Thank you all for taking the time to attend
this webinar Just a few housekeeping things before we do
get started Everyone will remain on mute for the duration
of the presentation But there is a chat bar in your control panel
so feel free to chat in questions during and at the end of the presentation
and our presenter will answer questions at the end of the webinar
and just a quick little introduction about the webinar
today�s webinar is buying medications online how to do it safely and affordably.
We have Shabbir Safder, who is the director of National Outreach for
the Partnerships for Safe Medicine. The Partnership for Safe Medicines is group
of not for profit organizations and individuals that have policies, procedures, or programs
to protect consumers from counterfeit or contraband medicines
I am Elizabeth Messenger, I am the Director of Outreach at Needy Meds
And this one of our Needy Meds special topic webinars
So before I pass it over we are just going to do a quick poll just to get things started
We are going to launch that poll right now. The question is: do you know someone or
have yourself ordered from an online pharmacy that stated it was not in the United States?
Select one of the following if you want to start answering that question.
We will just wait a second. Ok, another minute. Ok, so it looks like we are pretty split.
About 48% yes, and 52% no. At this time I am going pass it over to Shabbir, if you want
to give an introduction and start your presentation. Good afternoon or good morning, if you are
on the west coast like myself. My name is Shabbir Imber Safder and I am the
Director of National Outreach for the Partnership for Safe medicines of which we are proud to
count Needy Meds as one of our members and so who we are is a not for profit organization
incorporated in Virginia, that works primarily on patient safety issues around counterfeit
drugs, although we do do a lot of outreach to health care professionals and if you want
to know more about that, we can talk outside the scope of this conversation, which is mostly
about patients. Our mandate from our board, which includes
very eminent experts in the pharmacy, law enforcement, and legal fields of counterfeit
drugs is to help educate the public and reduce the problem of counterfeit drugs which is
actually really awful throughout a great deal of the world and getting worse in America
and that is mostly because of globalization and the porous nature of borders.
The poll question is actually very a propos There are in fact a lot of people who have
encountered counterfeit drugs and bares a moment to think about how it is that Americans
are protected. In particular, one of the most clear ways
that we are protected, in fact the only way that we are protected is because we have a
regulated closed secure supply chain Everybody from the person who manufactures
the drug to the person who actually hands it to you and the last step before you take
it, is regulated within the US Most of them by the FDA but in some cases
they are regulated at the State level So pharmacists and wholesalers are often actually
regulated at the state level And that is part of the challenge that we�ve
seen in Massachusetts with compounding regulations and throughout the states.
Other ways in which folks are regulated include the fact that the FDA does extensive testing
of medications The fact that there are pharmacovigilance
programs, if you actually have adverse reaction from a drug, what happens is you can make
an adverse event report to the FDA and they actually collect those
and additionally, when you are taking a drug there is a physician or pharmacists or both
involved in the supervision of medication choices and the dosing and the protocol and
we will see, we have had a couple of cases, one just in the last week, where people who
were actually operating through an online pharmacy who did not have physician or pharmacists
supervision actually managed to o.d. themselves on drugs they should not have been taken.
The most important thing about this is that patients are protected basically because of
the regulation and the closed supply chain which is not true in many other countries.
Any break in that supply chain exposes patients to dangers, as I�ll demonstrate.
So the most common way in which patients are in danger are the patients who actually break
the supply chain themselves. They will go online and they will buy from a pharmacy that
says they are in Canada when they in fact they usually aren�t. Or they will buy off-line
from a non-pharmacy and we�ve seen a couple incidences of those recently. We saw in the
south part of the US, in Texas there were fake antibiotics being sold in basically bodegas,
not pharmacies they were targeted at the Spanish speaking market. Their printing and writing
was all in Spanish and they were not in fact antibiotics and the problem was discovered
in Texas when parents started bringing children into emergency rooms with infections that
had run all over their bodies and so it is possible to have both offline and online breaks,
a little less common but unfortunately becoming more common. As we are seeing physicians who
are administer drugs in the office like osteoporosis drugs or oncology drugs actually buying from
unlicensed distributors, and then getting fake medication or adulterated medication.
There were a couple of incidences of pharmacists doing that, in running their own online pharmacies
within the US which is sort of terrifying they are in fact putting their pharmacy license
at risk and then uncommonly although it does happen, we�ve seen specific incidents in
the supply chain, you all remember the Heparin problem of many years ago and that is where
an active pharmaceutical ingredient producer managed to get a fake drug into the manufacturing
supply chain and that made its way to patients, so those are the different ways in which these
problems happen. One quick poll just to keep you all active
�Can a Canadian pharmacist fill a prescription written by a US physician?� Please select
yes or no, if you want to begin answering that.
This is a very common question that you see because there are so many websites claiming
to be Canadian pharmacies and of course they are really aren�t they are neither Canadian
nor pharmacies. They have no pharmacy license, even in Canada,
but one of the popular questions people say is well you know, it is just like driving
over the border, but the fact is, I guess we will see from the poll results whether
or not a Canadian pharmacist can fill prescriptions. Looks like 44% think yes, 56% think no. The
answer is no. Legally, the answer is no.
It is also no in the Uk and many of the other what we call first world nations, they are
not allowed to fill prescriptions written by foreign doctors who are not licensed to
practice in that country. So if you go online to a quote Canadian pharmacy
and they ask you for your prescription from your US doctor they are not actually, they
don�t really care, they don�t really need it, because they are already breaking the
law, they cannot actually fill that prescription. So here is an example here of buying meds
online. There is a weight loss drug called Alli, that
was counterfeited several years ago and instead of containing the actual product, it contained
sibutramine which is a prescription only ingredient. And it has some, it�s very active ingredient
so you need to be supervised by a doctor to take it, and I think actually it has already
been taken off the market. And so what this person did was he made large
quantities of this fake medication, printed fake boxes, and then sold them both wholesale
and retail. He sold them wholesale to lots of people who
then started selling them to places like Amazon, stores, on Ebay, on their own fake pharmacies
and he himself, with a partner actually had a fake online pharmacy.
They had many names, Two Day Diet Shopping. So people would buy this and in some cases
they had lots and lots of horrible side effects because the active ingredient there does not
go well with people who have the conditions that you should not be taken them for.
And there is at least one person that had a pretty severe stroke and he was an emergency
room physician. So you think he would know better but people
make one tiny bad judgment, they end up paying a very serious price.
And the folks in this case were actually convicted in 2011.
The overall population out there of online pharmacy websites is huge and the National
Association of Boards of Pharmacy does an annual review of those websites and consistently
finds that 96% of those sites are out of compliance. They are either not in possession of any pharmacy
license or they pretend to be in a country they are not.
It is very simple to put up a website and the Philippines that says that you are a Canadian
pharmacy. It is very hard for a consumer to tell the
difference. Many of them actually don�t require a valid
prescription. For example, something that says it�s a
Canadian pharmacy that accepts a US doctor prescription is not requiring a valid prescription
and some of them just have absolutely no basis for safety whatsoever, no pharmacy license,
no licensed pharmacists, or they sell controlled substances, or they don�t actually have
secure connections to protect your credit card.
When you get right down to it there is only about 3 or 4% of all the websites out there
that are actually licensed and legitimate and safe for US consumers and there is a way
to see them but it is not obvious. If you just randomly Google Canadian pharmacy
or online pharmacy you are going to get one of these bad ones.
Now even when you actually get the drug that you order it is still quite dangerous and
when actually saw a death in the Uk just this week.
This is actually from about a year and a half ago where Lorna Lambden was an EMT in the
UK. She was presumably trained on how to read
a Physician�s Desk Reference and she unfortunately went online and bought a sleeping aid and
got what appears to be the real thing but it was an aid that was very sensitive to dosing
and was not recommended to be taken with alcohol or with people with a potential heart arrhythmia
and she sat down with a glass of wine after a long shift and took the medication that
she received which did not have safety warnings or any pharmacists or physician oversight
because it came from an online pharmacy. And she went into a coma and died and so she
is a good example, it�s not just about whether or not the drug is the right thing but it�s
whether or not you are under the care of a supervising physician.
When people order from these online pharmacies they are often not talking to their doctor
about what they are getting first. There is also a lot of really, really scary,
bad people out there who are selling things that should never be sold without the supervision
of a physician. We have seen, and this is an infograph that
we did last year, that there are people out there selling targeting to teens birth control
devices including IUD�s and other kinds of implants and then publishing You Tube videos
about how to insert them. The danger there is quite serious, obviously
infection and death is far worse than even just the unintended pregnancy and they are
all over social media working very, very hard to target people in every communications vehicle
possible. If anybody knows anything about the internet,
it is not possible to regulate them very effectively from within the US.
So those are patient breaks in the supply chain there is also a number of physician
breaks. In the last two years the FDA has discovered
and pursued a fake cancer drug that found its way into the US.
What happened was someone in Turkey made a fake version of Avastin which is an anti-cancer
injectable often administered within a clinic setting within a doctor�s office and that
was sold and resale a number of times to obscure its true origin.
Until it ended up in the UK a country that many doctors feel safe ordering from
In that case, even then some of the doctors were not lead to believe that the drug was
not coming from the UK, so various shell companies in the US would fax doctors saying I can sell
you Avastin for $400 or less per dose then it is normally listed at and a number of doctors
did business with these entities and when those drugs arrived from the UK directly they
were puzzled by the fact that they had writing in Arabic on it instead of what you would
expect from a drug approved for the US market by the FDA and is not known how much of that
drug ended up in patients. But they did in fact seize the material and
the FDA did test it and it didn�t have any of the active ingredient in it
and we�ve seen this with cancer drugs, osteoporosis drugs, and with Botox with sometimes terrifying
consequences. You can see up there some photos of a woman
who was given counterfeit Botox and you can see below that the examples of Avastin that
had been seized by the FDA. This is becoming a big issue; doctors are
not well trained in secure supply chain issues. So they are starting to make these mistakes,
sometimes unintentionally and sometimes purposefully. The fake cancer medication came through a
crazy supply chain in order to obscure its true entity being sold and resold from Turkey
through Switzerland, Denmark, the UK, and then it enters a series of shell companies
controlled by Canadadrugs.com and sold to American physicians by companies that were
within the US but actually were non-licensed distributors of the product.
Finally, we are starting to see a couple of pharmacists who are breaking the supply chain
themselves to make money. We saw Chicago pharmacists just this month
who was substituting real drugs from an online pharmacy with fake Chinese counterfeits.
We saw a chain in New York that last year had stolen or basically bought from patients
medications and then resold them. Back in 2005, one of the worst ones was counterfeit
heart medication that a Canadian pharmacist was basically having made which contained
just talcum powder and then selling to patients and there were many deaths from that entirely
avoidable, preventable deaths. We often see people talk about the safety
of the UK and so think that must be a safe country to import from.
It turns out actually that the fifth most likely country in which you will find counterfeit
drugs is the UK. Reports came out this month. It is partially
because the MHRA, which is their version of the FDA, is so aggressive about finding them
but those borders are very porous and so they are finding because of their part of the EU
and not everybody in the EU has great governance and regulatory authority over there pharmaceutical
industry that there are drugs entering the UK through their porous borders through parallel
trade that are then finding their way into the supply chain and it is terrifying.
So there is a couple of myths and what I want to do today is help you both learn how to
talk to your patient communities about the myths of buying online but then quickly follow
up with safe ways to save money online because that�s really you can�t just say don�t
do this without also saying here�s how you do it better.
So I want to give you both. So let�s go through a couple of myths first.
First of all, Canadian online pharmacies are pharmacies in Canada with a website and that
it is not true. Most of you actually drive into Canada and go to a Brick-and-Mortar pharmacy.
Overwhelming amounts of research and data from the National Association of Boards of
Pharmacy finds that these are in fact not pharmacies.
What they are is someone who set up a website in Canada and typically the business model
is they are a shipping company and therefore they cannot be regulated by either the pharmacy
boards or Health Canada. In fact, they don�t even take possession
of the drugs. When you go to their website, and you maybe
fax them or scan a prescription for something they actually send it on to a partner in another
country maybe Pakistan, maybe China, maybe the UK, and that entity then sends you the
drugs directly. The drugs never even enter Canada and they
do this because the Canadian government knew that there were these shipping companies that
were operating out of Canada and they told them if they brought the drugs in they would
try to find a way to regulate them. They just worked around it. It is not the
same. Driving into Canada is not the same as going to a Canadian pharmacy.
The FDA has done a lot of research in this and found that there is a number of people
who practice this way and they have tried to prosecute as many as possible.
Those Canadian pharmacies or pretend pharmacies look very realistic online and heavily work
social media in order to try and hook their audience.
Just recently a gentleman who was one of the pioneers of the Canadian online pharmacy movement
who you can see in that picture holding stacks of orders was actually finally caught and
his pharmacy that the FDA prosecuted was selling really, really important chronic medications
that were fake, Lipitor, etc. etc, Celebrex, Crestor.
All of these medicines and he would claim were Canadian medicines but they were fakes
from all over the world and he was giving them to American patients who were paying
for them. Both the US, the FDA and Heath Canada have
been very clear that they cannot control what get sold on websites within their country
so we have to be very, very careful. Furthermore if you get medication from outside
the country that is not FDA approved you have neither a legal recourse nor do you have any
ability to even have the FDA trace where that came from.
Another thing about it is that, another myth is that Canadian prices are cheaper.
This is actually something that has come up in Maine which has been proposing an importation
bill in the legislature to bring in drugs from overseas to try and save money.
The truth is that when we actually look at the top ten drugs that they were going to
bring into the country in many cases there was a generic in the US that was cheaper and
what the Canadian price was and it was not in fact a Canadian price because CanaRx a
company that worked here admitted that those drugs were actually going to come from New
Zealand, Australia, the UK, and other places. So quite often the claim that Canadian medications
are cheaper is false for two reasons one of which is that those are not Canadian medications
that you�re getting but also that you can actually get a generic product cheaper.
I mentioned this before but Canadian pharmacists cannot legally fill American prescriptions
so any Canadian pharmacy that says that they can fill an American doctor�s written prescription
really is not using the prescription for anything. If a real Canadian pharmacist actually wanted
to fill that prescription they would be endangering their pharmacy license which as we all know
takes years to get and lots of school and probably student loans.
Another popular myth is that you can actually bill insurance back for important drugs and
we�ve seen actually a number of physicians get prosecuted by the FDA for billing Medicare
back for important drugs. It is illegal to do that and while they probably
won�t prosecute individual patients they certainly are prosecuting medical practices
and physicians. So where do you think pharmacies get there
medications? They get them from all over the world.
It is remarkably easy to make medication, to make realistic looking pills.
The folks at Phizer who are actually very aggressive busting fake labs around the world
sent us these photos. The one on the left is a lab in which they
were making Lipitor, which is what they found in that bucket.
On the right they were just doing some common unsterile sterilization of bottles that they
were then going to put an antibiotic in. They had all sorts of labels on them, they
were presumably going to peel them off and put a new set on.
There are very, very few security features that you can you to try and spot a fake drug.
Here are a couple of examples You can see on the left and the right, authentic
and fake Lipitor. They look virtually identical.
Another number of examples you can see on the right are the approved versus the counterfeit
medications. These things are too good of fake for even
a pharmacist to look at them and tell the difference.
They have to go to a lab and quite often when they find them in the lab and they actually
find the fakes, the fakes actually contain a trace amount of the real active pharmaceutical
ingredients. So what they will do is take a batch of Lipitor,
for example, and grind it up and then make three batches from it.
There is a great profit margin in that and you can do sort of superficial testing and
find that it contains the active ingredient but if you actually dig down it doesn�t
contain enough of the actual ingredient to help you.
We�ve seen this with lots and lots of drugs there is probably no drug that has not had
a counterfeit incidence. We just saw some Adderall, some fake Vicodin,
there is just a ton of fake tablets out there, that are indistinguishable from the real thing.
Complete with bubble packs, bubble packs are the easiest thing that they seem to fake.
So once you�ve go someone�s attention and you�ve got a patient who understands
that is a dangerous thing to do, to order from an online pharmacy how do you tell them
to save money because they are not doing it because they want to endanger themselves.
Patients are going to order from these pharmacies because they want to save money.
So there is a couple ways to do it If the patient is in the doctor�s office,
which is not a perfectly safe space because of the stories I�ve told you, patients can
ask to see the delivery vials. Quite often these things especially for injectables
are delivered in bottles that may even be one needed of use but either way they are
going to have a lot number on it. In the Avastin case, the products actually
had writing in Arabic, which you will never see for an FDA approved drug and so you can
take your camera phone and take a picture of it, take a look at the lot number, record
that, if it is a bottle, bag, or some other unit and see if you can keep a record of it.
You can trace the lot number. That is how many counterfeits are found.
You can also simply pay attention to the effects of the drug.
In the case of the weight loss drug, Alli, I actually spoke to a woman in southern California
who bought a dose on Ebay and noticed that she was having some very, very odd side effects.
She stopped taking it and then went to her normal pharmacy, she usually goes to Costco,
and bought a new batch and then compared the two.
She said once I actually had what I knew was probably real side by side with the fake I
could tell immediately. So looking for therapeutic failure while it�s
very hard to spot is another good way of spotting a counterfeit. ad keeping yourself safe.
And frankly, if you are having therapeutic failure or having weird side effects you are
going to want to talk to your doctor anyway. Another way in which you are all familiar
with of course is to work with Needy Meds, they are one of the best, most up to date
databases of discounts for medications around. We love them as a member.
Another thing to do is shop around online. There are web pharmacies that have been reviewed
to ensure that they have American pharmacy licenses and that they have been inspected
and the National Association of Boards of Pharmacy does that and those 3 or 4% that
are safe those are safe to purchase from so they carry a special program called the VIPP
Seal, for Verified Internet Pharmacy Practice that you can use to tell people to look for
when trying to figure out a safe pharmacy. So we just did this last year, my wife actually
does take Advair and so I asked her to look at a number of asthma drugs online and then
look at the price difference and you can see by looking at these different places that
the price difference was significant. So over a year if you�re taking that Advair
diskus 150, depending on where you bought it, you could save $1300 when you�re dosing
for a year. So you can still get the savings of comparison
shopping online without actually endangering yourself by only picking pharmacies with the
VIPP seal. I mentioned this before but in many cases
you can find a cheaper generic in the US from a real pharmacy like a VIPPs pharmacy then
if you try and buy the brand name from a fake web pharmacy because they are going to try
and charge what the brand name product is costing.
So there is a number of resources on our website which you are welcome to take advantage of
and download for free. There is a brochure that covers these tips,
�Save Money Safe on Your Prescriptions� There is also an interactive flash piece about
the five kinds of poisons in fake medications. There are five secrets Canadian pharmacists
don�t want you to know which cover those five myths and a then couple of other ones
safe drug and safe savings that cover exactly different ways of advice.
And then we have a special report on children and fake drugs and then finally we can take
questions and answers. I just want to mention we do do a number of
patient group specific outreach programs. We partner with our members, Select Men�s
Health Network, and we�ll do a special report for example on counterfeits and men�s health.
So if you are interested in working with us on that we would invite you to join PSM our
dues a very low, $100 a year, and we would love to craft a program to work with your
specific patient community and probably pay for it. We would be very, very happy to work
together. Now, Elizabeth, I would be happy to do questions.
Great, thank you so much. A few basic things, we will have you will get an email with a
link to a place where you can download the Powerpoint and this webinar was recorded so
we will have that up on our website probably within a week or so, so you can check back
on our website or our You Tube page for the video.
So if you do want to start typing questions we do a few.
There is a question about if you are traveling abroad and you need a prescription can you
call your US doctor for a temporary refill. How does that work?
That is a really good question. You�ve got two problems there, the one of
which is that you have to find a valid prescription and the second of which is that you have to
find a place that is a valid pharmacy. And yes I believe that your doctor would be
happy to write you a temporary prescription for a refill if your doctor doesn�t dislike
you for some reason. The harder question is to figure out what
is valid pharmacy. Usually I recommend that for people who are traveling to try and go
to a hospital to fill a prescription because they are going to be the most likely to be
the best regulated in a country in which you are not sure if everybody who is selling medication
is properly regulated. In India for example I would never buy a prescription
anywhere but accept a hospital even then I would be a little bit careful about what I
got because the counterfeit problem is very significant in India and in China.
But the best regulated place you are going to find is going to be the most careful about
what they dispense is going to be in a hospital. Thank you.
There was a question about whether you are breaking the law if you buy legal drugs outside
the country. Yes, in most places you are breaking.
There is an exception for personal importation of medication from outside the country but
it is not as broad as people think. You cannot for example leave the country and
buy Lipitor and bring it back. It has to be more along the lines of drugs
that are not available in the US and so it is not actually legal to do so.
Now the truth is that the FDA does prosecute individual patients for doing this.
There focus has been on the sellers of this medication or the others that facilitate the
websites or the payment process or the people who process the transactions.
That�s where they have been spending their time but it is not in fact legal for a patient
to just decide to switch all their prescriptions to a web pharmacy outside the country.
This is actually a question about our discount card, if pharmacies can reject them.
There are pharmacies that agree to accept our card and that is all the major chains.
I believe we are up over 70,000. You can go to our website and do a zip code
search to make sure a pharmacy accepts the card and if they do then they do need to accept
it like the company agreed to. I�m reading through about whether any online
pharmacies are safe. Shabbir showed us slides that there are a
few that have been looked at. The question is what prevents counterfeit
online pharmacies from counterfeiting the seal you showed us.
That is a really good question. When you work in the international space and
you realize that not everybody cares about US laws people that do steal programs like
this work on the basis of trademark and copyright. The VIPP seal is trademarked and copyrighted,
but I think it is the trademark that actually works better and they tend to shut these organizations
down through that method. However, a really good way of shopping safely
is to actually go to that website, VIPPs.info where they have the list of all the licensed
VIPPs pharmacies, so you can do your shopping from there.
So when we do our comparison charts, trying to figure out what the price range and differences
of Advair from different online pharmacies. That�s how we do it, we actually go to VIPPs.info
and we pull all the pharmacies and go ahead and surf from here from that list as opposed
to just randomly Googling VIPPs pharmacy and ya you might find someone who has faked the
seal. Thank you.
Another question coming in. The question is: are many of the drugs that
are prescribed in this country actually made in other countries anyway, how safe is the
supply that we get from our own pharmacy? So, instances of counterfeit in the secure
supply chain in licensed pharmacies in the US are very, very rare.
They are rare enough that I would say you are nearly perfectly safe in the sense that
nothing in life is ever perfectly safe. If you are going to encounter a counterfeit
drug in your life it is not going to be from a registered and licensed pharmacy.
Many of the products that we take and use everyday are made in other countries and that
includes pharmaceuticals. However, the manufacturers of those pharmaceuticals
are inspected by the FDA. The frequency in which they are inspected
is a popular topic of debate amongst policy makers and Congress but if you are a major
manufacturer and you�ve got a factory lets say in China, that factory has to be inspected
by the FDA and it is under regulatory authority by the FDA so whether or not it is in the
US they are in fact regulated by the FDA and inspected by them.
Those are actually very comfortable, you could have right next to it another factory that
it is not regulated by the FDA and I would not want anything made in that factory.
There is a question about whether the sequester will effect pharmacies, medications, anything
that relates to this webinar today. Oh God, I hope not. To the extent that the
sequester seems to effect like 10% of all spending it is presumed that at some point,
somewhere, someone who has an oversight in regulatory safety burden is going to actually
lose some part of their funding and to that extent inspections will probably take longer
but I don�t specifically know if there is a direct connection between the sequester
and drug safety. I just presume there is because there is a
connection between the sequester in everything. I would think so.
I think we are going to wrap up, so you all for attending this webinar.
Thank you Shabbir for being our presenter today.
Again, you�ll receive an email with a link to download the Powerpoint and the video will
be up on our website hopefully within a week or so.
For any questions about this presentation you see Shabbir�s email address is there
For any questions about Needy Meds or how to access our resources you can email me at
[email protected] but you will also be receiving an email from me so you will
get my contact information. I would also encourage you to visit our webinar
page, it is where we post all of our free webinars that we do, including the regular
webinars, I do going over our resources the next one is on the 30th if you want to learn
a little more about Needy Meds as well as these special topic webinars we do as well
and just as Shabbir mentioned you can always go to our website if you are looking for a
more secure way to find some lower cost medications and discount medications, use the resources
we list, use our discount card, and visit savemedicines.org for questions about shopping
for online pharmacies and everything we covered today.
I hope you all have a great afternoon and thank you again.
Thank you everybody.