Inconvenient truths about foreign online pharmacies

It is an inconvenient truth but millions of Americans will find their lifeline of affordable and safe medication gone if there is a broad-based, ill-considered crackdown against foreign online pharmacies. Congress should investigate the public health consequences before it’s too late. Consider another truth: about fifty million adults, ages 19-64, do not fill a prescription each year due to cost. This doesn’t include the millions of seniors still struggling with their pharmacy bill. Americans need all the help they can get with their drug bills.

And another truth: people who take counterfeit medication ordered online have become sick and died. More truths: despite federal restrictions, about five million Americans turn to foreign medication each year, often purchased online, because it’s up to 90 percent cheaper. The FDA doesn’t prosecute people for importing small amounts of medication as long as it’s for personal use. To Americans it’s a lifeline, but to the pharmaceutical industry it means lower profits. 

{mosads}The Partnership for Safe Medicines (PSM) tells members of Congress that Americans who shop online for lower cost foreign medications are simply victims to rogue online pharmacies peddling counterfeit drugs.  PSM, which calls itself an advocacy organization dedicated to stopping the spread of counterfeit drugs, is funded by the pharmaceutical industry and its executive director is a vice president of “advocacy” for the Pharmaceutical Researchers and Manufacturers of America (PhRMA).

On these blog pages this week, Jim Dahl, a PSM board member and former deputy of FDA’s Office of Criminal Investigations, wrote, “Drug counterfeiting, aided by the explosion of Internet pharmacies and the ease of online purchasing, is a multibillion dollar industry.” That sentence encapsulates the essence of a media relations effort to scare Americans and influence Congress about online pharmacies and personal drug importation.

This strategy dates back to 2003 when PhRMA wanted to learn how to stop Americans from importing lower cost medication for their own use, including through online pharmacies. PhRMA engaged public relations giant Edelman to find a solution. Edelman’s focus groups demonstrated that instilling fear in Americans and elected officials about counterfeit drugs would be most effective. Today, PhRMA’s soundbite is essentially that all non-U.S. online pharmacies that sell to Americans are illegal, dangerous or rogue.

PhRMA’s strategy has gained traction. In fact, cooperation between PhRMA and the FDA on this issue is closer than ever it was during the Bush administration. FDA staff members make up a good part of the audience and guest speakers at PSM’s annual Interchange Conference. PSM’s Dahl is calling for appropriate funding – meaning more money – for FDA to get the counterfeiters. What Congress needs to know before allocating taxpayer resources is that much of these efforts are focused on stopping safe personal drug importation.

The key is recognizing distinctions among certain adjectives that are used to describe medication. Dahl wrote, “…legislation should be enacted to give FDA/OCI administrative authority to require production of documents to assist in their Internet and related investigations, and increase penalties for trafficking in counterfeit, substandard, unapproved, and misbranded drugs.” When Dahl writes “unapproved” and “misbranded” drugs he means medication sold in pharmacies in other countries that are personally imported – not counterfeit. Another truth coming: virtually all medications sold in Canadian and other foreign pharmacies – real, safe, and effective ones – are considered unapproved or misbranded when they are imported by Americans for personal use.

Recent tragedies in America involving bad meds had nothing to do with Americans buying medication online. In 2008, 81 people died from ingesting tainted Heparin, a blood thinner manufactured by an American drug company that used bad Chinese pharmaceutical ingredients. Another tragedy was fully homegrown: 64 Americans died and many hundreds more were sickened by tainted steroids manufactured by American compounding pharmacies.

Truth: after 15 years of online pharmacy purchases, not a single American has been reported killed by a medication purchased over the Internet from an international online pharmacy that requires a valid prescription and does not sell controlled drugs.We’re talking about Internet pharmacy companies that work with licensed pharmacies in many countries – not just Canada.

The FDA and PhRMA are right that there are many rogue pharmacy websites: they say tens of thousands.  One last truth: foreign online pharmacies are not all created equal. The best ones are exceedingly safe. The FDA knows that there are credentialing agencies (including this authors’) that verify safe international online pharmacies that help consumers distinguish them from rogues. They know that empirical research demonstrates this truth. It may be very inconvenient but ignoring this truth will be a public health disaster when millions of Americans find their lifeline has gone offline.

Levitt is the vice president of, an online business that, according to its website, helps consumers find the best drug prices from verified online pharmacies.


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