nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Saturday, September 11, 2010

Cheaper Drugs From Other Countries: Also Sometimes Counterfeit, Diluted, Or Adulterated

This is for those who think buying drugs abroad is a simple fix for the high cost of drugs.

From the Washington Post Health blog (Sep 11):
India, the world's largest manufacturer of generic drugs, has become a busy center for counterfeit and substandard medicines. Stuffed in slick packaging and often labeled with the names of such legitimate companies as GlaxoSmithKline, Pfizer and Novartis, the fake drugs are passed off to Indian consumers and sold in developing nations around the world.  Experts say the global fake-drug industry, worth about $90 billion, causes the deaths of almost 1 million people a year and is contributing to a rise in drug resistance.
Drug prices are a function of development costs, regulatory costs, marketing costs, the need to recoup investment while protected by branding, and of course, profit margin to grow the company (which they will maximize; that's how captialism works).

[The other side of the story on high profits for certain drugs is (1) only 1 in 300 drugs actually becomes a big moneymaker...the others are business losses, and (2) after the drug becomes generic, the profit becomes very small...if the company has not made back its costs by then, the drug is an overall loser.]

Given the temptation to counterfeit, and huge potential revenue, it's no wonder that a lot of what's on the market in other countries is harmful or worthless.  Some governments enforce product laws better than others.  People who buy online are particularly vulnerable to this kind of scam.

Even if the drugs contain the actual drug, in some countries there are few quality control measures that are enforced.  A product that is supposed to be the equivalent of, say, Lipitor (atorvastatin)--a common cholesterol drug--may actually contain little of the actual drug....just enough to pass a quick test by auditors that just checks whether the compound is there, not how much.

The companies who offer all these cheap drugs know all the dodges.  And there is no assurance that you are getting the right thing, in the right amounts, and nothing else (some unscrupulous companies add filler and other chemicals that may be harmful).

In fairness, there are countries who do a fairly good job of enforcing drug quality.  However, how do you tell whether a retailer in that country isn't just a shell for some other country's manufacturer?  Canada is a good example; you can get drugs cheaper from Canada.  The Canadian government does this by essentially blackmailing the drug companies; they legislate prices they will pay, and the drug companies have to go along (forcing US prices higher).

I've talked to people who say they can tell the difference between a good product and a bad one by how the website looks and the testimonials of previous customers.  Neither of these approaches are reliable.  Companies hire people to give testimonials, and web developers steal logos and content from legitimate companies. 

The classic story for bad drugs was the Fen-phen debacle.  Much of that product was produced overseas and bought cheaply by people who wanted to lose weight.   Result:  heart valve damage.

Doc D

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