Stephen Arundel, a 50-year-old Minneapolis executive, was paying $350 a month for a drug to treat his chronic colon condition. This spring, he saw a newspaper story about importing drugs over the Internet.
"I'm not a computer guy," he said, "so I told my 14-year-old son to get on the Net and check it out."
The result: Arundel is now paying $140 a month to buy the same drug, Asacol, from an Internet site called Canadameds.com. Drug prices are often lower outside U.S. borders, because other countries apply different price controls.
"When I'm running low, all I have to do is go online and hit refill, and a bag of pills comes to my door," he said. The savings are "dramatic"--about $2,500 a year.
If Congress passes a proposal allowing Americans to import legal, FDA-approved prescription drugs through the Internet or by mail-order, the ranks of people like Arundel will swell, lawmakers say. (The House approved a bill last week, and the measure next goes to the Senate, where its fate is uncertain.) According to the most recent estimate by the Food and Drug Administration, in fact, about 2 million parcels containing prescription drugs enter the country every year, ranging from growth hormones and steroids to garden variety medications.
But while some patient advocates insist that the practice is safe and invaluable to many Americans, others say that the measure, if it becomes law, would open the door to unscrupulous operators. Drug purchases made over the Internet are very difficult to monitor, and the business is virtually unregulated.
"Consumers will be put at risk, because drug re-importation would be a welcome mat for crooks and frauds." said Rep. John Dingell (D-Michigan), ranking member of the House Committee on Energy and Commerce, in a statement released after the House vote. The committee has oversight over interstate commerce and has investigated online pharmacies.
Americans "take drug quality for granted precisely because we are well-regulated," said Lucinda Maine, a spokeswoman for the American Pharmaceutical Assn., a professional group for pharmacists in Washington that has been skeptical of import measures.
The vast majority of drugs approved for sale in the United States, purchased from Canada and Western European countries, are safe, advocates say.
"The drugs coming from Canada seem very clean, we haven't heard of any problems," said Frederick Mayer, a pharmacist near San Francisco who runs the Pharmacists Planning Service, a nonprofit group advocating for lower drug prices. "But there are other countries, including Mexico and some Asian countries, which just don't have the same good manufacturing standards that we do here; we worry about sloppiness and about counterfeiting."
Already, more than 100,000 Americans die each year as a result of adverse drug reactions, according to some estimates, many from U.S.-made products. Mayer thinks the growth of online pharmacies will only increase that number. "A lot of people, especially seniors, just don't know what they're getting," he says. "Sure, we're saving a lot of money, but what we really need to do is talk to a pharmacist about the drugs."
When 2 million bogus birth control pills flooded the U.S. market in the mid-1980s, for example, the pills and the packaging duplicated that of legitimate drug companies. But one product contained so much extra hormone that it caused excessive bleeding, while another had no active ingredient, which resulted in unwanted pregnancies.
The House measure encourages people to deal with legitimate suppliers and include their doctor in the process, to verify prescriptions.
Still, Bush administration officials worry that drug traffickers could camouflage shipments of contraband and escape detection by attaching a phony label to the package. The Food and Drug Administration and the Customs Service, which oversee the importation of pharmaceuticals, don't have the resources to check all of these packages. In a letter to Congress, DEA officials noted that the proposed legislation would place an "undue burden" on these already overtaxed agencies.
But supporters of the bill said that, for some patients, it may be worth the risk. "This shows the lengths people will go to avoid paying high prices for drugs in this country," said Amanda McClosky, who studies drug pricing issues for Families USA, a Washington-based patient advocacy group. "We think it's important that the proposal in Congress becomes law because, technically, many of these people were illegally" importing the drugs.
While the measure passed easily in the House, 324 to 101, legislative analysts believe it faces a tougher test in the Senate.
But there's no lack of support among many people who are fed up with paying high prices for drugs used to treat their ailments. Karen Bergstrom, a Minneapolis secretary in her 40s, buys stomach medication for her mother over the Internet, also from Canada. "It's about half the cost, and it's very simple to do," she says. "My mom has some drug benefit in her insurance, but it's very confusing for an 83-year-old. It's confusing for me. Doing it online is much easier."