in the US for profits to sustain R&D, then how and where could price controls have been implemented on a larger scale? And what of the disastrous results? Would we have ANOTHER drug for erectile dysfunction by now if not for the horrendous price controls imposed on some unnamed country that was a juggernaut of drug development? Or is this comment just empty rhetoric?

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“There is almost no pharmaceutical development being done outside the US.”

That’s false, but I hope you’ll consider submitting your comment to the Lancet to see what sort of response it brings.

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“There is no free lunch. The real reform that needs to be passed is for other wealthy countries to pay their own way. That way prices in the US may become more competitive.”

I’m all in favor of drug pricing being more equitable across the developed world. But current pricing in the US isn’t sustainable here or elsewhere. Prices in the US need to fall and prices in Canada and Europe need to rise until the pricing is more or less the same across the board and the incentive for cross-border, post-delivery sales of drugs is eliminated.

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“It’s not for you or me to decide that the drug companies “waste” money; it’s their money to spend as they see fit after they earn it.”

I guess you consider Abbott Laboratories’ decision to quadruple the price of its AIDS drug Norvir a clever way of “earning” money. The fact is that market forces aren’t really at play in the medical world. It’s not as though a patient is shopping for a car and can take the time to become educated about all the various brands, models, options, and pricing, and then choose accordingly. Very often patent-protected drugs are the only game in town. That’s by design: purportedly limited-term patents allow manufacturers to recoup their investments and reap a fair profit before generic producers commoditize the drug. Since the public supports basic science research through the NIH and grants periods of protected profit-making through the patent office, the public most certainly does have a stake in how drug companies operate and should reasonably expect that regulation be brough to bear to thwart excesses and abuses. What is the Norvir story if not one of excess and abuse? (And please don’t insult my intelligence by desribing Abbott’s move as unique. It just happens to be one of the most flagrant.) What is the only real and meaningful solution? Regulatory price controls. Price controls have been used effectively for other products and services (e.g. electricity markets) and the truly “disastrous results” were obvious to everyone when pricing regulation was removed (think California and Enron).

How could anyone describe the current pricing scheme (and it’s rate of increase) as perfectly fine and sustainable? They would have to be high or on a drug company payroll. Hell, I’ve even had a physician who works for a major pharmaceutical company tell me that drug pricing has to change. Guess that just leaves being high. No wait, you could be Libertarian.

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chris,

My suggestion is international cooperation through the WTO and Interpol.

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The big problem with this is that none of these manufacturing plants are regulated, and are often churning out fake drugs. If the FDA cannot keep a tight grip on drug manufacturers, the US consumber becomes vulnerable to buying drugs with little, no, or harmful amounts of effective ingredient.

Fake drugs are already a big problem in the United States. Any time a product has the huge markup pharmaceuticals have, you can be sure there will be counterfeits.

One “simple” way to deal with a big part of the problem. Rationalize the patent system.

The simple and obvious solution to the high price of drugs is forced licensing of patents. Any other solution is just nubbling around the edges of the problem.

Fun fact: did you know the combined profits of the ten pharmaceutical companies in the Fortune 500 is larger than that of the other 490 companies?

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The prescription drug companies (pharma) do not operate in a free market, so the usual market forces do not fit. My libertarian impulses to cheer the profits for further new products are misplaced here.
The non-free market pharma industry makes the best industry profit year in year out, says an FDA economist who is my patient and did the study.
Fine, let them have a good profit, but there must be some reasonableness here.
FIRST, the advertising of prescription drugs to the public should stop.
SECOND, the FDA needs backbone and Congress (esp Hatch) needs to get off their back.
THIRD, if these don’t improve the situation in a year or two, then price regulation will be next.

For myself, I quit the Republican Party this winter after the new Medicare drug payment plan passed Congress. After decades, I was now embarrassed to claim to be part of that party. But I can’t see the Dem’s as any better.

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In rcentor’s quoted news item, the GOP condemned Kerry for advocating reimportation, but now it seems that Bush is getting on the bandwagon…

“President Bush, facing growing anger among senior citizens over the high cost of prescription drugs and a virtual revolt by some states, conceded on Wednesday it ‘makes sense’ for Americans to be able to import cheaper medicines as long as they are safe,” Entous writes.

“I’m looking at this,” Bush said. “There is a lot of pressure in Congress for importation. So I think it makes sense for us to make sure that we can do so in a safe way. If it’s safe, then it makes sense.”

http://www.reuters.com/newsArticle.jhtml;jsessionid=5BNVWERTMNE0ECRBAELCFEY?type=topNews&storyID=6012501

Bush flip-flop? Never!

I am grateful for Jim McMurry’s comment, and I’m glad to know that even people with “libertarian impulses” can recognize when market forces are not operational and will admit the possibility that regulation might be needed and helpful.

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I am really worried about the medications of many people use… thats the reason because show that theme to you… The Drugs like the LORATADINE

the most important things about Loratadine

Loratadine is used to relieve hay fever and allergy symptoms, including sneezing; runny
nose; and red, itchy, tearing eyes. Loratadine is in a class of medications called
antihistamines. It works by blocking histamine, a substance in the body that causes
allergic symptoms. Loratadine may cause less drowsiness than other antihistamines.

In the same calification we can find drugs like

Flonase is a steroid. It prevents the release of substances in the body that cause inflammation, is used to treat the nasal symptoms of allergies and other seasonal reactions.,may also be used for purposes other than those listed in this medication guide.

Use Flonase spray exactly as directed by your doctor. Read the information insert included with your medication. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
To use the nasal spray:
Shake the bottle gently and then remove the dust cover,It is necessary to prime the pump
into the air the first time it is used, or when you have not used it for a week or more.
To prime the pump, hold the bottle with the nasal applicator pointing away from you and
with your forefinger and middle finger on either side of the nasal applicator and your
thumb underneath the bottle. Press down and release the pump three to four times until a
fine spray appears. The pump is now ready to use,
Blow your nose to clear your nostrils,

the fioricet is a pain reliever and fever reducer.
is in a class of drugs called barbiturates that slow down your central nervous system (brain and nerve impulses) causing relaxation.
is believed to constrict dilated blood vessels that may contribute to tension headaches.
Together, acetaminophen, butalbital, and caffeine are used to relieve complex tension (muscle contraction) headaches although precisely how it works is unknown.
Fioricet may also be used for purposes other than those listed in this medication guide.

Amoxicillin is used to treat certain infections caused by bacteria, such as pneumonia;
bronchitis; gonorrhea; and infections of the ears, nose, throat, urinary tract, and skin.
It is also used in combination with other medications to eliminate H. pylori, a bacteria
that causes ulcers. Amoxicillin is in a class of medications called penicillin-like
antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for
colds, flu, and other viral infections.
Amoxicillin comes as a capsule, a tablet, a chewable tablet, a suspension (liquid), and
pediatric drops to take by mouth. It is usually taken every 12 hours (twice a day) or every
8 hours (three times a day) with or without food. To help you remember to take amoxicillin,
take it around the same time every day.

you can find more information about vicodin at http://www.crdrx.com, 10/325 at http://www.10-325.com, vicoprofen at http://www.1vicoprofen.com and lortab at http://www.1lortab.com

Have a great day

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