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Comment by gtop3 | Hacker News Reader

Our prescription drug system needs an overhaul. This isn't a matter of all drugs are illegal to import because of quality control issues. You can import aspirin, if you are so inclined. This is asthma and cancer medication being seized because of an overly tight control of prescription drugs. I understand that some drugs sold overseas are not suitable for human consumption. I understand that some drugs require close supervision. I argue that many medications are quite safe to take without supervision and using doctors as gatekeepers functions primarily to increase the billings generated by sick people. I think the bar for what medications are prescription and which medications are OTC needs to be reevaluated. Perhaps the way in which we market drugs and disclose there risks should be reevaluated simultaneously.

Imagine taking away someone's asthma medication and thinking you are making America a safer, better place.

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> I understand that some drugs sold overseas are not suitable for human consumption

Frankly, a lot of FDA-approved drugs sold in the US aren't suitable for consumption, especially generics manufactured outside the US. The FDA simply doesn't have the resources to enforce good manufacturing practices and product consistency, so a lot of subpar medication manages to slip under the radar and into the US market. The situation is much more grim for non-US buyers, who often get products of significantly worse quality.

'Bottle of Lies' by Katherine Eban[1] provides a thorough and very unsettling exposé on the issue.

[1]https://www.nytimes.com/2019/05/13/books/review/bottle-of-li...

Prescription drugs are barred from being imported for a different reason than quality control because non prescription drugs are allowed to be imported.

Yes, primarily for a few well justified reasons: 1) usage of prescription drugs usually entails significantly greater risks of adverse effects compared to OTC drugs (barring some grandfathered-in legacy substances like acetaminophen, which would probably not be approved for OTC use today), 2) relative to usage of OTC drugs, the stakes associated with usage of an under-performing prescription drug are much greater in magnitude, and 3) there is an economic incentive to produce counterfeit or otherwise subpar prescription drugs that doesn't exist for OTC drugs, the wholesale value of which can be often be measured in fractions of a penny.

Counterfeits are also a lot more common in the developing world than people would expect, and this stuff frequently ends up in online pharmacies. Manufacturers of drugs bound for international markets do implement measures that you usually don't see in the US (e.g. consumer-accessible websites/phone lines to verify a lot number and unique serial printed on counterfeit-resistant holograms), but even that doesn't do a lot of good. I've personally purchased antibiotics from a pharmacy in Vietnam that had convincing anti-counterfeit labels - but shame on me for not paying attention to the serial numbers. I bought two boxes with lot numbers and serials that checked out on the manufacturer website...but both boxes had the same serial, which shouldn't have been possible. The hologram stickers were indistinguishable from images of legitimate ones portrayed on the manufacturer website. I'm assuming everything the pharmacy had on hand for that drug (amoxicillin + potassium clavulanate) had the same serial on the label.

What's wrong with paracetamol? It's a liver toxin. Why's that bad?

Teenage girls.

People who live with teensge girls should treat paracetamol like firearms.

Just regulate that, whatever? 100mg of n-acetyl-cystiene be in each tablet, thereby rendering the overdose potential significantly reduced.

By teenage girls you mean suicide attempts via pills. The solution to that problem might not be restricting basic painkillers.

Buying affordable medicine is a crime not because there is a health risk, but because you are engaging in copyright infringement. You aren’t paying your toll to the Nice Men who bought their right to monopoly.

'Buying affordable medicine' in your argument begins false premise.

Whether or not many cheap generic substances produced for sale primarily in the developing world actually qualify as 'medicine' by US/EU standards is a very serious problem, and it's very common that these generic drugs don't live up to the standard for various reasons. Issues like under-dosing of the active compound, contamination, and use of unsafe additives are all frequent issues with drugs not intended for sale in the North America/The EU/markets that follow US/CA/EU approval in lieu of strong local standards.

In reality, the 'crime' here is buying something that may, or often may not qualify as medicine per leading standards, for which there are both safety and intellectual property concerns.

The FDA has rules limiting the import of all prescription drugs, and does not distinguish between drugs with an active patent and those with an expired patent. In addition, it's possible to purchase patented drugs that are manufactured legally overseas. I think you are conflating illegally manufactured medicine and laws for importing medicine.

You can see the FDA makes no mention on if the medicine is under a patent when setting it's rules for which prescription drugs can be imported [0].

[0] https://www.fda.gov/industry/import-basics/personal-importat...

> This is asthma and cancer medication being seized because of an overly tight control of prescription drugs.

Actually, many of these are medications (even life saving ones) being seized to protect inflated pharmaceutical pricing and profits at the expense of poorer Americans (and those lacking health care). Significant numbers of people are ordering the medications out of desperation.

I order my medications illegally because it's so much cheaper than doing it through the legitimate system.

how is this not stealing from people who are buying these drugs through the legitimate system.

Wow thats a big assumption that the system the user is circumnavigating is legitimate. Their are 2 "official" reasons for that system, safety and patent protection. While both have their merits they don't legitimatize the current state of that system. By your definition the only difference in its status of legality is the location those drugs are purchased and used. This is a very flaky foundation for your argument of legitimacy and the outcome of theft. Most of the time any legitimate protest against what you believe is wrong elicits shouts of "theft", "illegitimate", "think of the children", "safety". This conversation would be much more productive if you provided any examples of that theft or support for why the system is legitimate to begin with. That being said I do think the system has a place but it desperately needs overhauled and people seeking alternatives to the system aren't the problem but the canary in the coal mine signalling the weakest of our fellow citizens can't make do with the system that should be serving them.

" because it's so much cheaper"

thats the reason gp is doing it. has nothing to do with all the stuff you've written. Gp doesn't care about 'weakest fellow citizens' plight or whatever, infact they don't care that prices for 'weakest citizens' might go up from his actions.

I think your misguided in thinking someone who purchases outside the system is contributing to higher costs when you have fraud like this taking place in the government run systems let alone the private systems. https://www.cnbc.com/2023/03/09/how-medicare-and-medicaid-fr...

Funny you see the theft in one direction and not the other. Isn't the black market just a natural expression of agents engaging in free market principles?

… because stealing would require something being taken away from one person and being possessed by another?

The drugs are paid for, they’re not stolen, and they’re not taken from the people who are buying the drugs another way - they’re separate systems. That’s actually more ridiculous than calling media piracy ‘theft’ and that’s a high bar. I honestly don’t see how you could possibly see the illegal drug trade as ‘stealing’

> … because stealing would require something being taken away from one person and being possessed by another?

wouldn't it raise prices for legitimate buyers? ( ppl not willing to commit a federal crime) , hence taking money away from them.

Why on earth would it do that? If anything I'm reducing demand for "legitimate" avenues, which should reduce the price.

Because capital expects profits. Why on earth would anyone invest capital in biotech if its losing money.

> If anything I'm reducing demand for "legitimate" avenues, which should reduce the price.

These aren't stale muffins at your local grocery store to induce demand by lowering prices. These are supposedly life saving 800/month drugs, what would be the motivation for lowering prices.

They're drugs. The market in America wants $800/mo. The international online market wants what comes out to $34/mo.

It's the same drug. It costs $34 online because that's how much it costs for the factory to produce it and make a profit. It costs $800 in America because that's how much my insurance company decided I'm going to pay for it. It would be idiotic for me, with my extremely limited funds, to pay for the American one.

ok tell that to the judge when they send you to prison, smh.

You need to be less angry.

Because there is no actual theft going on? Are you suggesting that local “legitimate” users pay higher costs to recoup R&D expenses? I’d love to hear the evidence - it sounds a lot to me like the “piracy is theft” argument which has not been proved or well supported.

> Are you suggesting that local “legitimate” users pay higher costs to recoup R&D expenses? I’d love to hear the evidence

Yes ? Are you suggesting they that comes out of pharma profits?

> it sounds a lot to me like the “piracy is theft” argument which has not been proved or well supported.

No because not taking medication isn't an option like not watching a pirated movie.

Perhaps a closer analogy is shoplifting . Sure some amount of stealing is accounted for in the system but large scale shoplifting gets passed on to consumers.

I think the pricing is based on the maximum amount each individual can bear, independent of costs. If your hypothesis was accurate, we should see prices go up when sales go down (independent of the cause of the sales drop). I don't think that is clear, but open to evidence if you have it handy.

There might be a long term impact where fewer drugs are developed because there are lower profits, but even that feels awfully close to the "piracy hurts creative industries" argument that has been proven inconclusive at best and directionally wrong at worst.

There is a reason why patents have time limits.

Friend, I still purchase them from companies that manufacture the drugs.

Just not through the non-free American prescription drug market.

How am I stealing from people that can afford $800/mo medications by ordering them at actual market value?

> to protect inflated pharmaceutical pricing and profits

If federal laws were created with sole purpose of inflating pharma profits then you would just invest your life savings in these pharma companies and be set for life. You've literally found the golden goose if you really belive what you wrote there.

> I argue that many medications are quite safe to take without supervision and using doctors as gatekeepers functions primarily to increase the billings generated by sick people.

A may be safe. B may be safe. A + B may very well be deadly.

C may be safe, but in combination with grapefruit is ineffective.

D may be safe, but interactions with E and F need to be balanced and monitored to ensure that the body's systems don't get out of whack.

G may be safe, but it has recreational use (and abuse) possibilities.

H may be safe, but is a precursor to creating Z which is heavily regulated.

... and the list goes on.

Most drugs have a "this can go wrong" and with the prevalence of people taking whatever they find or people are talking about (see hydroxychloroquine and ivermectin for some widely popularized examples), I am hesitant to suggest that the common person is sufficiently informed about drugs to take that aspect of their medical care into their own hands without oversight.

I've never had a doctor tell me what drugs are safe or unsafe to take with others, almost never had a doctor ask what drugs I already take.

You grossly overestimate healthcare providers, and there are many things much more dangerous that people are just freely allowed to risk their lives doing.

> I've never had a doctor tell me what drugs are safe or unsafe to take with others, almost never had a doctor ask what drugs I already take.

The doctors in my system constantly are reviewing the drugs I'm taking. It helps that the computer system that they use actually captures the drugs I'm taking from all the doctors I see.

Before a procedure, the surgeon even went over the supplements that my wife takes. I applaud that surgeon for going above and beyond the call of duty--my wife brought in two huge ziploc baggies of all the crap she takes.

It can be annoying as sometimes it takes a couple rounds of "No, I'm not on that anymore" to actually pull the thing from the system record, but I actually approve of it overall.

Healthcare quality varies.

> I am hesitant to suggest that the common person is sufficiently informed about drugs to take that aspect of their medical care into their own hands without oversight.

I generally agree that there are cases where prescription medications should be controlled. My argument is that too many medications are prescription. Several OTC medications are inappropriate to mix with other OTC medications, require monitoring with long term use, or have interactions with grapefruit. People make fatal decisions with OTC medications. Some OTC medications have recreational potential. These concerns are not unique to prescription medication.

I am not persuaded by the argument that individuals are not capable of making their own medical decisions. A doctor can advise a patient which OTC medications to take, and this type of consultation will still be available. Pharmacists will also answer questions about OTC medications they sell. I think there is an ocean of difference between "Medical advise is available to you if you choose this treatment" and "Medical advise is required to even choose this treatment." We are using the later too frequently, and I suspect many want to keep it this way to drive up healthcare costs.

In theory you can oversee without broadly disallowing.

How much of G and H are you going to let one person buy?

How do you make sure that the person is coming in to have bloodwork done if they're on D, E, and F?

If a person is buying A over the counter and you prescribe B - where is that check being done?

The FDA model is broken. It is pretty much a Nazi model where private industry is protected from competition and also dictated to by heavy handed government pencil pushers. Good things wont come out of it.

The claims like "foreign drugs might be dangerous" is simply dumbing down of reality of world and false. While your average joe wont know if the insulin he got from Tijuana is good or not, denying him the insulin entirely is even bigger threat to Joe's life. Not just that but now you have insulin smugglers who are even bigger threat as they are totally off the legal scrutiny.

But American Diabetic Association can do a better job of importing insulin from world over at cheaper prices and distributing it to their members while ensuring reasonable quality. Unlike FDA, ADA can actually work with insurance companies to compensate the victims if things go wrong.

You Goodwin'd yourself in the first line, killer.

The Nazis have nothing to do with this, it's bog-standard regulatory capture, which is a thing everywhere but extremely prevalent in the US.

Take a look at the F500 (or F50) list and see how many large insurance and healthcare companies are on there. None of them are Nazis; most of those companies have straight-up woke policies. But they lobby hard, and that's why the model is broken.

The international pharmaceutical trade market is already under fire with contamination and fraud issues as it is. 300.000 to 1 million people are estimated to die each year from that per the WHO [1] - that's frankly insane, and it's not just fake penis enlargement pills that people buy on random spam platforms, but the fraudsters even manage to penetrate into the legitimate supply chain of German pharmacies.

The solution is obvious: more domestic production, and for the US to get their shit together. You don't need to throw pills for every little cough, the fact that y'all have ads for prescription medicine is completely mind-blowing. Like, I go to the doctor with symptoms, not with a shopping list of stuff shilled in yesterday's cable news.

[1] https://www.tagesschau.de/inland/securpharm-101.html

Anytime the topic of the FDA/customs seizing pharma drugs imported by Americans comes up, big pharma and confused citizens conflate the amount of counterfeit branded drugs with actually dangerous drugs. No one is fighting for the right to be able to buy fake Cialis. They are fighting for the right to buy generic Tadalafil manufactured by billion-dollar Indian companies trusted by over a billion people with the proper FDA certifications in India. Those who mislabel their brand should still be prosecuted. That's barely relevant. Yes, we take too many drugs. But we also don't take enough, because we can't afford it, because we're all being squeezed by big pharma. (You're also conflating the Americans who have decent health insurance with those who don't.) And almost no health insurance covers dick pills and no adult should have to explain to a stranger that their dick doesn't work to get their permission to take a super safe drug with a few clearly-described risks. (The truth is, half the online pharma business is literally just dick pills. Half.)

I've been interested in this topic for 15+ years. The good news is, despite what this article may lead a casual reader to believe, 99% of the DEA-uncontrolled medications imported are not seized. You can order them safely, and if they are seized, they shipper will probably send them again for free, and you won't have any legal issues.

>They are fighting for the right to buy generic Tadalafil manufactured by billion-dollar Indian companies trusted by over a billion people with the proper FDA certifications in India.

The revenue of a pharma manufacturer is not necessarily an indicator of quality. Many international pharma firms of supposed good repute have repeatedly been found to be committing egregious levels of good manufacturing practice (GMP) violations, and even when they have production lines that stand up to FDA audits, parallel production lines in the same firm that aren't subject to FDA scrutiny (as they produce for non-US markets) often are churning out very suspicious products for local / developing world consumption. And even US-based production lines can be churning out product with potential defect for quite some time during gaps between FDA audits - it happens all the time.

A really eye opening read on the global pharma quality situation: https://www.nytimes.com/2019/05/13/books/review/bottle-of-li...

Anther problem is that most drugs you buy in the US with extremely inflated prices are produced overseas within those facilities.

I understand where you’re coming from because our medical system IS lazy and DOES overprescribe, but the knee-jerky “pills bad” thing is frustrating for those of us who are necessarily on a lot of medications.

This cultural phenomenon has roots so deep that I’ve had actual medical professionals (usually nurses) tell me that I’m on too many pills. On a few occasions I’ve invited them to tell me which ones I should get rid of and, of course, they don’t know because all of the medications are currently doing something important.

It’s an attitude that mystifies me. Pharmaceuticals have side effects, do people think I want to take this stuff?

I'm referring to antibiotics prescriptions for clear-as-day viral infections (~~strep~~, influenza, covid). That shit is one of the largest contributors to multi- or omniresistant superbugs, right behind the even worse practice of using human reserve antibiotics routinely in industrial farming.

Your post is almost correct but strep is Streptococcus Pyogenes, it is a gram positive bacteria and it is usually treated with PenVK.

Actually, that's hard to say. Many people don't completely take the antibiotics prescribed to them. They don't take them when they are supposed to and take them for a few days or less than the total time they are supposed to. The bug can then become resistant to the antibiotic, so they have to switch to something else. Problem is, there are only so many types of antibiotics, which may or may not work on that specific bug. This foolishness leads to resistant superbugs as well.

https://www.bmj.com/content/358/bmj.j3418

Oh, I'm with you on this one. Antibiotics and opioids are special categories when it comes to overprescription.

On the bright side, I think in recent years American doctors have been much better about waiting until an infection is likely to be bacterial before prescribing antibiotics. There's probably still room to improve but at least it feels like we're working on that.

The farming thing, though, is a huge problem and an international embarrassment.

I get strep every 2-3 years and go through 4-5 days of misery before paying to see a doctor, paying >$50 for a strep test, waiting another day for that to come back, just so I can finally get antibiotics from which I'm feeling much better (not "well", but much better) in under 8 hours.

The system sucks and strep is a bacterial infection. And big ag will hire whatever vet that says their cows need more antibiotics so it's not like my super expensive human system is really impacting the rate of superbugs.

Superbugs are a general class. Each disease evolves its own resistance (though, it does get around - https://academic.oup.com/cid/article/34/Supplement_3/S78/292... ). You are creating antibiotic resistant strep in your own body. At some point, the antibiotics won't be able to knock it down to the asymptomatic form.

Antibiotic resistance isn't a joke. Take the full course.

How on earth am I creating antibiotic resistant strep in my own body? I do take the full proscribed course of antibiotics. I don't see what that has to do with having to spend at least $150 (consultation + lab test) just to get permission to get the antibiotics I need, which then cost additional money. While big ag gets whatever antibiotics they want.

Thank heavens I work in tech and $150 isn't like a whole month's worth of groceries to me. But there's no way to look at this and think "Yup, that's the system working as intended."

how would they possibly know what the full course length is for each bug. I've always gotten the same length and dose, how is that the prefect length and dose when the doctor doesn't even know that exact bug that i have.

https://www.bmj.com/content/358/bmj.j3418

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