Mail-Order Drugs: Direct to Consumer - from India via Canada

It came in the mail to one of my partner's patients, a direct mailing (4 pgs, pdf, 1.2M) promising cheap drugs at significant cost savings from Global Pharmacy Canada. A closer look at the flier, however, discloses the drugs are not from Canada, but rather pharmacies somewhere in India.

Call it global direct-to-consumer pharmaceutical advertising. All you have to do is sign a little waiver and send your money:

I appoint Global Pharmacy Canada to act as my agent to send my order and prescriptions to a licensed pharmacy in India, so that the pharmacy can send my medications directly to me. I understand that my prescriptions will be filled according to the laws of India, as defined by India's FDA. By completing and signing this form, I understand that I am placing an order for generic medications to be shipped from India. I understand I am not relying on Global Pharmacy Canada for any health-related counseling. The medications ordered on this form have been prescribed by a licensed medical practitioner and I am relying on him/her for all medical advice relating to the use of these medications.

At a time when seniors are increasingly taxed by high drug costs and Medicare's "doughnut hole," these fliers are filing our patients' mailboxes. As the world is increasingly becoming a global medical marketplace, it is not surprising to find these marketing tactics by well-organized challengers arriving directly to our patients by any means possible.

For doctors, the ramification of this is significant. Historically, US physicians have enjoyed a relatively safe pharmaceutical marketplace, thanks to regulators and pharmacists. Because of the internet, pharmacists are becoming irrelevant to patients and the challenges of policing global pharmaceutical manufacturing and packaging operations has been difficult for the US Food and Drug Administration. One only has to recall the recent heparin recall to understand the far-reaching implications of this reality for doctors, especially in the age of generic medications. Now, not only will we have to know the name, dose and amount of the drug a patient is taking, we'll have to know where it was manufactured. The need for monitoring the origin of individual pills has not been lost on the pharmaceutical industry as they consider means to label pills with ingestible RF id tags.

It is any one's guess about the safety and efficacy of the Indian pharmacies co-oped by Global Pharmacy Canada, since the patient is not privy to the location or name of the pharmacy or pharmacies utilized. While I have no idea of the legitimacy or safety of Global Canadian Pharmacy, it appears the Canadian government is quite accustomed to these marketing practices, at least on the internet:

Buying drugs from Internet pharmacies that do not provide a street address and telephone number may pose serious health risks. You have no way of knowing where these companies are located, where they get their drugs, what is in their drugs, or how to reach them if there is a problem. If you order from these sites, you may get counterfeit drugs with no active ingredients, drugs with the wrong ingredients, drugs with dangerous additives, or drugs past their expiry date. Even if these drugs do not harm you directly or immediately, your condition may get worse without effective treatment.

While problems with generic drug manufacturers from India are not new (see here and here), doctors must realize that patients desperate to find affordable alternatives to their high drug prices will be vulnerable.

The same concern of these cheep overseas drugs goes for our pets, too. I find it concerning that Global Pharmacy Canada also advertises the sale of pet medications on the same flier. Melamine-contaminated pet foods are in our recent past, and the thought of such a contaminant in human drugs would make the diagnostic challenge for physicians rival any episode of House.

What is clear for the US pharmaceutical industry is that their pricing structure makes them vulnerable to disruption by the global marketplace. If quality and safety issues are overcome by these overseas pharmacies, the proverbial health care cost curve that Congress has found so elusive to bend, will soon be bent in the patient's favor.

For now, however, for those who decide to proceed with the purchase of drugs from these direct-to-consumer pharmaceutical fronts, caveat emptor.

-Wes