The high price of cheap pills

By Peter Pitts
November 7, 2007

When was the last time you picked up a bottle of Bayer Aspirin and wondered whether it was authentic?

Never? Well, that's because Bayer is a well-known brand. You were probably in a chain store, or at least on a popular website like DrugStore.com. Plus, you don't need a prescription for aspirin.

But what if you wanted a drug that might be unavailable or cost too much in your area?

What would you do if, alternatively, the government, your doctor, or your insurance company denied your request for something you thought could help you?

Like many others, Marcia Bergeron of Quadra Island in Canada was in just such a situation when she turned to the Internet.

While she likely thought she was purchasing inexpensive medicine from a safe online supplier in Canada, authorities found that she had actually ordered pills produced in Southeast Asia from a website based in the Czech Republic. It was a costly mistake that killed Bergeron.

Toxicology tests found three well-known drugs in her system: alprazolam � more commonly recognized as the anti-anxiety drug Xanax; zolpidem � which most are acquainted with as the brand-name sleeping pill Ambien; and acetaminophen. Zolpidem is not available in Canada, so it's understandable why Bergeron turned to the internet to try to get the drug.

The number of additional substances found in the toxicology tests, however, was astounding. Bergeron was found to have high levels of �filler� materials like aluminum, tin, and even arsenic in her system. Such materials are the hallmark of dangerous counterfeit drugs.

As more and more consumers head online for cheap drugs, it's all too likely that Bergeron's story could become common � especially because the world's drug market is already wash in counterfeits.

The World Health Organization estimates that up to 10 percent of drugs sold around the world are fake � a number that jumps to 50 percent or higher in some countries. In fact, a 2005 FDA sting operation at the New York, Miami, and Los Angeles airports found that 85 percent of drugs from so-called �Canadian pharmacies� were actually coming from other countries, thanks mainly to eased trade in the European Union.

Supporters of drug importation hope to ease concerns about counterfeits by calling for new laws mandating the thorough inspection of imported drugs. Unfortunately, the FDA will have a hard time making sure everything is safe, legal, and properly labeled because counterfeiting is so decentralized.


In the European Union, for example, regulations actually prohibit manufacturers from managing their E.U. supply chains.

This results in a lucrative market for wholesalers, who can open a package of pills only to repackage and re-label it. Because the manufacturer has no say in the process, dosages and expiration dates are frequently incorrect, and the drugs themselves are also subject to tampering.

So a box of meds that looks like it came from Britain could easily have originated anywhere in the E.U., including places like Latvia, Malta, or the Czech Republic.

In order to prevent these pills from making it to American shores, the United States would have to convince the E.U. to abolish portions of the Treaty of Rome, a European trade agreement signed over a half century ago. Or, government officials would have to monitor all overseas transactions in order to pick out pill packages, intercept them, and investigate their origins.

Neither of these options is feasible.

Fortunately, elderly Americans don't need to scour the Internet for cheap drugs. Anyone who's 65 or older qualifies for the Medicare drug benefit. Although this program is only two years old, it is already providing subsidized coverage to around 24 million seniors. Its remarkable success is due to the fact that the drug benefit, unlike most government programs, is administered by private companies.

Despite these facts, many lawmakers continue to claim that drug importation is necessary to give seniors and other consumers access to cheaper drugs. But if the tragic story of Marcia Bergeron has proven anything, it's that turning to a pharmacy supposedly based in Canada to fill one's medical needs can have disastrous consequences.

Saving money should take coupons, not lives. If only policymakers kept up on the news.

Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner.