Healthy Skepticism Library item: 6353

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Publication type: news

Bruser D.
Net pharmacy closing amid conflict questions
The Toronto Star 2006 Oct 28
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1161985810163&call_pageid=968332188492

Full text:

Net pharmacy closing amid conflict questions
PharmaDirect cites shift in strategy

J&J’s indirect control raises eyebrows
Oct. 28, 2006. 03:34 PM
DAVID BRUSER
STAFF REPORTER

An online drugstore owned by a major U.S. drug maker and run by a prominent Waterloo pharmacist is suddenly shutting down Monday amid questions about a possible conflict of interest.

The move comes after the Toronto Star started asking questions about the unusual arrangement that had industry observers worried.

PharmaDirect.ca is indirectly owned by New Jersey-based Johnson & Johnson and managed by pharmacist Phil Hudson – an unusual arrangement between drug maker and drug dispenser that has raised concerns about whether the traditional independence of pharmacists is being undermined by corporate interests.

Unlike typical pharmacies that sell drugs made by numerous manufacturers, PharmaDirect.ca sells to Canadians only over-the-counter drugs made by Johnson & Johnson.

Critics fear that this kind of exclusive relationship can result in consumers paying higher prices or not getting unbiased advice on the most effective drug for their needs.

“Due to changing strategic focus from the company’s perspective the online pharmacy will be closed as of Oct. 30,” said J & J spokesperson Lan Lai-Minh.

Industry experts have been raising ethical concerns about the unorthodox Internet drugstore in interviews with the Star in recent days.

“I haven’t heard of this kind of thing before. How do you know whose interest they’re putting first?” said Joel Lexchin, an emergency room doctor in Toronto, York University professor and a long-time pharmaceutical industry researcher.

“They could be seen as furthering the interests of their employer indirectly, Johnson & Johnson, and not the patients. Whether or not they are is irrelevant because there’s the perception of a conflict of interest. That can take away the confidence that people should have in their pharmacists.”

The Ontario College of Pharmacists, the province’s regulatory body, would not talk to the Star about the online business managed by Hudson.

Hudson says he was president of the college in the mid 1990s and currently sits on one of its committees. Hudson also teaches at the University of Toronto.

Both Johnson & Johnson and Hudson had said before the shutdown announcement that they’re doing nothing wrong, noting the pharmacy is fully accredited by the Ontario College of Pharmacists and operates as any independent pharmacy should.

“Nothing has ever arisen to make me question that the public interest was not being put first,” Hudson has said. “As a pharmacist, that would be one of my first interests.

“At all times the primary role of the pharmacist is to have the public interest at heart. That should always be placed above self-interest.”

Johnson & Johnson’s ownership of PharmaDirect is not illegal. Ontario law says no corporation can own a pharmacy unless the majority of its directors are pharmacists. At PharmaDirect, two of the three directors are pharmacists who work at a Johnson & Johnson subsidiary, McNeil Consumer Healthcare in Guelph.

“This is troubling to me because I want to see independent advice,” said Eleanor Friedland of the Consumers Council of Canada. “This does not look transparent.”

Friedland said she’d rather buy from her pharmacist “across the street,” who tells her whether there is a cheaper equivalent.

So, why not clearly label the website as a Johnson & Johnson enterprise?

“Johnson & Johnson is, firstly, not a Canadian company and the other thing is, it’s to be able to provide the people a pharmacy or a name that makes sense,” said J & J’s Lai-Minh.

“There’s no smoke and mirrors here. I don’t think that knowing that Johnson & Johnson owns PharmaDirect – (and) we’re not trying to hide that – is a detriment to consumers. I don’t think that there’s anything there that would cause a consumer to wonder.”

While the site encourages consumers to call “our pharmacist” with questions, the number takes the consumer to a call centre in Guelph subcontracted by Johnson & Johnson.

A reporter posing as a potential buyer with a history of chronic headaches and with questions about possible side effects of using Imodium – a product available on PharmaDirect – reached an operator who consulted a medical textbook to advise on “contra-indications.” The operator said “Pharmacist Phil,” as he is identified on the PharmaDirect site, was not available at this number and that the consumer should consult his own health care professional.

At the Ontario Pharmacists’ Association, where Hudson is a member, CEO Marc Kealey is troubled.

“If you’re telling me that there’s something missing, that is the proverbial counter (and) the access to reliable and expert information, that is unacceptable,” Kealey said.

“What we strive to maintain is that you as a consumer will have access to that reliable and expert information from a pharmacist.”

PharmaDirect appears to violate two of the college’s guidelines on online pharmacy operations, which state that consumers should:

Avoid websites where the pharmacist cannot be directly identified, contacted or verified.

Avoid websites that … can only be reached through a phone number that is answered by a customer service representative.

Johnson & Johnson says that the site, created six years ago, was designed to do two things: capitalize on the growing Web economy and consumers’ increasing willingness and desire to buy online; and to provide a more private marketplace for products that consumers might not choose to buy in the more public setting of a bricks-and-mortar pharmacy.

They include so-called schedule III over-the-counter products – such as Monistat for yeast infections and Rogaine for hair loss – that cannot be sold in a corner store. Schedule III products are available in the regular consumer aisles of pharmacies but must be sold near the pharmacist’s counter so consumers with questions can get answers. Hudson, who runs another pharmacy in Waterloo called Beechwood Wellness Centre, said his experience means he understands how to properly operate a pharmacy.

When told the Star could not reach him through the call centre, Hudson said, “I can be contacted by email. I answer probably 20-odd emails a week.”

Email isn’t good enough for Kealey, of the pharmacists’ association.

“In most cases, people want telephonic information at the very (minimum).

Health care is all about communication..”