Outsourcing Drugs

First law of economics: There is no such thing as a free lunch. First law of life: there is no such thing as a quick fix.

John Kerry, the Democratic nominee for president, has supported importation of drugs from Canada in order to lower the price to US citizens. George W. Bush has objected to the importation because, as he tells it, Canadian drugs aren't safe. Bloomberg Business News reports that Republicans running for Congress in Ohio, Iowa and Florida are splitting with Bush over the issue of importation of Canadian drugs. That's probably a good sign. Not so long ago, anybody who disagreed with President Bush could be pilloried as unpatriotic -- and that may happen yet.

Neither one has a good solution to the problem. The Bloomberg report continues: "... I don't see why we shouldn't be able to import,'' said Ohio Republican Frank Cusimano, 39, who is trying to unseat a Democrat in the House. The issue became personal when his 58-year-old mother-in-law needed a two-week supply of the Pharmacia Corp. antibiotic Zyvox. It cost $697 and wasn't covered by insurance."

Mr. Cusiman's mother-in-law isn't going to be helped by importing drugs from Canada. Zyvox is a drug that's used to treat methicillin resistant Stapylococcus aureus, which is to say that this is not a drug you can order by phone and wait for delivery. When you need it, you need it now. Importation and mail order are fine for chronic-use drugs, the kind that you'll be taking at the same dose for a long time. If you're taking a drug for high blood pressure or to lower cholesterol, and know you'll be on the same dose next month and the month after that, you can go to a mail-order pharmacy or a Canadian pharmacy which is really the same thing, and have a regular schedule, delivered to your home with the same regularity as the Reader's Digest. Some companies recommend that you get your physician to write two prescriptions, one, for a few days' supply, to be filled at your local pharmacy, and the other to be sent to the mail-order operation.

The trouble is, this is out-sourcing as sure as having computer support systems run from a telephone line in Bangkok. It's not corporate out-sourcing, and the people practicing it need to control costs more than the multinational corporations that are sending jobs overseas, but it amounts to the same thing. When prescriptions are filled in Canada, then local US pharmacies lose business. Then the local pharmacies close and there's no place to get the antibiotic or pain medication, the stuff you need in a hurry.

This is a problem that has existed for decades -- do you go for the lower prices, or pay more for service and convenience? The supermarkets put the neighborhood groceries out of business, and Home Depot and Lowe's have killed off the neighborhood hardware store.

Unfortunately, there isn't always a practical choice. Most people would like to support a local retailer, but can't afford to. When your job has been down-sized or out-sourced, you may not have the luxury of shopping at the local grocery. Wal-Mart hasn't built its business on ambience, service and charm -- it's just that Wal-Mart is all many of us can afford. Faded Glory isn't just the symbol of Wal-Mart, it's the symbol of America under the Bush administration.

The plight of the independent pharmacy is similar to that of the family farm, the neighborhood hardware store or the shoe store, but there's an added dimension when you're the parent of a child with a strep sore throat and there's no place to fill the prescription for penicillin or a cancer patient waiting for Federal Express to bring your morphine.

The lure of the quick fix is tempting, but there are always going to be problems. The problem of Islamic terrorism isn't going to be fixed by bombing another country in the name of democracy, but by the slow process of supplanting the madrasahs with proper schools, and promoting generations of Islamic people who follow their own traditions but respect those of others. The problem of high drug prices won't be solved by sending the business to Canada and Mexico, but by a system of universal health care that covers everyone, everywhere. Neither one can be achieved by a quick fix.

Importing Canadian drugs is a Band-Aid; importing the Canadian healthcare system is a cure. Could we please get started?

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

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