

Currently released so far... 12404 / 251,287
Browse latest releases
2010/12/01
2010/12/02
2010/12/03
2010/12/04
2010/12/05
2010/12/06
2010/12/07
2010/12/08
2010/12/09
2010/12/10
2010/12/11
2010/12/12
2010/12/13
2010/12/14
2010/12/15
2010/12/16
2010/12/17
2010/12/18
2010/12/19
2010/12/20
2010/12/21
2010/12/22
2010/12/23
2010/12/24
2010/12/25
2010/12/26
2010/12/27
2010/12/28
2010/12/29
2010/12/30
2011/01/01
2011/01/02
2011/01/04
2011/01/05
2011/01/07
2011/01/09
2011/01/10
2011/01/11
2011/01/12
2011/01/13
2011/01/14
2011/01/15
2011/01/16
2011/01/17
2011/01/18
2011/01/19
2011/01/20
2011/01/21
2011/01/22
2011/01/23
2011/01/24
2011/01/25
2011/01/26
2011/01/27
2011/01/28
2011/01/29
2011/01/30
2011/01/31
2011/02/01
2011/02/02
2011/02/03
2011/02/04
2011/02/05
2011/02/06
2011/02/07
2011/02/08
2011/02/09
2011/02/10
2011/02/11
2011/02/12
2011/02/13
2011/02/14
2011/02/15
2011/02/16
2011/02/17
2011/02/18
2011/02/19
2011/02/20
2011/02/21
2011/02/22
2011/02/23
2011/02/24
2011/02/25
2011/02/26
2011/02/27
2011/02/28
2011/03/01
2011/03/02
2011/03/03
2011/03/04
2011/03/05
2011/03/06
2011/03/07
2011/03/08
2011/03/09
2011/03/10
2011/03/11
2011/03/13
2011/03/14
2011/03/15
2011/03/16
2011/03/17
2011/03/18
2011/03/19
2011/03/20
2011/03/21
2011/03/22
2011/03/23
2011/03/24
2011/03/25
2011/03/26
2011/03/27
2011/03/28
2011/03/29
2011/03/30
2011/03/31
2011/04/01
2011/04/02
2011/04/03
2011/04/04
2011/04/05
2011/04/06
2011/04/07
2011/04/08
2011/04/09
2011/04/10
2011/04/11
2011/04/12
2011/04/13
2011/04/14
2011/04/15
2011/04/16
2011/04/17
2011/04/18
2011/04/19
2011/04/20
2011/04/21
2011/04/22
2011/04/23
2011/04/24
2011/04/25
2011/04/26
2011/04/27
2011/04/28
2011/04/29
2011/04/30
Browse by creation date
Browse by origin
Embassy Athens
Embassy Asuncion
Embassy Astana
Embassy Asmara
Embassy Ashgabat
Embassy Apia
Embassy Ankara
Embassy Amman
Embassy Algiers
Embassy Addis Ababa
Embassy Accra
Embassy Abuja
Embassy Abu Dhabi
Embassy Abidjan
Consulate Auckland
Consulate Amsterdam
Consulate Adana
American Institute Taiwan, Taipei
Embassy Bujumbura
Embassy Buenos Aires
Embassy Budapest
Embassy Bucharest
Embassy Brussels
Embassy Bridgetown
Embassy Bratislava
Embassy Brasilia
Embassy Bogota
Embassy Bishkek
Embassy Bern
Embassy Berlin
Embassy Belmopan
Embassy Belgrade
Embassy Beirut
Embassy Beijing
Embassy Banjul
Embassy Bangkok
Embassy Bandar Seri Begawan
Embassy Bamako
Embassy Baku
Embassy Baghdad
Consulate Barcelona
Embassy Copenhagen
Embassy Conakry
Embassy Colombo
Embassy Chisinau
Embassy Caracas
Embassy Canberra
Embassy Cairo
Consulate Curacao
Consulate Ciudad Juarez
Consulate Chennai
Consulate Casablanca
Consulate Cape Town
Consulate Calgary
Embassy Dushanbe
Embassy Dublin
Embassy Doha
Embassy Djibouti
Embassy Dili
Embassy Dhaka
Embassy Dar Es Salaam
Embassy Damascus
Embassy Dakar
Consulate Dubai
Embassy Helsinki
Embassy Harare
Embassy Hanoi
Consulate Ho Chi Minh City
Consulate Hermosillo
Consulate Hamilton
Consulate Hamburg
Consulate Halifax
Embassy Kyiv
Embassy Kuwait
Embassy Kuala Lumpur
Embassy Kinshasa
Embassy Kingston
Embassy Kigali
Embassy Khartoum
Embassy Kathmandu
Embassy Kampala
Embassy Kabul
Consulate Kolkata
Embassy Luxembourg
Embassy Luanda
Embassy London
Embassy Ljubljana
Embassy Lisbon
Embassy Lima
Embassy Lilongwe
Embassy La Paz
Consulate Lahore
Consulate Lagos
Mission USOSCE
Mission USNATO
Mission UNESCO
Embassy Muscat
Embassy Moscow
Embassy Montevideo
Embassy Monrovia
Embassy Minsk
Embassy Mexico
Embassy Mbabane
Embassy Maputo
Embassy Manila
Embassy Manama
Embassy Managua
Embassy Malabo
Embassy Madrid
Consulate Munich
Consulate Mumbai
Consulate Montreal
Consulate Monterrey
Consulate Milan
Consulate Melbourne
Embassy Nicosia
Embassy New Delhi
Embassy Ndjamena
Embassy Nassau
Embassy Nairobi
Consulate Naples
Consulate Naha
Embassy Pristina
Embassy Pretoria
Embassy Prague
Embassy Port Of Spain
Embassy Port Louis
Embassy Port Au Prince
Embassy Phnom Penh
Embassy Paris
Embassy Paramaribo
Embassy Panama
Consulate Peshawar
REO Basrah
Embassy Rome
Embassy Riyadh
Embassy Riga
Embassy Reykjavik
Embassy Rangoon
Embassy Rabat
Consulate Rio De Janeiro
Consulate Recife
Secretary of State
Embassy Suva
Embassy Stockholm
Embassy Sofia
Embassy Skopje
Embassy Singapore
Embassy Seoul
Embassy Sarajevo
Embassy Santo Domingo
Embassy Santiago
Embassy Sanaa
Embassy San Salvador
Embassy San Jose
Consulate Strasbourg
Consulate St Petersburg
Consulate Shenyang
Consulate Shanghai
Consulate Sao Paulo
Embassy Tunis
Embassy Tripoli
Embassy Tokyo
Embassy The Hague
Embassy Tel Aviv
Embassy Tehran
Embassy Tegucigalpa
Embassy Tbilisi
Embassy Tashkent
Embassy Tallinn
Consulate Toronto
Consulate Tijuana
USUN New York
USEU Brussels
US Office Almaty
US Mission Geneva
US Interests Section Havana
US Delegation, Secretary
UNVIE
Embassy Ulaanbaatar
Embassy Vilnius
Embassy Vienna
Embassy Vatican
Embassy Valletta
Consulate Vladivostok
Consulate Vancouver
Browse by tag
ASEC
AE
AF
AM
AR
AJ
AU
AORC
AG
AEMR
AMGT
APER
AGMT
AL
AFIN
AO
AMED
ADCO
AS
ABUD
ABLD
ASUP
ASECKFRDCVISKIRFPHUMSMIGEG
APECO
AID
AND
AMBASSADOR
AN
ARM
AY
AODE
AMG
ASCH
AMCHAMS
ARF
APCS
APEC
ASEAN
AGAO
ANET
ADPM
ACOA
ACABQ
AORL
AFFAIRS
ATRN
ACS
AFSI
AFSN
ADANA
ASIG
AA
AX
AUC
AC
AECL
AADP
AGRICULTURE
AMEX
ACAO
ACBAQ
AQ
AORG
ADM
AINF
AIT
ASEX
AGR
AROC
ATFN
AFGHANISTAN
AFU
AER
ALOW
AZ
AVERY
BA
BY
BU
BR
BE
BL
BO
BK
BM
BILAT
BH
BEXP
BF
BTIO
BC
BBSR
BMGT
BTIU
BG
BWC
BB
BD
BX
BP
BRUSSELS
BN
BIDEN
BT
CW
CH
CF
CD
CV
CVIS
CM
CE
CA
CJAN
CLINTON
CIA
CU
CASC
CI
CO
CACM
CDB
CN
CMGT
CS
CG
CBW
CIS
CR
CONDOLEEZZA
CPAS
CAN
CWC
CY
COUNTER
CDG
CL
CT
CIC
CIDA
CSW
CHR
CB
CODEL
COUNTERTERRORISM
CTR
COM
CICTE
CFED
CJUS
CKGR
CBSA
CEUDA
CARSON
CONS
CITEL
CLMT
CROS
CITT
CAC
CVR
CDC
CAPC
COPUOS
CBC
CBE
CARICOM
COE
COUNTRY
CLEARANCE
CACS
CTM
CNARC
ECON
EFIN
ETRD
EUN
EFIS
EG
ETTC
EZ
EPET
EAID
EAGR
ENRG
ECUN
EU
ELAB
ECPS
EAIR
EINV
ELTN
EWWT
EIND
EMIN
EI
ECIN
ENVR
ELECTIONS
EINVEFIN
EN
ES
ER
EC
EUC
EINT
EINVETC
ENGR
ET
EK
ENIV
ETRDEINVECINPGOVCS
ECONOMY
EAP
EFTA
EUR
EUMEM
EXIM
ERD
ENERG
EUREM
ESA
ERNG
EXTERNAL
EPA
EINVECONSENVCSJA
ECONOMICS
ELN
EINN
EFINECONCS
ENNP
EEPET
ETRDEINVTINTCS
ENVI
ETRO
ESENV
ECINECONCS
ECONOMIC
EAIDS
EDU
ETRA
ETRN
EFIM
EIAR
ETRC
EAIG
EXBS
EURN
ECIP
EREL
ECA
ENGY
ECONCS
ECONEFIN
ETC
ETRDECONWTOCS
EUNCH
EINDETRD
IR
IZ
IS
IAEA
INRB
IRAJ
IQ
IN
IT
IMO
INTERPOL
ICAO
IO
IC
ITALY
ITALIAN
IRAQI
ICTY
ID
IPR
IWC
ILC
INTELSAT
IL
IBRD
IMF
IA
IRC
ICRC
ILO
ITU
ITRA
IV
IDA
IAHRC
ICJ
ISRAELI
IRS
INMARSAT
ISRAEL
ISLAMISTS
INDO
IZPREL
ITPHUM
ITPGOV
ITF
IBET
IEFIN
INR
IACI
INTERNAL
IDP
IGAD
IEA
ICTR
IIP
INRA
INRO
IF
KJUS
KSCA
KNNP
KU
KCOR
KCRM
KDEM
KTFN
KHLS
KPAL
KWBG
KACT
KGHG
KPAO
KTIA
KIRF
KWMN
KS
KG
KZ
KN
KMDR
KISL
KSPR
KHIV
KPRP
KAWK
KR
KUNR
KDRG
KCIP
KGCC
KTIP
KSUM
KPKO
KVIR
KAWC
KPIN
KGIC
KRAD
KIPR
KOLY
KCFE
KMCA
KE
KV
KICC
KNPP
KBCT
KSEP
KFRD
KFLU
KVPR
KOCI
KBIO
KSTH
KMPI
KCRS
KOMC
KTBT
KPLS
KIRC
KREL
KFRDKIRFCVISCMGTKOCIASECPHUMSMIGEG
KFLO
KBTS
KSTC
KTDB
KFSC
KX
KFTFN
KNEI
KIDE
KREC
KMRS
KICA
KPAONZ
KCGC
KSAF
KRGY
KCMR
KRVC
KVRP
KSEO
KCOM
KAID
KTEX
KNUC
KNAR
KNUP
KNNPMNUC
KLIG
KFRDCVISCMGTCASCKOCIASECPHUMSMIGEG
KCRCM
KHDP
KGIT
KNSD
KOMS
KWMM
KPAI
KHSA
KTLA
KO
KMFO
KRCM
KCSY
KSAC
KTRD
KPWR
KID
KWNM
KRIM
KPOA
KCHG
KOM
KSCI
KFIN
KMOC
KESS
KWAC
KMIG
KSEC
KIFR
KDEMAF
KPRV
KBTR
KERG
KTER
KDDG
KPAK
KRFD
KHUM
KDEV
KCFC
KWWMN
KWMNCS
KJUST
MARR
MOPS
MU
MTCRE
MNUC
MY
MASS
MCAP
MOPPS
MAR
MPOS
MO
ML
MR
MASC
MX
MD
MP
MA
MTRE
MIL
MCC
MZ
MK
MDC
MRCRE
MAPS
MV
MI
MEPN
MAPP
MEETINGS
MAS
MTS
MLS
MILI
MTCR
MG
MC
MARAD
MIK
MILITARY
MEDIA
MEPI
MUCN
MEPP
MT
MERCOSUR
MW
MASSMNUC
MQADHAFI
NZ
NATO
NG
NI
NO
NATIONAL
NU
NPT
NIPP
NL
NPG
NS
NA
NGO
NP
NSG
NDP
NAFTA
NR
NC
NH
NE
NSF
NPA
NK
NSSP
NRR
NATOPREL
NSC
NT
NW
NORAD
NEW
NV
NSFO
NAR
NASA
NZUS
OTRA
OVIP
OPRC
OPDC
OSCE
OAS
ODIP
OIIP
OFDP
OVP
OREP
OFFICIALS
OSAC
OEXC
OPCW
OIE
OIC
OFDA
OSCI
OPIC
OBSP
OECD
ON
OCII
OHUM
OES
OCS
OMIG
OPAD
OTR
PGOV
PREL
PHUM
PINR
PTER
PSOE
PINS
PARM
PK
PBTS
PEPR
PM
POLITICAL
PARTIES
PREF
PBIO
PROP
PA
PSI
PINT
PO
PKFK
PL
PAK
PE
POLITICS
PINL
POL
PHSA
PU
PF
POV
PFOR
PHALANAGE
PARTY
PARMS
PRGOV
PNAT
POLINT
PRAM
PMAR
PG
PAO
PROG
PRELP
PPA
PCUL
PSEPC
PSA
PREO
PAHO
PGIV
PREFA
PALESTINIAN
PAIGH
POSTS
PTBS
PGOVLO
PORG
PGOVE
PLN
PINF
PAS
PUNE
POLICY
PDEM
PDOV
PCI
PGOVSMIGKCRMKWMNPHUMCVISKFRDCA
PBT
PHUMPGOV
PMIL
PNG
PP
PS
PHUH
PECON
POGOV
PY
PHUMPREL
PHUS
PRL
PGOC
PNR
PGGV
PROV
PTERE
PGOF
PHUMBA
PEL
RS
RU
RW
REGION
RP
RICE
ROBERT
RSP
RUPREL
RM
RO
RCMP
RSO
RELATIONS
REACTION
REPORT
RIGHTS
ROOD
RF
RFE
RIGHTSPOLMIL
SP
SA
SY
SF
SYR
SENV
SCUL
SOCI
SNAR
SO
SU
SG
STEINBERG
SHUM
SW
SMIG
SR
SZ
SIPRS
SI
SAARC
SPCE
SARS
SN
SYRIA
SANC
SL
SCRS
SC
SENVKGHG
SAN
SNARCS
SHI
SWE
SNARIZ
SIPDIS
SEN
SNARN
SPCVIS
SEVN
SSA
SH
SOFA
SK
ST
TPHY
TU
TRGY
TI
TX
TS
TW
TC
TFIN
TD
TSPA
TH
TT
TIP
TBIO
TSPL
TZ
TERRORISM
TRSY
TN
THPY
TINT
TF
TL
TV
TK
TO
TP
TURKEY
TNGD
TBID
TAGS
TR
UP
US
UNSC
UK
UZ
UE
UNESCO
UV
UNGA
UN
UNMIK
UNO
UY
UAE
UNEP
UG
UNHCR
UNHRC
USUN
UNAUS
USTR
USNC
USOAS
UNCHR
UNCSD
UNDP
USEU
USPS
UNDC
UNDESCO
UNCHC
UNFICYP
UNC
UNODC
UNPUOS
UNCND
UNICEF
UNCHS
UNVIE
USAID
UNIDROIT
Browse by classification
Community resources
courage is contagious
Viewing cable 03OTTAWA1383, INTERNET PHARMACIES: MANITOBA LEADS THE WAY IN
If you are new to these pages, please read an introduction on the structure of a cable as well as how to discuss them with others. See also the FAQs
Understanding cables
Every cable message consists of three parts:
- The top box shows each cables unique reference number, when and by whom it originally was sent, and what its initial classification was.
- The middle box contains the header information that is associated with the cable. It includes information about the receiver(s) as well as a general subject.
- The bottom box presents the body of the cable. The opening can contain a more specific subject, references to other cables (browse by origin to find them) or additional comment. This is followed by the main contents of the cable: a summary, a collection of specific topics and a comment section.
Discussing cables
If you find meaningful or important information in a cable, please link directly to its unique reference number. Linking to a specific paragraph in the body of a cable is also possible by copying the appropriate link (to be found at theparagraph symbol). Please mark messages for social networking services like Twitter with the hash tags #cablegate and a hash containing the reference ID e.g. #03OTTAWA1383.
Reference ID | Created | Released | Classification | Origin |
---|---|---|---|---|
03OTTAWA1383 | 2003-05-15 16:04 | 2011-04-28 00:12 | UNCLASSIFIED | Embassy Ottawa |
This record is a partial extract of the original cable. The full text of the original cable is not available.
UNCLAS SECTION 01 OF 03 OTTAWA 001383
SIPDIS
STATE FOR WHA/CAN PNORMAN AND EB/DCT
USDOC FOR ITA GWARD AND CBUSQUETS
DEPT PASS USTR SCHANDLER
DEPT ALSO PASS FDA DAUTOR AND MECKLES
E.O. 12958: N/A
TAGS: ECON ETRD EIND CA
SUBJECT: INTERNET PHARMACIES: MANITOBA LEADS THE WAY IN
EXPORTS TO THE U.S.
REFTEL: 2002 OTTAWA 2048
¶1. SUMMARY - WITH STRONG SUPPORT FROM THE PROVINCIAL
GOVERNMENT AND REGULATOR, MANITOBA HAS BECOME A HUB FOR
THE GROWING CROSS-BORDER TRADE IN PHARMACEUTICALS FROM
CANADA TO THE U.S. CANADIAN INTERNET PHARMACIES, SOME OF
WHICH FILL MORE THAT 1000 PRESCRIPTIONS A DAY, HAVE BEEN
SUCCESSFUL IN TAKING ADVANTAGE OF THE DISPARATE U.S. AND
CANADIAN MARKET PRICES FOR PHARMACEUTICALS AND LEGAL
UNCERTAINTIES ON BOTH SIDES OF THE BORDER. MANITOBA'S
STRONG PROMOTION OF THE INDUSTRY IS IN STARK CONTRAST
WITH THE CAUTIOUS APPROACH TAKEN BY OTHER PROVINCES,
ESPECIALLY ONTARIO. THE FUTURE OF THE INDUSTRY WILL
DEPEND ON THE INTERNET PHARMACIES' ABILITY TO RESPOND TO
THE INCREASING PRESSURE ON THE SUPPLY OF PHARMACEUTICALS
AND NAVIGATE THE MURKY LEGAL AND ETHICAL WATERS
SURROUNDING THE TRADE. END SUMMARY.
--PHARMACEUTICAL EXPORTS - A BOON FOR MANITOBA--
¶2. MANITOBA HAS BECOME A MAJOR HUB IN A GROWING TRADE IN
PRESCRIPTION PHARMACEUTICALS FROM CANADA TO THE U.S.,
MUCH OF WHICH IS NOW ORDERED OVER THE INTERNET AND
FULFILLED BY MAIL. MANITOBA-BASED INTERNET PHARMACIES
ACCOUNT FOR WELL OVER HALF OF THE ESTIMATED USD 500
MILLION WORTH OF PRESCRIPTION DRUGS SOLD TO THE U.S. FROM
CANADA LAST YEAR. THE MANITOBA PHARMACEUTICAL
ASSOCIATION (MPA), WHICH REGULATES PHARMACIES IN THE
PROVINCE, ESTIMATES THAT 53 MANITOBA PHARMACIES ARE
INVOLVED IN CROSS-BORDER TRADE WITH THE UNITED STATES.
THE INDUSTRY HAS CREATED UPWARDS OF 2000 JOBS IN TOWNS
THROUGHOUT THIS TRADITIONAL MANUFACTURING AND FARMING
PROVINCE.
¶3. KRIS THORKELSON, CHAIRMAN AND CEO OF CANADA DRUGS, ONE
OF THE LARGEST INTERNET PHARMACIES IN MANITOBA, INVITED
MISSION PERSONNEL FOR A TOUR OF THE COMPANY'S FACILITIES
TO HELP DEMONSTRATE THAT THE NEW INTERNET PHARMACIES ARE
NOT "FLY BY NIGHT" OPERATIONS, AND THAT THEY HAVE
INVESTED HEAVILY IN BRICKS AND MORTAR, AS WELL AS
SOPHISTICATED COMPUTER AND ELECTRONIC TRACKING SYSTEMS.
CANADA DRUGS FILLS OVER 1000 PRESCRIPTIONS A DAY, ALL FOR
EXPORT TO THE UNITED STATES. CUSTOMERS INITIATE AN ORDER
BY FAXING OR MAILING TO CANADA DRUGS A COPY OF THEIR U.S.
PRESCRIPTION, TOGETHER WITH A POWER OF ATTORNEY FORM THAT
WAIVES THE CANADIAN PHARMACIST OF LIABILITY, AND A
PATIENT QUESTIONNAIRE. AN IN-HOUSE PHARMACIST AT CANADA
DRUGS REVIEWS MATERIALS, A CANADIAN PHYSICIAN CO-SIGNS
THE PRESCRIPTION, AND THE PHARMACIST REVIEWS IT A SECOND
TIME AFTER A TECHNICIAN FILLS THE ORDER, AND ONCE MORE
BEFORE IT IS SHIPPED OUT. EACH ORDER IS CONFIRMED BY
PHONE WITH THE CUSTOMER BEFORE IT IS SENT. CANADA DRUGS
HAS 18 PHARMACISTS ON STAFF, OVER 40 PHARMACEUTICAL
TECHNICIANS, AND APPROXIMATELY 170 STAFF IN TOTAL.
--PROVINCE STEPPING IN TO SUPPORT THE INDUSTRY--
¶4. THE GOVERNMENT OF MANITOBA (GOM) IS A STRONG SUPPORTER
OF THE PHARMACEUTICAL EXPORT INDUSTRY AND VIEWS THE NEW
BUSINESSES AS A KEY COMPONENT OF ITS PROVINCIAL GROWTH
STRATEGY. EXPORTS FROM CANADA STILL ONLY ACCOUNT FOR
LESS THAN ONE-HALF OF ONE PERCENT OF THE U.S.
PRESCRIPTION DRUG MARKET. THE GOM IS WORKING WITH THE
MPA AND THE MANITOBA COLLEGE OF PHYSICIANS AND SURGEONS
(MCPS) ON SMOOTHING OUT THE REGULATORY PROCESS TO
LEGITIMIZE THE INDUSTRY. AS FAR AS THE GOM IS CONCERNED,
EXPORTING PHARMACEUTICALS TO THE U.S. IS NOT ILLEGAL
UNDER CANADIAN LAW, AND THEY ARE NOT INTERESTED IN
ENFORCING U.S. PROHIBITIONS ON PHARMACEUTICAL PRODUCTS IF
THE FDA WILL NOT ENFORCE THEM. THE GOM IS INSTEAD
FOCUSED ON ENSURING THAT THE PRACTICE IS SAFE, MEETS
CANADIAN FEDERAL AND PROVINCIAL GUIDELINES AND PRACTICES,
AND THAT INTERNET PHARMACIES PROVIDE U.S. CONSUMERS WITH
THE SAME SAFEGUARDS AND LEVEL OF SERVICE AS CANADIAN
CITIZENS.
¶5. ONE OF THE BIGGEST CONCERNS FOR THE PROVINCIAL
REGULATORY AUTHORITIES ACROSS CANADA HAS BEEN THE
PRACTICE OF CANADIAN PHYSICIANS CO-SIGNING, OR RE-WRITING
PRESCRIPTIONS FOR U.S. PATIENTS THEY HAVE NEVER SEEN.
REGULATORS HAVE QUESTIONED WHETHER SIGNING OFF ON
PRESCRIPTIONS WITHOUT PERFORMING AN APPROPRIATE PHYSICAL
EXAMINATION IS TANTAMOUNT TO PROFESSIONAL MISCONDUCT.
THE MPA HAS WORKED WITH THE MCPS TO CLAMP DOWN ON THE
MOST EGREGIOUS CASES WHERE PHYSICIANS WERE "RUBBER
STAMPING" MORE THAN 1000 PRESCRIPTIONS A DAY. DESPITE
THESE CONCERNS, THE MPA, THE MCPS, AND MANITOBA'S
INTERNET PHARMACIES RECENTLY SIGNED OFF ON A GOM PLAN TO
ELIMINATE CO-SIGNING BY A CANADIAN PHYSICIAN ALTOGETHER
AND TO ACCEPT PRESCRIPTIONS FROM U.S. PHYSICIANS ON PAR
WITH THOSE FROM CANADA. THE GOM IS EXPECTED TO ANNOUNCE
THEIR PROPOSAL SHORTLY AND SEEK THE NECESSARY LEGISLATIVE
CHANGES TO DO AWAY WITH CO-SIGNING IN THE FALL. THE
FEDERAL GOVERNMENT WILL LIKELY CHALLENGE THIS PROVINCIAL
LEGISLATION.
¶6. THE STRONG PROMOTION OF THE INDUSTRY FROM MANITOBAN
OFFICIALS IS IN STARK CONTRAST TO THE CAUTIOUS APPROACH
OF OTHER PROVINCIAL GOVERNMENTS AND REGULATORS. ONTARIO
HAS TAKEN THE STRONGEST STANCE AGAINST INTERNET
PHARMACIES, QUESTIONING BOTH THE LEGITIMACY OF THE CROSS-
BORDER TRADE IN PRESCRIPTION PHARMACEUTICALS AND THE
ABILITY OF THE PROVINCIAL REGULATORS TO EFFECTIVELY
MONITOR THE SALE OF PRESCRIPTION DRUGS SOUTH OF THE
BORDER. THE COLLEGE OF PHYSICIANS AND SURGEONS OF
ONTARIO, THE SELF-REGULATING BODY FOR THE PROVINCE'S
MEDICAL PROFESSION, HAS STATED THAT "IT IS NOT ACCEPTABLE
FOR A PHYSICIAN TO SIGN OR CO-SIGN A PRESCRIPTION WITHOUT
ATTENDING THE PATIENT." THE ONTARIO COLLEGE OF
PHARMACISTS HAS ALSO WEIGHED IN STATING THAT PHARMACISTS
"SHALL NOT FACILITATE OR ENTER INTO AGREEMENTS WITH
PHYSICIANS FOR THE PURPOSES OF CO-SIGNING OR REWRITING
PRESCRIPTIONS FOR OUT-OF-COUNTRY PATIENTS." IN JUNE THE
ONTARIO COURTS WILL HEAR A CASE AGAINST A NUMBER OF
INDIVIDUALS AND COMPANIES DOING BUSINESS WITH AN ONLINE
PHARMACY, THE CANADIAN DRUG STORE INC., WHICH IS ACCUSED
OF UNLAWFULLY OPERATING AN UNACCREDITED INTERNET PHARMACY
AND FILLING PRESCRIPTIONS WRITTEN BY U.S. PHYSICIANS FOR
U.S. PATIENTS.
--CLOUDS LOOMING OVER THE INDUSTRY--
¶7. DESPITE THE INDUSTRY'S RECENT GROWTH, THE ENORMOUS
POTENTIAL FOR LOWER-PRICED PRESCRIPTION DRUGS IN THE U.S.
MARKETPLACE, AND STRONG SUPPORT FROM GOVERNMENT AND
REGULATORY OFFICIALS, THE LONG-TERM VIABILITY OF THE
CROSS-BORDER INTERNET PHARMACEUTICAL TRADE IS TENUOUS.
IN ADDITION TO A POSSIBLE CRACKDOWN ON IMPORTERS BY THE
FDA OR A LEGISLATIVE FIX BY CONGRESS TO PROVIDE SENIORS
WITH PRESCRIPTION DRUG COVERAGE, THERE ARE SEVERAL
DOMESTIC FACTORS THAT COULD SEVERELY DAMAGE THE CANADIAN
INDUSTRY.
¶8. BRITISH PHARMACEUTICAL MANUFACTURER GLAXOSMITHKLINE
(GSK), WHICH ANNOUNCED IN JANUARY THAT THEY WOULD NO
LONGER SUPPLY THEIR PRODUCTS TO CANADIAN PHARMACIES
SELLING TO THE U.S. MARKET, IS APPLYING THE GREATEST
PRESSURE. PHARMACEUTICAL MANUFACTURES ARE CONCERNED THAT
THE GROWING CROSS-BORDER TRADE COULD LEAD TO A NUMBER OF
PROBLEMS: SHORTAGES OF BOTH CANADIAN PHARMACISTS AND DRUG
PRODUCTS FOR CANADIAN CONSUMERS, DRUGS UNAPPROVED IN THE
U.S. BEING DISPENSED TO U.S. PATIENTS, INFRINGEMENT OF
U.S. PATENTS, AND POTENTIAL LIABILITY FOR CANADIAN DRUG
COMPANIES. IN PRIVATE WE HAVE ALSO BEEN TOLD THAT FOR
THE FIRST TIME COMPANIES HAVE EXPERIENCED DECREASED SALES
OF KEY DRUGS IN NORTHERN BORDER STATES.
¶9. KRIS THORKELSON FROM CANADA DRUGS ADMITTED THAT
SUPPLIES OF SOME GSK DRUGS ARE STARTING TO RUN SHORT.
THE COMPANY HAS BEEN ABLE TO SECURE SUPPLIES THROUGH
OTHER CANADIAN PHARMACIES, BUT IS BEGINNING TO EXPERIENCE
DELAYS AND IS CONCERNED THAT THEY MAY NO LONGER BE ABLE
MEET THE DEMAND. EFFORTS BY THE PHARMACEUTICAL EXPORTERS
TO COUNTER GSK'S ACTIONS WERE DERAILED WHEN CANADA'S
FEDERAL COMPETITION BUREAU RULED IN MARCH THAT GSK HAD A
"REASONABLE BUSINESS JUSTIFICATION" TO BLOCK THE EXPORTS.
ASTRAZENECA'S RECENT ANNOUNCEMENT THAT THEY WILL LIMIT
SUPPLIES OF THEIR PRODUCTS TO CANADIAN PHARMACIES AND
WHOLESALERS HAS COMPOUNDED THE SUPPLY PROBLEMS FOR
INTERNET PHARMACIES.
¶10. A RELATED, AND YET UNTESTED, QUESTION IS HOW FEDERAL
AND PROVINCIAL GOVERNMENTS WILL REACT IF THE DEMAND FROM
INTERNET PHARMACIES BEGINS TO AFFECT THE SUPPLY OF DRUGS
TO TRADITIONAL PHARMACIES SERVING CANADIAN PATIENTS. THE
GOM IS PROMOTING A "MANITOBA FIRST" POLICY TO ENSURE THAT
MANITOBANS ARE NOT DENIED ACCESS TO DRUGS IF THERE IS A
SHORTAGE, BUT THE POLICY LACKS THE REGULATORY TEETH THAT
WOULD FORCE PHARMACIES TO SELL TO THE MANITOBA MARKET.
FEDERAL REGULATIONS DO NOT STIPULATE THAT PHARMACIES MUST
MAINTAIN AN ADEQUATE SUPPLY OF DRUGS OR COMPEL THEM TO
GIVE FIRST PRIORITY TO CANADIAN CONSUMERS. BOTH HEALTH
CANADA AND INDUSTRY CANADA ARE MONITORING THE CANADIAN
DRUG SUPPLY AND HAVE INDICATED THAT THEY WOULD INTERVENE
IN EMERGENCY CIRCUMSTANCES, AS THEY DID WHEN THERE WAS A
RUN ON CIPRO DURING THE ANTHRAX SCARE IN 2001.
¶11. PROVINCIAL EFFORTS TO PROMOTE THE PHARMACEUTICAL
EXPORT INDUSTRY ARE ALSO BEING CLOSELY WATCHED BY THE
FEDERAL GOVERNMENT. PROVINCIAL REGULATORS SET AND
ENFORCE THE PROFESSIONAL STANDARDS FOR PHYSICIANS AND
PHARMACISTS, BUT HEALTH CANADA, THROUGH THE HEALTH ACT
AND FOOD AND DRUG ACT, IS ULTIMATELY RESPONSIBLE FOR THE
SAFETY OF FOODS, DRUGS AND HEALTH PRODUCTS. IN A RECENT
MEETING WITH USG OFFICIALS, DAVID EDWARDS, LEGAL COUNSEL
AT HEALTH CANADA, NOTED THAT ACCORDING TO THE HEALTH ACT,
A "PRACTITIONER" MUST BE A CANADIAN, AND THAT IT WOULD
NOT BE POSSIBLE FOR THE GOM TO ELIMINATE THE NEED FOR A
CANADIAN DOCTOR TO CO-SIGN A PRESCRIPTION BEFORE IT COULD
BE FILLED BY A CANADIAN PHARMACIST.
--COMMENT-
¶12. DEPENDING ON WHOM ONE SPEAKS WITH AND THEIR RELATION
TO THE PHARMACEUTICAL INDUSTRY, BI-NATIONAL TRADE IN
PRESCRIPTION PHARMACEUTICALS IS EITHER A MARKET WITH HUGE
GROWTH POTENTIAL FOR RURAL CANADIAN COMMUNITIES, OR A
LEGALLY QUESTIONABLE BUSINESS THAT HAS ACHIEVED TEMPORAL
SUCCESS ARBITRAGING GAPS IN REGULATIONS AND PRICES. THE
LEGAL FRAMEWORK SURROUNDING THE CROSS-BORDER TRADE HAS
NOT BEEN SOLIDIFIED ON EITHER SIDE OF THE BORDER, AND
UNTIL IT IS MANY OF THE ISSUES WILL REMAIN OPEN TO
INTERPRETATION. OTHER PROVINCES ARE PAYING CLOSE
ATTENTION TO DEVELOPMENTS IN MANITOBA TO SEE HOW THE
INTERNET BUSINESS MODEL WILL RESPOND TO CHANGES IN THE
MARKETPLACE AND WHAT IMPACTS THIS MAY HAVE FOR THE
CANADIAN HEALTH CARE SYSTEM.
CELLUCCI#