It’s hard to imagine why people would actually prefer to buy drugs from internet websites that are obviously not licensed legitimate pharmacies. That is, those that do not require proof of a valid prescription from a legitimate prescriber, and/or do not carry an online pharmacy certification (especially from the National Association of Boards of Pharmacy, NAPB, VIIPS program). In an earlier essay I said this about people who would buy drugs from these illegitimate sources:
“Most of the criminal activity has moved out of the legitimate supply chain, mostly onto the internet. You know, the internet, where criminals can sell drugs directly to the few consumers who are dumb enough to think that someone will sell them legitimate prescription drugs, but do so illegally by not requiring a prescription. That is, they think that some faceless company would be willing to knowingly break one law, but could then be trusted to provide real pharmaceuticals at below market prices. In the age of the internet, how do you protect people who are that gullible?”
A few weeks after writing that rather disparaging passage I met one of those gullible people…at a family Christmas gathering—my Aunt Mary. First of all, you need to know a little bit about my Aunt. She is over 80 years old and she has had a bad case of Rheumatoid Arthritis for the last 50 years. She was a Registered Nurse before she retired early due to the disease. While having successfully raised six children, she and my Uncle have always barely held onto the bottom rung of the lower-middle income scale. Which is to say that when they retired, they had very little savings and rely heavily on Medicare and Medicaid. Fortunately my Uncle is an Army veteran and so he gets regular medical care through the U.S. Department of Veterans Affairs (VA). Between the two of them, they consume a HUGE amount of prescription drugs every day.
At our family gathering Aunt Mary asked me what I had been up to lately and I told her about my work in various venues, all focused in some way on protecting the supply chain from counterfeit and other illegitimate drugs. With that she straightened up and said, “Hah! I’d like to find where I could get some counterfeit drugs.”
I assured her that counterfeit drugs were not something that anyone would want to buy and especially not consume in place of legitimate medicine.
“No,” she assured me, “I would really like to find where I can buy counterfeit drugs. I would much rather take counterfeit medicine than the stuff the big drug companies in the U.S. gouge us for, where they charge us many times the actual cost we’d pay for counterfeits.” She was dead serious.
My wife and I looked at each other, partly aghast and partly amused. Obviously she didn’t understand what she was saying. We spent the next twenty minutes trying to explain that counterfeit drugs rarely have any medicinal ingredients at all. She refused to accept that.
“Surely they put some of the proper ingredient in them. So maybe you have to take twice as many pills—at least you come out ahead if you only paid one tenth the inflated price the drug companies charge for the real thing,” she said.
We did our best to explain why that wasn’t true but eventually decided to drop the topic before it started to have a negative effect on the festive occasion.
“COUNTERFEIT” OR “UNAUTHORIZED GENERIC”?
Aunt Mary had fallen into the misunderstanding between what is a true “counterfeit drug“—one that is designed to look exactly like the real drug but may have too little medicine, the wrong medicine, or most often, no medicine in them and is specifically designed to deceive the buyer—and an unauthorized copy of a real drug, sometimes referred to as an “unauthorized generic” drug—one that may be manufactured to the same standards as the original but which violates the exclusivity rights of the patent holder. Both violate the law (the former in all countries, the later in countries that support international patent rights, although this is the subject of intense debate), but true counterfeit drugs are the worst form of crime because they are intentionally deceptive and can often be life threatening.
My Aunt Mary assumed that “counterfeit drugs” are always nothing more than “unauthorized generic drugs” that are offered without the built-in overhead costs of marketing, basic research, lab trials, clinical trials, patent acquisition, FDA approvals, licensing, inspections, current good manufacturing practice (cGMP) validation and the profit margin that is granted by virtue of patent exclusivity. She doesn’t want any of that stuff, she just wants the drug, and by her logic, a counterfeit is the drug minus all the overhead costs.
What is the best way for people to tell they are getting “real” counterfeit drugs on the internet? Easy, the selling price will be a fraction of what you would pay in a legitimate pharmacy and you won’t need a real prescription to get it. You and I might think this makes it clear that one should avoid buying from those websites. Those who follow the same logic as Aunt Mary would see the same thing, but they would view the low price as proof that they are getting the real drug without paying for all that overhead—a real “deal”.
My Aunt is a very nice lady and I don’t mean to pick on her, but I suspect the way she views counterfeit drugs is more common than those of us in the industry realize. This may be the kind of logic that leads people to trust uncertified websites which obviously sell counterfeit and other illegitimate drugs. Perhaps it is similar logic that leads people to support reimportation of drugs that have been outside the security envelope of the U.S. supply chain (see my essay, “Safe Prescription Drug Reimportation: An Oxymoron”). Aunt Mary is also a strong supporter of reimportation of drugs.
THE REIMPORTATION DEBATE: BACK AGAIN…BRIEFLY
Reimportation was in the news again a few weeks ago during the Senate debate over the Prescription Drug User Fee Act (PDUFA). Senator John McCain (R-AZ) had introduced an amendment that would have opened the doors to drug reimportation into the U.S. supply chain. Fortunately it was defeated 43 to 54. (BTW, that full PDUFA bill is currently in a Senate and House Conference Committee where they must resolve the differences between the Senate and House versions, but reimportation won’t be in the final version.)
Fortunately Aunt Mary’s computer skills do not go beyond email so she doesn’t know how to buy counterfeit drugs on the internet and we’re not going to tell her. But apparently somebody is buying them or we wouldn’t keep hearing about how counterfeit drugs are flooding our shores. Maybe we just need to educate those buyers about what counterfeit drugs really contain. Would they believe it any more than Aunt Mary believed me?