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Read Making a Killing

home / healthcare / in the media

The Toronto Star
Oct 15, 2004

by Miro Cernetig, Toronto Star

The Yonge Street drug connection

The doctor is in - checked in, to be exact, to the gloomy confines of room 1101, sitting behind the sort of shaky table where hotels usually put the guest coffee maker and all those tiny packages of sugar and cream.

Pen in hand, cash box open and an empty prescription pad at the ready, the doctor is doling out something more potent: thousands of dollars' worth of medicine to complete strangers - two dozen Americans, walking and limping through the door, in search of prescription bargains.

"I don't believe Americans should need to be doing this, coming to Canada for our drugs," says 69-year-old Joyce Shannon, the first patient in this temporary doctor's office. "But here we all are," she quips, before she sees her new Canadian physician and greets him in her slow, southern drawl. "Hello, doctor."

The doctor, who allowed the Toronto Star into the $99-a-day room on condition of anonymity, first asks her to sign a form agreeing that if she sues him, she must do so only in Ontario. She signs.

Soon she's getting her blood pressure checked, her sinus poked and explored and, finally, the doctor is writing up three prescriptions for ailments she prefers not to discuss.

"This is completely proper," according to the doctor, a 36-year-old family practitioner. "I'm examining these people before prescribing."

A glance away, 73-year-old Joe Shannon sits patiently on the edge of one of the room's hard twin beds, watching the examination of his wife of 48 years, a frail figure lit by the room's one-bulb lamp and the thin white light filtering in through the dirty window.

He's in pain most days - he had both hips replaced within the last two years. The former Liptons tea executive has come to Canada for painkillers. He'd like to find something cheaper than Ultracet, a tablet he buys back home in Raleigh, N.C., at more than $52 (U.S.) for a one-month supply of 40 tablets.

"I don't have any coverage for drugs any more," he says, leaning on his cane. "So my wife and I are hoping to save some money up here in Canada - maybe $1,800 (U.S.) over a year. It's money we could use to make our retirement better."

The doctor also gives him his prescription - for Tylenol 3. The pensioners then hand over $40 each to the doctor and head for the elevator, descending to the street and a nearby Shoppers Drug Mart.

The Shannons are just two among two dozen Americans who rolled into Union Station Wednesday night on the Rx Express - a train voyage that started five days ago in Miami. Invited aboard by the non-partisan Foundation for Taxpayer and Consumer Rights, they saved an average of 56 per cent on their drug purchases yesterday.

They also say they accomplished a far greater objective: make a political splash for 100 million other Americans who also have little or no coverage for prescription drugs, which have soared in price by 200 per cent in the last 12 years, according to the foundation. They want the U.S. government to buy drugs in bulk, as Canada does, to use the government's clout to bargain for better prices.

"I'm going to go back and tell my neighbours about how it works here in Canada," said Joyce Shannon, followed by a small army of Canadian and international media as she made her drug run. "Maybe all my yakking will convince our politicians they need to help Americans who can't afford drugs."

Aside from raising that policy question - hot enough that Canada's drug sales to Americans got the attention of both U.S. President George W. Bush and John Kerry in Wednesday's presidential debate - the Shannons also prompt an important debate here in Canada: Is it ethical for Canadian doctors to sell drugs to people crossing the border for a pharmaceutical bargain?

The U.S. drug industry says no. Without charging U.S. consumers high prices, the industry says it won't be able to develop new drugs.

The U.S. government also considers it illegal to smuggle prescription drugs into the country and has been apprehending mail shipments from Canada. But it does not prosecute individual Americans coming back with medicine for their own use, even though it is a crime.

The College of Physicians and Surgeons of Ontario says doctors who are participating in filling prescriptions over the Internet, without seeing a patient, are committing a serious ethical violation. Four allegations of such conduct are now before College disciplinary panels.

It is considered ethical, however, if a doctor physically "attends" a foreign patient, as appears to have happened yesterday, before rewriting a U.S. prescription, which is the only way Americans can buy drugs at a Canadian pharmacy.

The Ontario Colleges of Pharmacists, which regulates 9,500 pharmacists and 3,000 pharmacies, has a similar policy stating "pharmacists who knowingly facilitate the practice by any Ontario prescriber to co-sign/authorize prescriptions where no established physician-patient relationship exists are acting unethically..."

As the man in the middle of Americans' revolt against their drug companies, Par Singh may have been the most nervous man on Yonge Street yesterday. He's the owner of the Shoppers Drug Mart at Yonge and College Street and as the Americans entered the store, he was shocked at the presence of so much media, including the BBC and the U.S. network ABC.

"I didn't think this would be so political," he said. "But this is completely legal. These people have a prescription from a licenced Ontario doctor who saw them. I must serve them as anyone else."

That he did, having his staff meticulously fill out each prescription and then explaining the possible side-effects and dangers of every drug.

"This is great," bellowed Joe Shannon, holding his Tylenol 3 bill, which was about $12 (U.S.) - more than four times less than the pain killer he normally buys. "Maybe I should move to Toronto." Six hours later, he and his wife were at Pearson Airport, clearing customs with many of the other Americans.

None had their drugs seized, according to Jerry Flanagan, the spokesperson organizing the train trip to Canada.

"The first wave got in," he said.  "There's more to come." 'I'm going to go back and tell my neighbours about how it works here in Canada'

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