Monday, May 27, 2024

At last someone’s saying it and, even better, backing it up with a numbers: “The question is really safety, and the fact is … Canadian procedures for safety are comparable and sometimes even better” than those of the United States.

The speaker was Illinois Gov. Rod R. Blagojevich, a leader in the effort to import prescription drugs from Canada, where government price controls make them cheaper than in the United States, where, of course, the competition of the free market conspires to blah, blah, blah. Blagojevich’s 70-page study says that “as much as $90.7 million a year could be saved if drugs for (Illinois) state employees and retired employees were brought across the border,” according to the Monday New York Times. Readers were implicitly invited to multiply that by 50.

The idea is obviously seductive, and Springfield has followed Illinois, and Cambridge, Boston and Somerville are following Springfield. There’s a Congressional field hearing today in Boston — yes, a politicians’ field trip, with U.S. Rep. Dan Burton (R-Ind.) visiting to weigh the pros and cons.

But the debate has so far been framed by the pharmaceuticals and biotech industry, which carries a lot of weight in Massachusetts, and the industry seems unfortunately to have been studying the playbook of the Recording Industry Association of America: hysteria and lawsuits for everyone!

“Industry leaders are concerned that short-term price cuts will undermine investment in research and development. That could slow the progress of drugs in the pipeline to the consumers who need them,” writes the credulous Boston Herald today. But Jennifer Heldt Powell’s article fails to note how little those consumers will care if they can’t afford the drugs in the first place.

It’s been reported that drug companies have threatened to end sales of pharmaceuticals to Canada, but that surely must be a reporting error, especially for an industry so weepy over the costs of research and development. The revised threat — that sales to Canada would be limited to just what it’s determined Canada needs — is more likely, but also a little silly. First would come the lawsuits when the inevitable shortage occurs, depriving sick people of their medicine; then would come the realization that making revenue in Canada from lower-cost exported drugs is better than making no revenue in the United States from people (and governments) who can’t buy them at the higher cost. Memo to the drug industry: Your products are frequently too expensive. Americans shouldn’t have to subsidize your research and development, and they no longer can.

The industry has hired the voice of reason in ex-New York City cop Richard “Bo” Dietl, who was played by Stephen Baldwin in <a href=””>“One Tough Cop: The Bo Dietl Story”</a> (a 1998 release the Los Angeles Daily News called boring for those “not interested in self-destructive stupidity or counting how many expletives can be squeezed into an hour and a half”). Dietl, according the Wall Street Journal, interrupts news conferences to yell policy statements such as “This is a life or death issue … you’re going to poison half of America.” (Half? Reminder: Dietl is a duly paid employee of the Pharmaceutical Research and Manufacturers of America, so this may have to be considered an official policy statement.)

Dietl has a standard packet he hands out showing “a mug shot of a convicted thief who runs online Web sites selling prescription drugs,” the Journal’s Sarah Lueck wrote on Oct. 22, and “another shot, snapped by Mr. Dietl’s man on the ground in Kashmir, shows a dusty truck allegedly transporting medications that will be shipped to U.S. consumers who ordered them online.” And here’s a picture of the dog that almost bit me.

Dietl says his underage children have ordered drugs online, too, as a test of safety protocols. But either he or Lueck fail to note whether the drugs were to be delivered from a different country, such as Canada, or from one of the jillions of questionable businesses operating right here in these United States, bastion of drug safety and reputable business practices.

What’s gone missing in all this, until the study Blagojevich handed over to the U.S. government yesterday, is that Canada, our friend to the north, our Nafta buddy, is not a fly-by-night fell-off-the-back-of-a-truck business in Kashmir. It’s not a developing nation. The drug industry assertions that the United States can’t inspect every drug that comes across its borders is about as reasonable as noting that it also can’t test drive every car that enters the country.

The United States did $353 billion in trade with Canada in 2002, making it our top trading partner, said Walker Pollard, an international economist with the <a href=””>U.S. International Trade Commission</a>, and we accept about $68 billion more in goods from Canada than we send it.

Check out the commission’s <a href=””>“data web”</a> and you’ll see that pharmaceuticals are only 0.576 percent of Canada’s exports to us (for about $1.2 million in 2002). So if we’re going to freak out about inspecting things entering the country from Canada, shouldn’t it be killer cars and other rolling deathtraps, which account for a quarter of all imports from Canada?

As any rational person would expect, especially if they visited Canada, which is one of the more rational countries on Earth, the efforts of the U.S. Food and Drug Administration are matched up north. The nation’s Food and Drug Act says, predictably, that before drugs “can be marketed for sale, they must go through a regulatory process for quality, safety and efficacy,” said Krista Apse, a spokeswoman for Health Canada. “Drugs not manufactured in Canada can only legally be exported if they are approved by us … and only a licensed pharmacist can dispense (drugs).”

The main difference is that regulation is handled at the level of provinces, Apse said, rather than federally, as is done in the United States, but the level of quality, safety and efficacy is set by the act, not by local officials.

Despite Dietl and the drug industry’s panicked warnings, it is not the sky that would fall if drug imports were allowed — just the cost of pharmaceuticals. Warnings about drugs bought from other nations or online are reasonable if there are no trustworthy mechanisms in place to ensure safety. In Canada, there are, and the U.S. Senate bill is written to allow imports only from Canada.

That’s fine news, and Blagojevich’s study will make such a bill more likely to pass.

If so, concern would have to shift to Canada, where Apse says there is already concern over drug shortages and industry anger making the problem even worse. But that would leave drug manufacturers looking like bad guys instead of saviors, and probably worsen the outlook for a sector that has struggled enough in recent years.

Pharmacist, heal thyself.