A Prescription for Safety

Why should Americans pay more — often a lot more — than Germans or Brits or Canadians for their drugs?

Pricey prescriptions are dead center in the finger-pointing going on in Washington’s health-care reform debate, as Americans of all parties demand access to the cheaper drugs readily available in the rest of the world. Among the solutions congressional leaders are proposing is to legalize the importation of cheaper drugs from places such as Canada and the European Union, where governments restrict drug prices.

The plan would certainly lower costs, but will the drugs be safe? According to a recent study published by my research team, they could be a lot safer than you think. In fact, with the exception of fake Viagra with packaging from China, which not only didn’t have the right active ingredient but could have contained a lethal one, none of the five drugs from the 26 Web pharmacies we assessed failed basic quality testing. Of the drugs that would be allowed to be imported under the new bill, all those we were able to test passed.

Yet so far, popular fear has paralyzed the legislation put forward by Sen. Byron Dorgan (D-N.D.) and Reps. John Dingell (D-Mich.), Bart Stupak (D-Mich.), and Frank Pallone (D-N.J.). Drug manufacturers argue that allowing widespread drug re-importation will increase the opportunities that counterfeiters and illegal operatives have to insert dangerous products into the supply chain. They seem to have a point. Well over a hundred deaths have been attributed to counterfeit products, often diverted through Europe (though most were made in China, not in the European Union). Drug companies might also suffer if prices fall too much; it costs hundreds of millions of dollars to take a drug from development to market, and high prices in the United States explain how they’re able to afford it for now.

But while Congress vacillates, the American public is already turning to the Internet to source cheaper drugs. In fact, consumers in the United States have been doing so for years. Surveys indicate that Americans are concerned about Internet drug quality — yet millions buy online. The market is already more than $12 billion a year. For the elderly and isolated in particular, convenience and low cost outweigh the potential harm of using Web pharmacies.

Certainly, there are still risks to buying drugs this way. Twenty percent of the drugs we ordered, for example, didn’t come as requested; instead of a name-brand drug, a substitute product was delivered. Because these drugs could not be tested accurately using our equipment, there is certainly room for concern.

This shouldn’t be enough of a problem to stall common-sense legislation, though. The World Health Organization reports that drugs from Web sites that conceal their physical address are counterfeit in more than 50 percent of cases. And indeed, the few drug failures in our analysis came from Web sites lacking a physical address. Our research suggests that even non-approved Web sites (those breaking U.S. law by not requiring prescriptions and importing drugs) that at least have a physical address will deliver decent-quality brand drugs — albeit illegally.

Contrary to what one might expect, we also found that price was no indicator of quality. Drugs from India, which were marked up 20-fold from their local retail price, passed our basic quality test. But so did those from Europe that were not only illegally diverted, but were probably stolen — and sold at a heavy discount. And with the exception of Viagra, whose price was cheaper on less regulated sites, drugs were less expensive on the better, U.S.-approved sites than on less regulated and even rogue ones.

It’s true our sample size is fairly small. But if replicated by further studies, the conclusion is clear: Though there remains a clear risk to buying cheaper drugs over the Internet, as long as the requested drug brand is delivered and the site has a physical address, contactable by phone, the risk is really pretty small.

Such a conclusion undermines the fear-based argument being used to oppose importation; if word gets out that imported drugs aren’t so bad, the stalled legislation might even pass Congress. Of course, that could lead to another problem: We all may well suffer if drug companies’ profitability — and research budgets — are cut.