A carefully worded question

[kayofcircles]

I know a friend of a friend who has a problem. (Hereafter referred to as Foof..nevermind the second o.) Okay, Foof's mother has to take a certain prescription that costs the mother an outrageous $160 a month. Foof did some searching on the net, and discovered that our government has made a deal with the manufacturer NOT to allow any generics, which makes Foof a bit suspicious about "under the table" activity, but that is the current reality. Foof saw on the national news that many people taking this particular prescription are going over the northern border of this country, and buying the exact same thing for a mere $40 a month. Unfortunately, Foof and her mother live much nearer the southern border, and when checking on the Net, Foof discovers it is against the rules to mail order the prescription. Foof is not sure about the quality control of the southern neighbor, and actually has no qualms about breaking a rule that only benefits the manufacturer...but??

Since Foof is pretty sure that her mother is not the only parent in this ridiculous situation of choosing between taking their meds or eating and paying the bills...Foof wonders if any of you have any ideas? And cautions for "careful wording" because of the..shall we say?..tipsters.

[Budfred]

I live in Minnesota and our local senator, Wellstone, is pushing to allow legal access to Canadian drug prices. There have been busloads of seniors from Minnesota who have crossed the border to buy prescriptions because of this. Apparently the drug companies can keep blocking production of generics for years after their patents expire by tangling any companies that want to produce them in court. This involves a loophole that allows them to challenge a company on each individual patent and most drugs have several patents. This allows them to tie up exclusive control for decades and make billions in the process. There is some effort to plug this loophole in the legilature, but it is unlikely to happen with a Republican government.

As for getting prescription drugs North or South of the border, many people do it although I believe it is technically illegal and the drugs can be confiscated if they bother to search for them On the other hand, they usually don't bother with prescription drugs if they are not drugs of abuse. To buy South of the border, you would need to be careful about the source and quality of the medication. If you buy a name brand drug and it looks the same, it probably is, but that is no guarantee.

Budfred

[RKBA]

Kay,

There's no need to be so cautious about it, because it's perfectly legal to purchase up to a 3 month supply of drugs for one's own use from another country. In fact, most of Canadian Meds USA's (http://www.canadianmedsusa.com/) business consists of mail order business from USA customers. My aunt (who does not have Internet access and lives in central California) asked me to check to see if I could find a Canadian Pharmacy who supplied some medication she was taking (I think it was for arthritis, but I forget exactly what), because she had heard the drug was much cheaper in Canada. I did an Internet search to compare prices of various on-line Canadian pharmacies, and Canadian Meds USA's (http://www.canadianmedsusa.com/) was consistently cheaper than other Canadian companies who sell via mail order, so that's who I referred her to. She called them up, and later sent them a prescription from her doctor along with payment for a 3 months supply of the drug she takes, and has been ordering from them for about 1 1/2 years so far. She says it costs about 1/3 of what it would cost to purchase the same drug from a US pharmacy.

I don't know what the quality control of Mexican pharmaceutical companies are like, but you'll often find that you can purchase exactly the same drugs manufactured by the same American pharmaceutical companies in Mexico at much lower prices there, than you would be charged for that same drug here in the US. My guess is that American pharmaceutical companies sell drugs cheaper in other countries because the citizens of those countries either can't or won't pay the high prices charged here in the USA. In most cases, the cost of manufacturing a drug is a tiny fraction of the retail cost (pennies per dollar). Drug prices are determined by marketing rather than manufacturing cost, and the drug companies will charge whatever the market will bear.

In any case, the worst that could happen is that the FDA detains a drug shipment and returns it to the sender unless you can justify the shipment (with a prescription, etc).

Here is a copy of their "Model Letter for Use in General Mail Importations" (http://www.fda.gov/ora/import/pipinfo.htm):
EXHIBIT 9-3

Model Letter for Use in General Mail Importations

(LETTERHEAD)

A mail shipment of an article from a foreign country addressed to you is being detained at the U.S. Post Office. All products of this kind must meet the requirements of the Federal Food, Drug, and Cosmetic Act or other laws enforced by the Food and Drug Administration. These laws are designed to protect you from, among other things, unsafe or misrepresented foods, drugs, biologics, cosmetics, devices, and other articles. The product addressed to you does not appear to comply with the law.

Please read the enclosed Notice of Detention and Hearing carefully since it explains why FDA believes that the product sent to you is in violation. The Notice does not in any manner accuse you of violating any law.

If you have good reason to believe that the product does comply with the law and wish to discuss it with us, you may personally come to this office, telephone, or write to us within the time limit shown on the Notice.

If you do not wish to claim this shipment, you may disregard the Notice and the shipment will be returned to the sender without cost to you. The shipment will be returned to the sender automatically if we do not hear from you within the time limit shown on the Notice.

Sincerely yours,

Enclosure:

I also suggest you read the FDA's own "General Guidance" instructions. (http://www.fda.gov/ora/import/pipinfo.htm) The General Guidance Section states that FDA should consider not taking enforcement actions against such importation:
"when 1) the intended use [of the drug] is unapproved and for a serious condition for which effective treatment may not be available domestically either through commercial or clinical means; 2) there is no known commercialization or promotion to persons residing in the U.S. by those involved in the distribution of the product at issue; 3) the product is considered not to represent an unreasonable risk; and 4) the individual seeking to import the product affirms in writing that it is for the patient's own use (generally not more than 3 month supply) and provides the name and address of the doctor licensed in the U.S. responsible for his or her treatment with the product or provides evidence that the product is for the continuation of a treatment begun in a foreign country."
More information about F.D.A. Policies (http://www.emedsdirect.com/policies/fda.asp) can be found on the E-Meds Direct (http://www.emedsdirect.com/) website.

I personally think that deciding what drugs I may or may not want to use is none of the government's damn business, and they have no business deciding without my consent what drugs I can or cannot take . This is "Big Brother" government at its worst. Government doesn't suffer from my medical conditions, they don't have to live on a budget (if you or I were half as profligate as the US Government, we'd have been forced into bankruptcy long ago - but the government just raises taxes or prints more money!), and they have no knowledge whatsoever of my particular situation or medical condition, so they have no business telling me what is or is not good for me. In my opinion, FDA approval should be like Underwriter Lab's approval of electrical appliances. They should give their stamp of approval to things that meet certain minimal requirements, but ultimately the choice of whether to purchase an item or not should be the consumer's rather than the government's - regardless of whether or not it has received the government's stamp of approval.

The fear of government prosecution evident in your post seems like something I'd expect to see in a repressive Fascist or Communist state in which the citizens are terrified of their own government. It's a sad state of affairs when that exact same situation exists here in what used to be a relatively free country, but that is now at least as repressive as any other, and worse than most. It reminds me of this quote:
"When governments fear the people there is liberty.
When people fear the government there is tyranny."

~~ Thomas Jefferson
(To Be Continued...)

[RKBA]

(Continued from above... I just found out what the upper limit on the size of a message is.)

It's much cheaper for me to purchase my prescription drugs under my health insurance plan that it is to pay for them out-of-pocket, because the insurance carrier pays most of the cost when I buy through their prescription drug plan, but awhile back I was curious whether or not some of the so called "No Prescription Required" Internet site's claims were legit or not, so I ordered a couple of things from two of them. Just to play it safe, I ordered drugs that I was currently taking and did have a prescription for, but at no time during the process did anyone actually ask to see a prescription. The two places I ordered from were E-Meds Direct (http://www.emedsdirect.com/) and LifeStyle Pharmacy (https://lifestylepharmacy.safeserver.com/index.phtml) (now defunct). I think they changed their name to Pharmacy International Inc (http://www.pharm-international.com/main.html), but I'm not sure because I haven't tried to order anything from Pharmacy International Inc (http://www.pharm-international.com/main.html).

At the time, I had no idea where either of these companies were located, so imagine my surprise when I received a package from a little island off Australia's coast by the name of Vanuatu! The box was clearly labeled as containing pharmaceutical drugs and was stamped by customs, and the shipping cost was only $10. Turns out the drugs were manufactured by a Wyeth-Amherst manufacturing plant in Australia. No one had ever contacted me about the shipment since I placed the order - it just arrived on my doorstep one day. The second shipment was from E-Meds direct (which turns out to be located in Southern California in the town of San Ysidro, which is situated near the US/Mexican border), and came in a plain brown cardboard box with a name and address I'd never heard of listed as the sender. One of the drugs was made a a major american pharmaceutical company, and the other was made by a Mexican drug company. I've never used them, so I don't know if they work Ok or not, but I would assume they do, since they came in the same bubble-wrapped press-out packaging and child-proof bottles as you find here in the US.

About the same time, I also ordered a couple of common antibiotics (Amoxicillin and Metronidazole) from an On-Line animal health care supplier called Lambriar Animal Health Care (http://www.lambriarvet.com/). When I received them, I checked the labels and found that the only ingredient listed was Amoxicillin and Metronidazole respectively, and curiously contained the exact same amount of the antibiotic as are contained in the pharmaceutical prescription drugs for humans (according to RxList.com (http://www.rxlist.com/)). I looked the manufacturers up on the Internet, and it turns out they are the exact same companies that manufacture the generic drug for human consumption. I'm almost certain the antibiotics are the same as generic antibiotics that are supplied to pharmacies, and that they are simply relabeled as being for use in animals only and sold at a fraction of the price they would be sold at for human use. Unfortunately, the selection of drugs available for "animal" use is pretty limited, and Lambriar apparently doesn't supply arthritis drugs for "animal" use. :(

I have Psoriasis and Psoriatic Arthritis (which is similar to Rheumatoid Arthritis), and participate in a forum for others like myself at http://groups.yahoo.com/group/PsoriaticArthritis/ Most of us take many different drugs concurrently, and some of them are extremely expensive (thousands of dollars per month), so your "friend's" mother is actually very fortunate to only be paying $160/month for her medications - but I agree that she shouldn't pay more than necessary. If you would like to contact me privately, perhaps I could help you with more information about the specific drug your friend "Foofoo's" mother needs. ;) If she is stuck with purchasing them in the US, DestinationRx (http://www.destinationrx.com/) is a handy place to compare prices. Also, be sure to look at the label and find out what the generic drug is. Sometimes, generic drugs are available for much less than the cost of a brand name drug.


-- Ron

[Gallaeglagh]

Keep in mind here before bashing US pharmacuetical companies, that yes the drugs themselves are not very expensive to produce however the cost of R&D,testing and approval is enormous.

But if legal or permissable ways exist to find them outside the border than all the more power to you.

[Budfred]

It is true that it is expensive to produce new drugs, but the drug companies report incredibly inflated amounts for this. They make huge profits on their drugs and pay for R&D several times over. They also spend a fortune on marketing including tons of free stuff to medical staff. I work in a medical setting and I could probably go the rest of my life without ever buying a pen, sticky note pad, or even a clock if I wanted to.

Budfred

[kayofcircles]

Yes, I know the drug companies have to spend a lot of money getting something through the approval process, but the fact that they report HUGE profits at the end of the year..and can easily afford lots of freebies for doctors and clinics, and show us the same commercial three times during the national news sort of points to gouging U.S. consumers to pay for that stuff. Oh yeah, and we'd also be "paying" for the lawsuits...as we do on every other product.

RKBA : Thank you so much. I am still a bit vague on the legality of it..I scanned through the link and it sounds like it is legal to import "unapproved" drugs for personal use, but not approved? But, regardless, I really appreciate the info! That's not the only presciption that Foof's mom is taking, but it is the most expensive, and thankfully, she's not in the $1000 range because she couldn't afford it.

I find this issue...escalating cost of health care..most upsetting because it seems to me that, like so many other "tricky" issues for politicians, it just keeps getting worse and worse and no one does anything at all..but "talk" occasionally. Here in New Mexico, we have the "same old same old" type governor's race, with both candidates repeating the same old tired rhetoric. "We need quality education for every child in our state." Duh...no substance on how we do that, or how we pay for it, or anything..just the same old slogans. "We have the highest state taxes around..vote for me, and I will lower taxes." Sigh..anybody heard that before? Where's Pat Paulson when I need him??? :)

Edit: Forgot to rant about one thing...Where are all those "free trade" people on this issue? The ones that don't hesitate at all to throw our home industries in competition with those countries that use slave labor...but hey, let's "protect" the drug manufacturers from competition?

[hiredgoonz]

Of course they make huge profits. If they didn't, they wouldn't be in the business. The patent issue is the US government's way of "making up" to the drug companies the amount of money it costs to develop a drug and get it approved.

The patent wears out eventually and generics will be made. Yes, there are loopholes, such as using the drug for a slightly new purpose, which allows a patent extension.

I'm not saying it's moral for the companies to do these things, but it's reality...as far as charging less in other countries, it's teh same deal with DVD regions...

They can't charge $20 for a DVD in most parts of the world, so in order to prevent individuals from just buying their DVDs by mail from a place where they're cheaper, they have the region feature that makes them incompatible...

The bigger issue here is what a "reasonable" profit for a company is. Could M$ sell Windows for less? Of course they could...any company making billions in profit is obviously maintaining a healthy markup on their products.

But do they have to? No, should they have to? No, not if we want to continue to live in a capitalist society. It's a harsh reality, but in our country, companies can, and do, charge whatever they can get for a product.

Try telling anybody you know that they shouldn't charge what they do for whatever job they perform. Tell them that they should only charge enough to get by. Do you think that suggestion would be met with praise? Of course not. That's just the way of things in a free market economy.

You can fault the drug comapnies for what they do, but the laws that allow them to do it were passed by our elected officials (likely good friends of the drug lobbyists). Complaining about it after the fact is really rather pointless. If everyone took a more individual interest in politics and used their vote the way they could, then things might be different, and this wouldn't be America...

Don't get me wrong, I love my country, I served in the Marine Corps, and there's no place else I'd rather live, but profiteering is not only human nature, it's almost the American way. Look at the baseball strike. The league minimum salary is $200,000...that's more than the vice president of the United States makes...

Are these people kidding me? They're bitching about drug testing? For 5 years, I could be called up at any time of the day or night to have to go take a "whiz-quiz" and I wasn't making anywhere near 200 grand. They play a game, obviously one they enjoy(ed), or they wouldn't have gotten to be so good at it and they complain about 200 Gs?!?

I don't know, but I think that irritates me more than the drug companies...at least Pfizer provide products that improve one's health. Pretty much everybody charges more for the service they provide than what it's actually worth, the drug companies just do it on a larger scale...does that make it any more wrong?

[Budfred]

Quote:"Try telling anybody you know that they shouldn't charge what they do for whatever job they perform. Tell them that they should only
charge enough to get by. Do you think that suggestion would be met with praise? Of course not. That's just the way of things in a free
market economy."

As I said above, I work in health care and we are told what we can charge and collect by almost everyone (except the direct consumers). My income has steadily declined for the last decade with the exception of this year since I got a new job. The company I work for is nonprofit and has lost money most of the last few years. Medical technology has been improving by leaps and bounds so that we can do things now that were not possible only a few years ago, but the people that make the money from this technology are the ones who produce it, not the ones who use it to help those in need. We are told constantly that we can charge only enough to get by or not even enough. Medicare has set a number of fees lower than the cost of providing the care. Medical costs continue to soar in spite of this. Why? Because the pharmaceutical companies and medical technology companies are making record profits. Because the administration of insurance benefits is wildly expensive to save a penny here or a nickel there. The people that tell medical providers what they can charge are hailed as heroes and people are leaving the medical profession in huge numbers. This is not a free market economy, this is an economy dictated by the people with the most power/money. In a free market, the medical care would be much more expensive and most people would not be able to afford the insurance. Is that what we want???

I love that we have more ways to help people feel better, but I think the priorities for how we us these resources are skewed and we are holding the wrong people accountable for the costs.

Budfred

[Mitch Hatfield]

I know that I live outside the US, but very well put indeed Budfred :)

[hiredgoonz]

The rise or fall of an individual's salary has nothing to do with the fact that people expect more for their work than what some others might consider reasonable...

I'm not saying I think what the drug companies do is admirable...HMOs and the current state of managed healthcare is rather sad, but I stick by my original point...it's a for profit enterprise. Maybe not your profits, but somebody is making money on it or it wouldn't exist...

As far as medical providers being told what they can charge...I don't know very many poor doctors. (begin sarcasm) Maybe this new fee generating system will be good. Does a doctor really deserve to drive a lexus or a bmw? Doctors have had money too long, now it's the insurance companies' turn...(end sarcasm)

But that's really the point...if a doctor can make enough money, he/she deserves whatever they get with that money. This is not a communist society where the government owns everything and going to a doctor is free.

We are in a capitalist society, like it or not. There will always be poor people, there will always be homeless people, and there will always be people who can't afford healthcare.

Is that sad? Does that suck? Of course...it's especially upsetting when it affects someone you know. But really, as I mentioned, the fault for all of these bad things lies with our elected officials and the laws they pass...

Do you blame the cheetah for eating the gazelle? I don't...no more than I blame human beings, who are inherently greedy, for taking advantage of their role in our "food-chain." You can complain about it, but ultimately, it just is one more crappy thing that we have to accept about life...

I'm not trying to shut anyone up or stop anyone's cathartic expression, but I guess I gave up a long time ago the notion that people are anything but self-interested opportunists...the answer to any question about why something in American society is the way that it is: money.

[Budfred]

My carefully crafted reply evaporated, so here is a condensed version.

Re sarcasm: Insurance companies have always made lots of bucks and will continue to do so. MDs have historically made a lot of money, but they are making less now while working more and many are leaving because of that. This may lead to increased demand and needing to pay them more to retain them. Most people who work in healthcare are not MDs and have always made considerably less. They are also being asked to work more and to accept pay cuts. There is currently a major nursing shortage in my area and will probably eventually be everywhere because of these changes.

In general, people who are not as much "self-interested opportunists" tend to work for lower wages and prestige. This includes teachers, childcare workers, most healthcare workers, and others.

I agreee that this is the capitalist system we live in, but that doesn't mean that we have to accept it. We can support legislators who try to make things better and vote out the ones who dance for the rich and powerful. I am no longer young and idealistic enough to believe that this will ever be complete, but I believe that talking with each other and those who have the power can lead to some changes.

I am part of the generation that will soon be the largest population of elderly that have ever lived. I want to be able to get help when I need it and that means having an accessible medical system among other things. This is my self-interest in wanting change.

Budfred

[RKBA]

The problem is that we do NOT live in a capitalist society - it's more like a quasi-socialist society. I say "quasi" because although the government doesn't actually own the means of production, etc., it does control it thoroughly, and I see very little difference between the two.

Evidence of this is all around us, including even in Kay's post: I scanned through the link and it sounds like it is legal to import "unapproved" drugs for personal use, but not approved? where she noticed that FDA "approved drugs" (those for sale in the US) may not be imported, whereas those that are unapproved and not available in the US may be imported. More to the point is item two in the FDA's "General Guidance" instructions I posted earlier, which says that it's Ok to import drugs if: 2) there is no known commercialization or promotion to persons residing in the U.S. by those involved in the distribution of the product at issue; This is blatant and explicit protectionism of US pharmaceutical companies if ever I saw it. If we lived in a capitalist society, we would be able to legally purchase pharmaceutical drugs wherever we wanted, including via mail order from another country. As it is, the drug companies are allowed to charge whatever they want (which is as it should be), but we consumers are prohibited by our own government from shopping around for the cheapest price. Not much of a "free-market" is it?

hiredgoonz said: "You can fault the drug companies for what they do, but the laws that allow them to do it were passed by our elected officials (likely good friends of the drug lobbyists)." That is exactly the problem - we have foxes guarding the hen house. Article II, Section 4 of the Constitution of the United States, states: "The President, Vice President and all civil Officers of the United States, shall be removed from Office on Impeachment for, and Conviction of, Treason, Bribery (http://home.pacbell.net/rsdotson/gov/govbribes.htm), or other high Crimes and Misdemeanors." Our Founding Fathers put the acceptance of bribes by government officials right up there in level of seriousness with treason, yet our elected officials dole out political favors (including both cash and laws favoring the donor) for bribes in the form of campaign donations (http://home.pacbell.net/rsdotson/gov/govbribes.htm) almost every day without even bothering to hide it. When is the last time anyone ever heard of that Constitutional impeachment clause being invoked for bribery? I think if the US Constitution were enforced as written, most of societies problems would evaporate. The problem is finding someone to enforce our Constitution who either can't or won't be corrupted by the bribery money and power that comes with holding political office. When we see injustice or inequity in the world, most people automatically look towards government for a solution, when in fact government is usually the cause of the problem in the first place. Good examples are the eastern European counties with socialist governments (anyone want to volunteer to go to Russia for their "free" medical care?), and even England and Canada where the national health systems have been nationalized. In theory, you get "free" medical health care ("free" for a tax rate of anywhere from 50% to 90% of your income), but in practice no one gets proper medical care. A good example of that is the drug Enbrel (one of the very expensive drugs for arthritis that I mentioned in my post to Kay). Enbrel isn't available in countries with nationalized health care systems because it is too costly. Enbrel may be very expensive in the USA, but at least it's available. Personally, I'd rather make choices for myself rather than to have the government take my money and decide what's best for me.

-- Ron

[Paul Komski]

I just think there is a vast distinction between profit and greed. Capitalism doesn't HAVE TO be greedy. The poor, those that have to eat dirt, just want enough; the more the rich have the more they generally seem inclined to crave.

As for the motivation to be involved in Health Care; I got out of the medical arena a decade ago and went from a salary of some $100,000 to about $10,000 from farming. No real complaints - though it is a waste of the skills learned and I miss the contact with patients. My sanity came first though. (Some will no doubt question that it ever returned! :D)

The things that drove me out were the increasing need to practice defensive medicine (just doing things to prevent being litigated against; why do you think the Caesarean Section rate has increased from 5% to 30-40%!!?), the way departmental budgets were contolled and not delegated, the influences of politics and politicians and the declarations that the services were just fine and dandy so long as the public perceived them as fine, no matter how deficient they actually were.

I could go on and on, but the essence was that it was increasingly hard to really be one's patients' true advocate and to be able to work in an atmosphere of co-operation rather than of confrontation.

Don't talk to me about bureaucrats, politicians or lawyers; they are the ones who make "easy profits" and generally in a totally risk free environment.

With nearly no exceptions, generics are just as good as the patented names - though the drug companies will do a great deal to try to persuade you otherwise. If the copyright has expired in Canada and generics are available, (it is unbelievable to me that you can't get them in the US), then the profit must have already been recouped from Canada and I would have no hesitation in advising you to get them from there using the approved channels already suggested.

[Pianorak]

Quote: (hiredgoonz) The patent issue is the US government's way of "making up" to the drug companies the amount of money it costs to develop a drug and get it approved.

UK - and most likely any other industrialized country you may care to mention - can be safely substituted for US.

[RKBA]

FRAUD PROBE TARGETS US DRUG FIRMS
Published on August 8, 2002. Author(s): Alice Dembner, and Shelley Murphy, Boston Globe Staff

SALES TACTICS, PRICING UNDER JURIES' SCRUTINY

State and federal prosecutors nationwide are expanding their investigations into alleged pricing fraud and kickbacks in the pharmaceutical industry, after a record $885 million settlement won by the US attorney in Boston last fall.

...

Across the country, several lawsuits have been filed, and many major drug
companies are under investigation as prosecutors take aim at drug pricing and
sales tactics they allege have defrauded the public of billions and driven up
the nation's medical bills.
______________________________________

Note: The full article can be found at:
http://groups.yahoo.com/group/PsoriaticArthritis/message/21958

To find the original article, go to http://www.boston.com/ and search the past month for "Dembner"

The URL is too long to post as an embedded link (it confuses vBulletin), but here it is if anyone wants to try it:

http://nl12.newsbank.com/nl-search/we/Archives?p_product=BG&p_theme=bg&p_action=search&p_maxdocs=200&s_dispstring=Dembner%20AND%20date(last%2030%20days )&p_field_date-0=YMD_date&p_params_date-0=date:B,E&p_text_date-0=-30qzD&p_field_advanced-0=&p_text_advanced-0=("Dembner")&p_perpage=10&p_sort=YMD_date:D&xcal_useweights=no