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Comment by mschuster91 | Hacker News Reader

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

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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.

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

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

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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