Thursday, January 2, 2014

Another opportunity for Maine to live up to its motto.

Adapted and vastly expanded from a comment I posted on :

We need ever more drugs for ever more things, and they keep getting more and more expensive. So what to do?

Well, in a place like Maine, where the motto is "Dirigo," the Latin for "I lead," the solution is as simple as it is bold: just get your drugs from someplace cheaper. 

PBS NewsHour delved this week into the debate over employer health plans that allow prescription drugs to be purchased and supplied from outside the U.S., saving both employees and companies money. Maine employers, patients, and (some) lawmakers appear to line up on one side of the issue, and pharmacies and their lawyers on the other. 

For real, watch the video.

This debate has been going on for at least a decade, and the arguments have essentially not changed.  

Affordability and choice or accountability and safety? Let's get something out of the way right up front: I believe this is a false choice sold to us by entrenched interests who stand to lose money if this becomes widespread practice.

I can remember driving (not walking) by the Auburn Mall in high school and seeing dozens of seniors boarding charter buses for Montreal (I assumed) to go buy cheap prescription drugs. A few weeks later, an ad came on TV doing a whole bunch of scaremongering about the possibly shady origins of "Canadian" medication. "What if it's out of date? What if it really came from, like, Mexico? Or worse, INDONESIA?! It's unsafe!"

Even back then, I thought "man, this would be a lot more convincing if it weren't paid for by the Maine Pharmaceuticals Commerce and Profit Association or whatever." I had never seen a more classic "fox guarding the henhouse" situation in all my 16 years.  Now, I'm straight incensed by the ability of moneyed, establishment interests to make the argument that this is all about safety while ignoring the $1,000,000 elephant in the room.

The legal and policy aspect of the argument is new to me, though, and now the pharmaceutical industry is going so far as to take action against Maine lawmakers who are attempting to make international medication purchases legal (and thus, one would presume, regulated) because that's out of sync with federal law. 

If safety and legitimacy are the main things dictating who should supply drugs, then it follows that FDA legal authority stems from the need to ensure safety. So why not establish a body, connected to the FDA, that vets international suppliers and makes sure their practices are reasonably up to snuff with U.S. standards and that they source their products from safe manufacturers? The FDA already tracks compliance by overseas manufacturers, so it doesn't seem like too much of a stretch to just make sure suppliers are buying from reputable places.

What it does seem like is that the law simply hasn't caught up to the information age and the decreasing relevancy of national borders to communication. I'm sure there would be some logistical hurdles, but not insurmountable ones, surely? Conducting overseas communication and collaboration is at least as simple and cheap as conducting overseas commerce now, and all four supplying countries (Australia, Canada, New Zealand, and the UK) even speak primarily English, so there's little reason such a program couldn't be made both safe and legal! 

The opponents of the bill are transparently defending the legal status quo as a method of defending their profit margins. I'm a little disappointed that Mr. Karr, the PBS correspondent, didn't press Mr. Murphy or Ms. Arnold, the lawyer and the pharmacist, on the disingenuous way they're espousing concern for Maine patients while failing to acknowledge that their bottom lines are what's ultimately at stake for them here. The only one who did, at least in this video, is Maine state senator Doug Thomas:

"You don't get to take advantage of people.  'I have this drug, this pill, and it will save your life.  
What will you give me for it?' is that the way we do business in the United States?"
Maine: Still the only place where a Republican lawmaker can say something that sounds sensible to a progressive.  That'd be good for a bumper sticker.                        

Here's an idea: find a way to make prescription drugs affordable in the U.S., and if you can't, make them safe internationally. Don't strangle Maine consumers to make sure the situation stays maximally favorable to drug companies and their hired guns.       


...all the cash, all the fame, and social change!