Federal Health Minister to Take on Internet Pharmacies

IT'S SUNNY AND -16º C, not too bad considering how cold it can get here in southern Manitoba. The only thing moving is the occasional passenger car or transport truck, billowing cotton balls of exhaust along Highway 3.

Federal Health Minister to Take on Internet Pharmacies

IT'S SUNNY AND -16º C, not too bad considering how cold it can get here in southern Manitoba. The only thing moving is the occasional passenger car or transport truck, billowing cotton balls of exhaust along Highway 3. The immediate area, 55 km southwest of Winnipeg, is predominantly flat frozen farmland with a few patches of trees. An icy gravel road leads visitors to the doorstep of HometownMeds.com, an Internet PHARMACY near the town of Carman, hunkered down next to a windswept field on which a farmer grew lentils last year.

Inside HometownMeds.com., one of Manitoba's smaller providers of discount prescription drugs to the U.S., Sandy Robinson operates the OptiFill-II system, a $2-million automated pill dispenser the size of four refrigerators placed side by side. Robinson, one of the firm's 25 employees, is concerned that federal Health Minister Ujjal Dosanjh, bending to pressure from U.S. President George Bush, might legislate an end to the hugely successful industry, throwing her and 2,300 other Manitobans out of work. "It would be devastating for the community and the province," says Robinson, a 40-year-old mother of two. "Around here, job opportunities are harder to find."

Despite recent and mildly conciliatory words about not wanting to put the kibosh on a $1-billion-plus business, Dosanjh has made it abundantly clear in the past month he is prepared to take on Canada's INTERNET pharmacies. Canadian companies selling prescription medication to U.S. patients they've never seen is unethical, argues Dosanjh, and could lead to drug shortages and cost increases in Canada. He's mulling the creation of a registry to track drugs that are running low. His all-out offensive follows Bush's visit to Canada in early December, when the President raised the issue of Canadian drugs undercutting U.S. retailers with Prime Minister Paul MARTIN. Some critics have even speculated about a direct trade-off: an end to the flow of cheap drugs in exchange for the reopening of the border to Canadian beef after the mad-cow scare. Ottawa denies there has been any deal. But Big Pharma likes what it's hearing from the feds. "We're gratified the government seems to be recognizing some of the issues, and that action needs to be taken," says Don Sancton, corporate affairs director at Pfizer Canada Inc. in Montreal.

If the Internet drug trade went under in Canada, up to two million Americans would find themselves without a ready source of affordable medicines. Because of government price controls here, the same drugs from Canadian pharmacies - many originally shipped north from their U.S. manufacturers - can cost anywhere from 40 to 80 per cent less than from their U.S. counterparts. Then there's the workforce. "If we were to lose 2,000 jobs in Manitoba," says Charlie McDougall, a spokesman for the province's Industry Department, "that would be like losing 27,000 jobs in Ontario." Manitoba employs the most Internet pharmacy workers in the country, with other provinces - primarily British Columbia, Alberta, Saskatchewan, Ontario, Quebec and New Brunswick - bringing the total number of workers nationwide to about 4,000. If operators are forced to shut down, many are expected (and some are already planning) to pull up stakes and set up shop in Europe, leaving behind - maybe - a few call centres. "Mr. Dosanjh," says McDougall, "is just trying to stick his finger in the e-commerce dike."

McDougall's line is rehearsed, the kind of catchy sound bite spokespeople get paid to dream up. But even industry leaders see room to compromise. "Can we be the wholesaler to the United States?" asks Paul Clark, one of HometownMeds' owners. "The answer's no." There simply aren't enough drugs to go around, he says. Clark favours banning wholesale exports to, for example, U.S. municipalities and states with employee drug benefit plans. He would also welcome a registry to monitor the supply chain. If a province runs low on, say, cholesterol-fighting Lipitor, the Internet pharmacies would be obliged to turn down U.S. orders. "There's a compromise that's out there," says Clark. "Why can't this business continue? No one's given me a good answer." If the industry is shut down, he adds, "the Europeans at this point in time are more than happy to see us come. They see the U.S. market as this big plum and they're ready to pick it."

This is a politically delicate time for Dosanjh. Early this month, the Commons Standing Committee on Health requested the health minister not act until committee members had a chance to study the Internet pharmacies, which, despite their name, do the vast majority of their business by fax, phone and the mail. This week, the committee was to hear two days of exploratory testimony by various interested parties. Dosanjh has said he respects the committee's request for restraint, but won't be bound by it if he deems it necessary to act.

There's another angle as well. Sancton at Pfizer Canada points out that the U.S. Congress is weighing a handful of bills which, if adopted, would allow for greater wholesale imports into the U.S. from Canada. That, he says, would dilute Canada's drug supplies. David MacKay, executive director of the Canadian International Pharmacy Association, which represents about 40 Web operators, says none of those bills have any chance of becoming law in the face of pressure from industry lobbyists in Washington. Sancton, he says, is just trying to scare people. "The Republicans will never permit drug importation because Big Pharma won't permit it," say MacKay. "He's fear-mongering. He's trying to push that button and scare Canadians into closing their border on behalf of the U.S."

Jeffrey Uhl, president and owner of UniversalDrugstore.com, located in an industrial park near Winnipeg's airport, ultimately expects a deal that will keep his 150 employees working. But Big Pharma and Ottawa need to turn down the rhetoric. "They have old people on the street thinking we're stealing their drugs from them," says Uhl - though, in fact, there have been no documented drug shortages in Canada. The health committee's go-slow approach, focused on studying the industry, is the way to go, Uhl adds. "It'll do nothing but help us. They'll see we can do business without harming Canadians."

Certainly customers in the U.S. are hoping for a solution. Bernice MacDonnell, a 77-year-old Canadian who has lived for decades in Holiday, Fla., lost her husband to prostate cancer last September. But his life, she says, was prolonged by the cancer medication Casodex. She bought it from HometownMeds, which charged her about US$600 for a 90-day supply - compared to roughly twice that in the States.

Canadian workers are keen to keep providing that service. Maureen Lemky, an office supervisor, has worked at HometownMeds for more than two years. Married and living in Carman, just a five-minute drive away, Lemky, 24, knows there aren't a lot of jobs in the farm fields that surround her. "It's really tough to find work around here," she says, "unless you're willing to drive an hour there and an hour back. It took me a year to find this job." She'd also miss the customers. "You meet some really great people on the phone. Your heart goes out to them. They'll say, 'Because of you, I can pay my rent.' "

Doctors working for the Internet outlets co-sign prescriptions sent from the States. That's where Denise Verville comes in. As a pharmacy technician at UniversalDrugstore.com in Winnipeg, the 32-year-old single mom of two children, ages 7 and 8, had to take an eight-month course before landing a job in which she fills the prescriptions. They are then double-checked by a pharmacist. Verville amassed $12,000 in student loans and needs the work. "If I lose my job, the government's going to be supporting me," says Verville, who makes $14 an hour. "To find another job like this is just impossible. It wouldn't hurt just me - it would hurt my children. It's all about the dollar. Well, what about those people who aren't going to have that dollar anymore?"

The whole process, of course, is controversial. The B.C. College of Physicians and Surgeons fined two doctors $25,000 each in December for approving prescriptions for U.S. patients they never examined. The college called it "unprofessional." More recently, the college fined a doctor $4,000 and suspended his licence for two years for committing the same offence, then lying about it. Obviously, some ground rules are needed. But safety - given the myriad bar codes and checks and counter-checks by pharmacists at Internet operations - doesn't appear to be compromised. As for U.S. patients, the industry asks that they get a pharmacy's licence number and check with the provincial regulator to make sure it's a reputable outfit.

Robert Fraser, director of pharmacy at CanadaDrugs.com, oversees one of the premier online operations. Filling up to 3,000 prescriptions daily, CanadaDrugs, on the outskirts of Winnipeg, employs almost 300 people. Its call centre, with more than 100 workstations, is a mass of telephones and computer screens. Industry and provincial regulations, plus the latest technology, ensure unparalleled accuracy in filling prescriptions, says Fraser. "We're not getting in a horrendous number of orders, closing our eyes and moving on to the next one," he says. "It's exceptional care."

For workers in the business, the uncertainty is taking its toll. Susan Duka, a 57-year-old customer service rep at UniversalDrugstore, knows that, at her age, another employer is unlikely to hire her. Married with three children, she's concerned about her own future and about the U.S. patients who've come to rely on cheaper meds from Canada. "I've gone home nights where I've wanted to cry," says Duka, her eyes welling with tears. "It really bothers me." Glen Nivet, 43, supervisor of billing and shipping at CanadaDrugs, says that, far from disappearing, the industry should be the future. "Just about everyone's online," he says, citing retailers and airlines. "I don't see why a pharmacy can't be."

Maclean's February 21, 2005