Safer to Buy Your Prescription Drugs in Canada?

I clipped an article from the Courier journal in December, 2010 entitled, “Pfizer issues 4th Lipitor recall” that was released by the Associated Press.  Although I had planned to focus on articles from the new year, a subsequent article about a recall of multiple products by Johnson & Johnson made the pair fair game.

The Lipitor recall was the most recent of a series reacting to an “uncharacteristic” odor.  The smell is blamed on a wood preservative often applied to wood pallets that might have been used to transport products.  The article quotes Pfizer that the use of such chemicals in the shipment of its products is prohibited.  (Are we are left to assume that the chemical tainted the pills in some other as yet unknown manner?)

The article goes on to mention that over 360,000 bottles of Lipitor have been recalled so far; that Lipitor is the best-selling prescription drug in the US; that other drug companies such as Johnson and Johnson have had trouble with smelly pills; and that the risk of serious harm from this particular contamination is remote.

The story about Johnson and Johnson is quite interesting.  As reported by Wall Street Journal and other sources,  Johnson & Johnson recalled tens of millions of packages of over 40 different medicines in 2010.     According to Reuters, at least one American Johnson & Johnson manufacturing plant “was closed to fix quality control lapses, including unsanitary conditions.”  The recall has generated citations from federal regulators and criticism by congress because of the “phantom” nature of the recalls.  This is a far cry from the actions of McNeil during the Tylenol poisoning incident in 1982 which brought  the Johnson & Johnson subsidiary praise for its bold and definitive response.

The pharmaceutical industry takes its fair share of criticism for the dysfunction of our health care system.  I think much of that criticism can be justified.  After moving to Kentucky 25 years ago, I learned to view the pharmaceutical industry as more akin to the tobacco companies I was learning about than the healthcare-provider partner the industry wished to resemble.  Books have and will be written about the way the drug industry does business, but one practice that particularly irks me is the way they have successfully lobbied (i.e. paid money to Washington politicians who want to remain in office) to prohibit Americans from buying their drugs in Canada (or any other civilized country for that matter).  The drug industry sees a problem when a citizen from from Detroit walks over into Canada to buy their brand-name drug in someone else’s neighborhood drugstore.  The arguments for prohibition usually contain the words counterfeit, uncontrolled, poor quality, and the like.   As reported by the New York Times in 2002, in speaking against a bill that would allow such purchases, Senator Hatch of Utah warned, ”If this proposal becomes law, we are just placing our country in the hands of foreign terrorists who could easily get hold of various prescription drug products and spread desolation and disease.”  More than a little over the top, but such scare tactics seem to carry the day in Washington.   Usually unaddressed in these debates is why the same drugs in the same bottles are so much more expensive in the United States.

I don’t want to hear those arguments about quality any more, least of all from the the corporate mouths of the American pharmaceutical industry.  If issues of protection and quality must be made, let them be voiced by the FDA or consumer protection groups.  Its not as if the US drug companies are giving us drugs clean as the driven snow!  It cannot even be said that “American” drugs are made in America!  A full two page advertisement I saw today tells me that Lipitor is made in Dublin, Ireland.  The advertisement did not mention where the raw ingredients for the drug came from in the first place. In fact in 40 years as a physician I have never seen such information provided in a drug ad.  I once served as a expert witness in a trial where harm was caused by a food supplement that was manufactured using contaminated ingredients from another country.  I came to understand that many of the chemical ingredients used in our “American” drugs come from abroad.   Of course we can get sold counterfeits and snake oil.   But there is a difference in buying drugs carelessly over the internet and buying from reputable and regulated prescription drug outlets in the United States and other developed countries.  Good and bad vendors are found everywhere– maybe even especially in the United States!   We rightly trust Canada to sell us our food, why not our drugs?

A fascinating commentary proves my point!  On the current McNeil Product Recall Information webpage  Canadian residents are referred to a separate website.  There they are told that, “This recall does not impact product sold in Canada.”   In other words, Canadians would have endangered themselves only if had come across the border to buy their drugs in the United States!   As a matter of record, these particular drugs were safer in Canada than the USA!   I rest my case.  The argument that drugs safe enough for our Canadian cousins are not safe enough for us ranks right up there with “there is not enough evidence that cigarettes cause cancer.”

I will leave for another time the question of why anyone should pay premium prices for Tylenol and Lipitor in the first place.  I can buy a year or two’s worth of acetaminophen (the active ingredient in Tylenol) for under $10.   I have some arthritis, so I pay more like $20-$30 for a year’s worth of ibuprofen (the active ingredient in Motrin).  In my considered medical opinion there is no reason to buy brand-name acetaminophen or ibuprophen unless you like the look or the smell of the pills.  I used to take Lipitor.  It worked fine for me.  Now that there are generic cholesterol lowering drugs, I pay $8 in my neighborhood American pharmacy for a three month supply and it works just fine.  Why should we spend our collective tax and insurance premium dollars to pay for anything else?  That is the real issue here!   The colossal waste depresses me.  If we had rational drug policy in the United States, we would not have to consider buying our drugs in Canada.

Peter Hasselbacher MD
24 Jan 2011