Canadians have access to it (in fact, it's cheap and plentiful) but U.S. residents don't. Since many Americans want it quite badly, some of them find ways around their laws in order to get access to it — which is where the Internet comes in. Is it marijuana? Illegally downloaded MP3 music files? No. It's prescription drugs.
The freewheeling nature of the Internet produces some pretty strange combinations, but in business terms one of the oddest has to be the "industry" that has grown up over the past year or so to supply cheap Canadian prescription medication to U.S. residents through Internet pharmacies based primarily in Manitoba.
If you're an average e-mail user, it should be noted that this on-line medication phenomenon has nothing to do with discount human growth hormone, Viagra, Propecia or any of the other drugs that you may be offered via e-mail on a daily (or even hourly) basis. We're talking about regular old blood pressure pills, arthritis medication and other prescription drugs.
Canada's role in the cross-border prescription drug trade goes back further than just the past year or two, of course. For some time now, U.S. seniors have banded together and organized bus excursions to various provinces for the sole purpose of filling their prescriptions for heart drugs, asthma drugs and other common medication. Canadian drug prices can be up to 80 per cent cheaper than the same U.S. drug, as a result of legislated price caps.
As it has with everything from music to coin collecting, the Internet has simply made this practice more efficient. Instead of travelling to Thunder Bay or Winnipeg to fill a prescription, U.S. residents can simply submit an order form over the Internet to one of a dozen or more on-line "pharmacies" and have their drugs shipped directly, just as some people do with contact lenses or candy bars.
For some reason that no one seems to be able to explain, Manitoba plays a large role in this phenomenon. Of the more than 100 Internet pharmacies that are estimated to be active in Canada, some of the largest and most active are based in Manitoba, including MediPlan — which has grown from a startup founded by a few twenty-something university friends into a business that now employs several hundred people.
Most of these pharmacies have professional-looking Web sites that promote the safety and efficiency of their service, and they are filled with glowing testimonials from U.S. residents who are overjoyed at paying so little for their medication. There's just one niggling problem with this booming business, however: it happens to be against the law in the United States, and it breaches Canadian regulations governing pharmacies and drug prescribing and so on. It has also made the world's major pharmaceutical firms very, very upset.
Earlier this year, drug giant GlaxoSmithKline started to crack down on Canadian pharmacies that it sends medication to, trying to prevent the cross-border movement of its drugs. Pharmacies must sign a document promising that they will not ship Glaxo drugs across the border, or the pharmaceutical company will refuse to ship to them. Several other companies, including Pfizer and Wyeth, have said they will be monitoring their customers' orders carefully.
Regulatory agencies such as the provincial pharmaceutical bodies and the Canadian Medical Association have also warned their members that selling drugs to patients they haven't met is not allowed — or signing prescriptions for patients they haven't examined, in the case of the doctors that Internet pharmacies use to fill their orders. Some doctors and pharmacists continue to ignore these rules, however, arguing that they are serving the needs of cash-strapped elderly Americans.
When it was just a few seniors driving across the border filling their heart medication prescriptions, the U.S. government effectively turned a blind eye to the practice — perhaps because they didn't want to be seen as attacking senior citizens. At least one U.S. congressman actually organized a buying group of seniors to purchase medication from Canadian pharmacies, despite the fact that such purchases are technically against the law. (FDA rules allow individuals to import certain kinds of medication from other countries, but only if there is no U.S. substitute.) Since it has exploded as an Internet industry, however, that laissez-faire attitude has changed — perhaps in part because millions of dollars worth of medication is being shipped across the border every day by Internet pharmacies. On Thursday, the U.S. Justice Department, acting for the FDA, filed an injunction against a U.S.-based pharmacy, Rx Depot, asking a judge to stop it from importing Canadian medication. The Oklahoma-based company has vowed to defy the law and continue its business.
Meanwhile, a group of U.S. senators have been trying for the past several years to get a law passed that would allow the large-scale importation of Canadian medication for those cash-strapped seniors who need it. The legislation has passed through both the U.S. senate and the House of Congress on two separate occasions, but both times it has stalled when it reached the White House.
At the moment, the U.S. seems to be caught in a vise between the needs of its senior citizens and the desires of multinational drug companies to protect their U.S. profit margins — and Canadian Internet pharmacies seem more than happy to take advantage of the government's inaction.
E-mail Mathew Ingram at mingram@globeandmail.ca
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