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Rx: Canadian Drugs
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     To the Editor: It is important to add the Canadian perspective to Zuger's discussion of Canadian drugs (Dec. 4 issue).1 The province of Manitoba is home to 40 percent of Internet pharmacies in Canada. With growth from nothing to sales of $400 million to $500 million (Canadian dollars) per year, Manitoba's Internet pharmacies now provide more medication to the United States than to the 1.1 million citizens of Manitoba. Local governments have been quick to get behind the industry and its economic benefits, but like most things political, this move is perhaps short-sighted. In Manitoba, all citizens are provided coverage for prescription medication after a threshold deductible of 2 to 3 percent. The mass exportation of prescription medication to the United States threatens the preferential pricing set by the Patented Medicine Prices Review Board.2 Companies may also choose not to market medication in Canada in order to protect the larger and more lucrative U.S. market.3 At risk is nothing less than the ability of countries to set their own policy regarding pharmaceuticals. The availability of Canadian medication is not a viable long-term solution to the problems of drug costs in the United States and represents a substantial threat to the access and affordability of drugs in Canada.

    Shawn Bugden, M.Sc.

    Prescription Information Services of Manitoba

    Winnipeg, MB R2H 1J2, Canada

    bugden@prisminfo.org

    References

    Zuger A. Rx: Canadian drugs. N Engl J Med 2003;349:2188-2190.

    Cohen JC, Cassels A. Canada: get ready to defend affordable drugs. Globe and Mail. August 26, 2003:A17.

    Blackwell T. Fears of internet sales delay release of HIV drug in Canada. National Post. November 4, 2003:A1.

    To the Editor: Zuger reports that Canadian Internet pharmacies may have to look outside Canada for supplies, with the result that Americans may receive products of indeterminate provenance. Although the evidence is circumstantial, this situation is almost certainly occurring already.

    Pharmaceuticals valued at approximately $300 million (all amounts are expressed in U.S. dollars) were imported into Canada in 20021 from countries without mutual-recognition agreements about manufacturing practices.2 Twenty-five such countries (including China, India, Brazil, Hungary, Slovenia, Ecuador, Thailand, Croatia, Chile, South Africa, Argentina, and Indonesia) each exported $300,000 to $59 million worth of pharmaceuticals to Canada.1 In 2002, the value of imports from Thailand, Indonesia, Argentina, Ecuador, Chile, and Brazil were 264 percent, 296 percent, 500 percent, 501 percent, 512 percent, and 3270 percent higher, respectively, than they were in 1999. In the first three quarters of 2003, the value of imports from Iran increased to $1.5 million (a 2372 percent increase over the total value in 2002).

    Because drugs from Internet suppliers may originate outside Canada and the United States, neither government takes responsibility for their safety. Canada should take prompt action to prevent large-scale, unregulated, cross-border sales to avoid any negative outcomes from drugs whose origin is unclear and whose quality is unknown.

    Nigel S.B. Rawson, Ph.D.

    Nesbitt Ave. S.

    Bloomington, MN 55437

    References

    Trade data online. Ottawa, Ont., Canada: Industry Canada, 2003. (Accessed February 19, 2004, at http://strategis.ic.gc.ca/sc_mrkti/tdst/engdoc/tr_homep.html.)

    Health Products and Food Branch. MRAs updates. Ottawa, Ont., Canada: Health Canada, 2003. (Accessed February 19, 2004, at http://www.hc-sc.gc.ca/hpfb-dgpsa/inspectorate/mrasupdate_new_e.html.)