Healthy Skepticism Library item: 17385

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Publication type: news

Friscolanti M
Discount Drugs of Canada in Florida: 'Unlicensed pharmacies' spring up in Sunshine State
National Post 2002 Dec 20

Full text:

Medical officials are concerned about a series of new Florida-based stores that have helped thousands of Americans order prescription drugs from Canada without ever visiting a doctor north of the border.

Over the past few months, a handful of tiny shops has surfaced in the Sunshine State, allowing patients to by-pass local pharmacies and order their medication from outlets in Canada, where regulated drug prices and a low dollar can translate into significant savings.

But while the stores have won over countless customers tired of being overcharged for prescription drugs, they have also sparked worry within the Canadian medical sector.

At each store, customers are required to provide a prescription from a U.S. doctor, fill out a confidential medical questionnaire, and read and sign a power of attorney agreement. That information is forwarded to a partner pharmacy in Canada, where staff doctors review the information and co-sign the prescription.

Without final approval from the Canadian doctor, the prescription cannot be filled.

That process, however, contravenes rules that prohibit doctors from prescribing drugs without examining the patient in person.

“This is, to us, tantamount to unprofessional conduct,” said Dr. Bob Burns, the registrar of the College of Physicians and Surgeons of Alberta. “Prescribing is part of a continuum. It’s not part of an isolated act.”

In recent years, as a growing number of Web sites began to peddle cheap Canadian drugs to U.S. buyers, each provincial college that regulates doctors instituted policy aimed at deterring physicians from co-signing prescriptions. Not only does the practice put the patient at risk, officials argued, but a doctor may be held accountable if the customer is harmed by the prescription.

Now that patients can order the drugs from their local mini-mall, officials feel compelled to reiterate that warning.

“If you co-sign a prescription, it implies a doctor/patient relationship,” said Barb Wilson, a spokeswoman for the Canadian Medical Protective Association, an organization that represents 95% of Canada’s physicians and maintains a $2-billion fund to defend doctors being sued. “If there’s an adverse reaction, you could be liable.”

Doctors who arbitrarily sign prescriptions can also be punished — to the point of being stripped of their licence — but finding potential perpetrators has proved difficult.

One of the new Florida stores, Discount Drugs of Canada, has a partnership with Winnipeg-based CanAmerica Drugs, itself a discount on-line pharmacy. But while the president of Discount Drugs said CanAmerica’s doctors fill out prescriptions without ever seeing the patients, none of those doctors has ever been punished.

Dr. William Pope, the registrar of the College of Physicians and Surgeons of Manitoba, said he has never received a formal complaint about any doctors, but if he did, jurisdictional issues could thwart an investigation.

For example, if doctors from CanAmerica were working out of British Columbia, privacy laws would prohibit authorities in Manitoba from providing their counterparts in B.C. with the necessary patient information to prove the accusations.

“Some of the individuals who are co-signing think that they can do it because they have licences in more than province,” Dr. Pope said. “I would immediately refer those individuals to my complaints investigations department, if I were provided names of those people.”

CanAmerica representatives did not return phone calls yesterday, but Earle Turow, the owner of Discount Drugs, said he has yet to hear any complaints. His store, which opened in October, is serving 300 customers every day. It is so busy that he has four people working overnight just to process paperwork.

Mr. Turow, whose profits come from a commission paid by the Canadian pharmacies, said although the patients are not examined by the doctors who ultimately approve their prescriptions, their medical records are thoroughly reviewed. Customers also sign a limited power of attorney, which he said “protects everybody from lawsuits.”

The end result, he said, is a safe system that saves people — especially the elderly, who are often on fixed incomes — thousands of dollars a year. At a traditional pharmacy, for example, a person could pay up to US$350 for the breast cancer drug Tamoxifen. Mr. Turow’s customers pay one-tenth of that price.

“The doctors are now recommending Canada to their patients,” Mr. Turow said. “It’s a major shift.”

Apart from the medical community in Canada, the discount stores are also being closely watched by U.S. law enforcement officials.

Edwin Bayo, a senior assistant attorney in the Florida Attorney-General’s office, said the stores are operating as unlicensed pharmacies, despite the owners’ contention they are simply acting as middle men.

However, officials are hesitant to shut the stores down, partially because all of the drugs being imported have been approved by the U.S. Food and Drug Administration.