Jewish World Review July 25, 2003 / 25 Tamuz, 5763
Drs. Michael A. Glueck & Robert J. Cihak
Drug reimportation: Bill translates to goodnight, patients
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Sometimes the Powers That Be and the Powers That Wannabe try to bribe you
directly. More often, and far more insidiously, they buy you indirectly, by
offering to "save you money." The Gutknecht "Drug Reimportation Bill",
tentatively scheduled for a vote in the U.S. House of Representatives at
the end of the week, seeks to do both.
This item would make it legal for Americans to purchase drugs from 26
foreign countries (including American drugs previously exported), and would
suspend the requirement that the Food and Drug Administration certify these
pharmaceuticals as safe and effective.
So, what's wrong with that? Your Medicine Men hold no great affection for
the FDA, with its bureaucracy-driven drug-approval processes and excessive
caution. We do cherish open markets and competition. And there's already a
thriving (if illegal) U.S.-Canadian trade in prescription drugs.
Just spend some time at any major border crossing, watching the American
seniors head north to get their subsidized drugs ... while Canadians of all
ages flock south for treatments unavailable under their system. Not to
mention the Internet commerce.
By some estimates, Americans spend well over half a billion dollars
annually on such drugs. Those who travel to Canada to purchase drugs need
not be alarmed, as this practice remains legal with or without the
Gutknecht Bill.
So, what's the dilemma?
There are at least three dilemmas.
The first is patient SAFETY. Free and easy importation from 26 countries
could lead to a flood of counterfeit drugs; to an influx of expired drugs
that have been repackaged; and to drugs manufactured, stored and
transported under unknown conditions. We could be importing poisons maybe
even terrorism.
Further, many advanced American drugs aren't even allowed into other
countries. Reimporting what's available somewhere else because it appears
to save money may often mean foregoing, or even not knowing about, the most
effective treatments.
Which brings us to the second dilemma: MONEY. Contrary to popular belief,
Canadians on average pay about as much as we do for drugs. This is
especially true for generic drugs whose patents have expired. Since it all
depends on what an individual needs, savings may be illusory.
But money here has another aspect. Pharmaceutical research and development
costs. The average drug takes about $800 million from inception to FDA
approval to market. Profits from sales have to amortize this investment.
They also have to pay for all the work that ends up in failure; for drugs
for rare diseases that will never turn a profit; and for all the drugs that
the firms sell (here and abroad) at discounts for various reasons.
Massive reimportation could well have a sadly deleterious effect on future
R&D especially if coupled with massive violation of patent and other
intellectual property rights. Let's not forget that without R&D we might
not have combated AIDS or the latest resistant organism de jour.
The third dilemma involves a philosophical MINDSET perhaps best depicted as
"Who needs cows? We get our milk from cartons." The Gutknecht bill is just
one more part of a massive state assault upon American medicine.
Indeed, the only reason why it's coming to a vote at all is that Missouri
Congresswoman Jo Ann Emerson, a Republican, swapped her vote for the
overall Medicare bill for a guarantee that the House would vote on
reimportation. The Medicare Bill, be it noted, passed the House 216-215.
In return, Emerson demanded a full House vote on a bill by Minnesota
Republican Gil Gutknecht that would make it legal for Americans to take
"advantage" of socialistic countries' government-imposed price controls by
reimporting our own prescription drugs.
Politicians buying citizens, yes. But such wholesale purchase would not be
possible were Americans to realize that health care, like the rest of
civilization, does not happen automatically, and is never free. And it's
being destroyed by those who think that it can be.
This legislation is an irresponsible political trick. Congressional leaders
of both parties know its dangers. Congress needs to say goodnight to the
Gutknecht bill.
Michael Arnold Glueck, M.D., is a multiple award winning writer who
comments on medical- legal issues. Robert J. Cihak, M.D., is past
president of the Association of American Physicians and Surgeons.
Both
JWR contributors are Harvard trained diagnostic radiologists.
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