

Currently released so far... 12478 / 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 Niamey
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 Sapporo
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
AU
ASEC
AE
AF
AORC
AEMR
AMGT
ABUD
AFFAIRS
APER
AS
AMED
AY
AG
AR
AJ
AL
AID
AM
AODE
ABLD
AMG
AFIN
ATRN
AGAO
AFU
AN
AA
ALOW
APECO
ADM
ARF
ASEAN
APEC
AMBASSADOR
AO
ASUP
AZ
AADP
ACOA
ANET
AMCHAMS
ACABQ
ASECKFRDCVISKIRFPHUMSMIGEG
APCS
AGMT
AINF
AIT
AORL
ACS
AFSI
AFSN
ACBAQ
AFGHANISTAN
ADANA
ADPM
AX
ADCO
AECL
AMEX
ACAO
ASCH
AORG
AGR
AROC
ASIG
AND
ARM
AQ
ATFN
AC
AUC
ASEX
AER
AVERY
AGRICULTURE
BL
BR
BO
BA
BD
BM
BK
BG
BU
BB
BH
BTIO
BY
BEXP
BP
BE
BRUSSELS
BF
BIDEN
BT
BX
BC
BILAT
BN
BBSR
BTIU
BWC
BMGT
CA
CASC
CVIS
CM
CH
CO
CU
CD
CWC
CI
CS
CY
CMGT
CF
CG
CR
CB
CV
CW
CE
CBW
CT
CPAS
COUNTERTERRORISM
CJAN
CODEL
CIDA
CDG
CDC
CIA
CTR
CNARC
CSW
CN
CONS
CLINTON
COE
CROS
CARICOM
CONDOLEEZZA
COUNTER
CL
COM
CICTE
CIS
CFED
COUNTRY
CJUS
CBSA
CEUDA
CLMT
CAC
COPUOS
CIC
CBE
CHR
CTM
CVR
CITEL
CLEARANCE
CACS
CAN
CITT
CARSON
CACM
CDB
CAPC
CKGR
CBC
EC
EG
EPET
ECON
ETRD
EFIN
EIND
EMIN
ENRG
EAID
EAGR
EUN
ETTC
EAIR
ENIV
ES
EU
EINV
ELAB
ECIN
EFIS
ELTN
EWWT
ECPS
ECONOMIC
ENGR
EN
EINT
EPA
ELN
ESA
EZ
ER
ET
EFTA
EINVECONSENVCSJA
EUMEM
ETRA
EXTERNAL
EI
EUR
EK
ERNG
ENGY
ETRDEINVECINPGOVCS
ENERG
EINVEFIN
ENVR
ECA
ELECTIONS
ETC
EUREM
ENNP
EFINECONCS
EURN
ECINECONCS
EEPET
EXIM
ERD
ENVI
ETRC
ETRDEINVTINTCS
ETRO
EDU
ETRN
EAIG
ECONCS
ECONOMICS
EAP
ECONOMY
EINN
EIAR
EXBS
ECUN
EINDETRD
EREL
EUC
ESENV
ECONEFIN
ECIP
EFIM
EAIDS
ETRDECONWTOCS
EUNCH
EINVETC
IZ
IT
IR
IS
IN
IC
IAEA
IO
ICAO
IWC
ID
IV
ISRAEL
IAHRC
IQ
ICTR
IMF
IRS
IDP
IGAD
ICRC
ICTY
IMO
IL
INRA
INRO
ICJ
ITU
IBRD
INMARSAT
IIP
ITALY
IEFIN
IACI
ILO
INTELSAT
ILC
ITRA
IDA
INRB
IRC
INTERPOL
IA
IPR
IRAQI
ISRAELI
INTERNAL
ISLAMISTS
INDO
ITPHUM
ITPGOV
ITALIAN
IBET
INR
IEA
IZPREL
IRAJ
ITF
IF
KDEM
KU
KPAL
KNNP
KCRM
KZ
KN
KS
KJUS
KTFN
KSCA
KV
KISL
KPAO
KPKO
KIRF
KTIA
KIPR
KFLO
KFRD
KTIP
KAWC
KSUM
KCOM
KAID
KE
KTDB
KMDR
KOMC
KWBG
KDRG
KVPR
KTEX
KGIC
KWMN
KSCI
KCOR
KACT
KDDG
KHLS
KSAF
KFLU
KSEO
KMRS
KSPR
KOLY
KSEP
KVIR
KGHG
KIRC
KUNR
KIFR
KCIP
KMCA
KMPI
KBCT
KHSA
KICC
KIDE
KCRS
KMFO
KRVC
KRGY
KR
KAWK
KG
KFIN
KHIV
KBIO
KOCI
KBTR
KNEI
KPOA
KCFE
KPLS
KSTC
KHDP
KPRP
KCRCM
KLIG
KCFC
KTER
KREC
KTBT
KPRV
KSTH
KRIM
KRAD
KWAC
KWMM
KFRDCVISCMGTCASCKOCIASECPHUMSMIGEG
KOMS
KX
KMIG
KRCM
KVRP
KBTS
KPAONZ
KNUC
KNAR
KPWR
KNPP
KDEMAF
KNUP
KNNPMNUC
KERG
KGIT
KPAI
KTLA
KFSC
KCSY
KSAC
KTRD
KID
KOM
KMOC
KJUST
KGCC
KREL
KFRDKIRFCVISCMGTKOCIASECPHUMSMIGEG
KFTFN
KO
KNSD
KHUM
KSEC
KCMR
KCHG
KICA
KPIN
KESS
KDEV
KCGC
KWWMN
KPAK
KWNM
KWMNCS
KRFD
MOPS
MCAP
MPOS
MARR
MO
MNUC
MX
MASS
MG
MY
MU
ML
MR
MILITARY
MTCRE
MT
MEPP
MA
MDC
MP
MAR
MASSMNUC
MARAD
MAPP
MZ
MD
MI
MEETINGS
MK
MCC
MEPN
MRCRE
MAS
MIL
MASC
MC
MV
MTCR
MIK
MUCN
MEDIA
MERCOSUR
MW
MOPPS
MTS
MLS
MILI
MTRE
MEPI
MQADHAFI
MAPS
NO
NATO
NL
NP
NZ
NSF
NI
NH
NG
NAFTA
NU
NASA
NR
NATOPREL
NSSP
NSG
NA
NT
NW
NK
NPT
NPA
NATIONAL
NPG
NSFO
NS
NSC
NE
NGO
NDP
NIPP
NRR
NEW
NZUS
NC
NAR
NV
NORAD
OTRA
OPCW
OVIP
OAS
OREP
OPIC
OIIP
OPRC
ODIP
OEXC
OPDC
OSCE
OIC
OSCI
OECD
OFDP
OFDA
OMIG
OPAD
OFFICIALS
OVP
OIE
OHUM
OCS
OBSP
OTR
OSAC
ON
OCII
OES
PGOV
PREL
PHUM
PTER
PINS
PINR
PREF
PK
PROP
PA
PARM
PBTS
PMAR
PM
PGIV
PE
PRAM
PHUH
PHSA
PL
PNAT
PO
PLN
PAO
PSA
PHUMPGOV
PF
PEL
PBIO
POLITICS
PHUMBA
PAS
POL
PREO
PAHO
PMIL
POGOV
POV
PAK
PNR
PRL
PG
PREFA
PSI
PINL
PU
PARMS
PRGOV
PALESTINIAN
PAIGH
POLITICAL
PARTIES
POSTS
PROG
PORG
PTBS
PUNE
POLICY
PDOV
PCI
PGOVSMIGKCRMKWMNPHUMCVISKFRDCA
PBT
PP
PS
PY
PTERE
PGOF
PKFK
PSOE
PEPR
PPA
PINT
PRELP
PSEPC
PGOVE
PINF
PNG
PGOC
PFOR
PCUL
POLINT
PGGV
PHALANAGE
PARTY
PGOVLO
PHUS
PDEM
PECON
PROV
PHUMPREL
RS
RU
RELATIONS
RW
RO
RM
RP
ROOD
RICE
RUPREL
RSO
RCMP
REACTION
REPORT
REGION
RIGHTS
RF
RFE
RSP
RIGHTSPOLMIL
ROBERT
SU
SCUL
SNAR
SOCI
SF
SA
SHUM
SENV
SP
SR
SY
SANC
SC
SMIG
SZ
SARS
SW
SEVN
SO
SEN
SL
SNARCS
SNARN
SI
SG
SN
SH
SYR
SAARC
SPCE
SHI
SCRS
SENVKGHG
SYRIA
SWE
STEINBERG
SIPRS
ST
SNARIZ
SSA
SK
SPCVIS
SOFA
SIPDIS
SAN
TC
TI
TBIO
TH
TSPL
TRGY
TSPA
TPHY
TU
TW
TS
TAGS
TK
TX
TNGD
TZ
TF
TL
TV
TN
TD
TIP
TR
TP
TO
TT
TFIN
THPY
TERRORISM
TINT
TRSY
TURKEY
TBID
US
UK
UNGA
UP
UZ
UNMIK
USTR
UNO
UNSC
UN
UNESCO
UNAUS
UNHRC
UY
UG
UNHCR
UNCND
USOAS
USEU
UNICEF
UNEP
UV
UNPUOS
UNCSD
USUN
UNCHR
UNDC
USNC
UE
UNDP
UNC
USPS
USAID
UNVIE
UAE
UNFICYP
UNODC
UNCHS
UNIDROIT
UNDESCO
UNCHC
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 16:27 | 2011-04-28 00:00 | 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#