Google is censoring Canadian pharmacy web sites

I have been a customer of the below Canadian pharmacy site for five years. I am incensed at the duplicitous stand Google is taking on China’s censorship of political dissidents which resulted in removal of their services in China and then turning around and censoring a legitimate Canadian business with no political overtones. This stand seems to violate the primary concept of an “open” internet.

I received the below message from CandianPharmacyMeds.com. It raises the keenest emotions of injustice. My head was whirling with what might be the motive. It seems that the western drug lobby must have scored a tremendous triumph.  You wonder what transpired to produce this apparent compromise in professed Google values?

Other search engines have not moved to censor Canadian pharmacy sites. Google claims legal concerns as it’s motivation to censor. It is very unclear why Google has this concern and not other search engines. While it has been technically illegal to buy pharmacy products from Canada the prevailing mood is to dismiss any interest in enforcement. See below link “states support”.

It seems very discriminatory to single out Canadian pharmacy from online pharmacy, many of which do not require a prescription which invites excess as opposed to Canadian pharmacies which require a prescription and operate in a regulatory environment similar to the US. It seems the reason may be that Canadian pharmacy commands the largest market share of online sales. This implies the involvement of the western drug lobby to precipitate censorship of Canadian sites.

It’s interesting that several states support online pharmacy programs for low income and seniors according to this Wikipedia article. Google’s interest in protecting their legal exposure throws a cinder block to the low income population already unable to keep their head above water in the out of control US health care system.

President Obama supports continuing access of Canadian online sales for US citizens. See complete article.

Well I can’t speculate further. I am including the e-mail I received from my Canadian pharmacy website below. If you have more information that would shed some light on this apparent travesty please comment here or on a public forum. The e-mail suggests writing to your federally elected officials.

The online pharmacy industry has produced about $2,000 per year in savings for my family. Learn more:

Indian suppliers are the generic sourcing choice for Canadian and online pharmacies because globalization is driving them toward U.S. FDA compliance in the move to more collaborative relationships with the US, EU and Japan. Learn more.

Be sure that your online vendor uses FDA compliant suppliers. This page represents proper disclosure that would be reassuring for a consumer.

Evolution of the Indian pharmaceutical industry:

In the 50’s and 60’s India had minimal domestic pharmaceutical production.  They were dependent on western sources for medicines which they could ill afford. The Indian government instituted tariffs and liberalized patent laws to nurture a domestic pharmaceutical industry. The patent laws allowed Indian companies to copy expensive original preparations by foreign firms and produced these by means of alternative production procedures. This had the effect of allowing Indian manufactures to duplicate western formulations before the expiration of the patent in the country of origin, typically the US. This environment caused western pharmaceutical companies to withdraw from India.

From the 70’s to 2005 the Indian pharmaceutical industry experienced double digit growth. They became expert at producing western preparations using a slightly modified process to stay within Indian patent law. They became known as the “Pharmacy of the poor”. Low wages and high educational standards lent it self well to super charging the growth of the pharmaceutical industry. Focusing on generic production eliminated developmental risk as well as prohibitively expensive research dollars.  India holds 20% of the world generic market but 2% of the pharmaceutical world market. 22% of total generic production is exported and of that 80% goes to US and the EU.

After the 2005 patent law reform, which resulted in the adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights, the industry entered a more collaborative environment with western pharmaceutical industry than during the earlier developmental period. This reorientation of the industry resulted in these important changes.

1. A segment still focuses on generic as its prime business. In this segment 80% of generic production is targeted for US, EU and Japan.

2. A major segment is focusing on development of new medicines. This has spawned new research relationships between Indian firms and western giants like Ely Lily.

3. Contract manufacturing for western giants is the last segment of the reorientation.

The most significant change resulting from patent reform is movement of the entire Indian pharmaceutical industry toward US FDA compliance due to the new western focus on so many touch points. The US, EU and Japan are the most lucrative world markets. Since the US FDA governs the major segment of export target market the move to FDA standards serves the reorientation of the Indian pharmaceutical industry.

Here are some relevant excerpts and website links.

The Indian pharmaceutical industry is also getting increasingly U.S. FDA compliant to harness the growth opportunities in areas of contract manufacturing and research. Indian companies such as Ranbaxy, Sun Pharma, and Dr. Reddy’s are increasingly focusing on tapping the U.S. generic market. Recently, Ranbaxy Laboratories Ltd has received a tentative approval from the US Food and Drug Administration to manufacture and market Lamivudine tablets (150 mg), a medicine used in treating HIV infection. This tentative approval has been granted under the US President’s Emergency Plan for AIDS Relief Initiative (PEPFAR).

Wage costs in the Indian drugs industry come to only about 30% of the European level or 20% of the US level. Overall drugs manufacturing in India is up to 50% cheaper than in western industrial countries.

Here is an overview of the Indian pharmaceutical regulatory structure. Click on full screen and use finger to advance through slides.

These circumstances generated the investigation which produced this information.

The event:

In November of 2006 I had a second heart attack. This event was in addition to the first heart attack and stent in 2002 and a 2005 a bad stress test report led to two more stents. This second heart attack was the first event which resulted in heart tissue loss. This loss was due to blockage from clotting in the LAD diagonal artery.

In August 2006 we moved from NJ to GA. I had no contact with a Cardiologist at this point.  The November 2006 heart attack left me at the mercy of the ER to produce a qualified Intervention Cardiologist. The surgery was to no avail. The artery was too firmly blocked to get a stent implanted. The LAD diagonal was lost. I was put on a Coreg a beta blocker designed for post heart attack patients.  Here is the difference between domestic brand and Canadian generic sourced from India.

Validate per pill pricing  Carvedilol  (Generic Coreg)

The story:

My plan was to get the med from Canadian online to save money. At this point I was three years short of being eligible for Medicare. I had no insurance. Investigation into private coverage produced the same answer from several insurers. I was uninsurable because of my cardio history. They said they could do something with corporate coverage but not private. Ultimately the whole 2006 event cost me around $10,000 cash. The hospital gave a 40% discount and the doctor around 30% for a lump sum cash payment. The alternative to cash would have been a pay schedule with interest.

In the follow up visit I asked the doc for a one month brand prescription which was called into a local pharmacy as well as a hand written script to fax to Canada. The reason for the one month local prescription was to accommodate the two to three week delivery time for Canadian generic product that would come from an Indian supplier. I found that local pharmacies will only give you a thirty day supply but Canadian or online pharmacies will fill a ninety or one hundred eighty day order.

When I went to pick up the prescription the local pharmacist frightened me. He was very adamant that the non-domestic suppliers universally produced unsafe, impure and ineffective products. After this unsettling experience I was determined to get to the bottom of this quality issue. So took the one month order of the brand from him and went home to investigate. Obviously I was very interested in getting proper effectiveness from this med.

I went on the computer and searched the word Coreg. This produced some Canadian pharmacies which had a generic. I looked up the generic name a Cardivas. This was very comforting. The word Cardivas let me to Intas Pharmaceutical a manufacturer in India. The above link shows that Intas is FDA approved and inspected.

These images show the 2005 and 2006 stent procedure. I had bypass surgery in 2008. I asked the 2006 surgeon “you think I would be better served with a bypass?” He said “no”. The bypass was done at the Atlanta VA by Dr. David Vega and the Emory University heart transplant team which does heart procedures at the VA twice per week. I felt very blessed to have that world class team do the procedure.

Heart images 2005-2006

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In our case there were four items that were prohibitively expensive through the AARP / United Healthcare plan. These expensive items were exhausting our allowance prematurely. The most expensive AARP drug plan items were around $5.00 per pill vs. $0.50 per pill off plan. When we went over the allowance we had spent $2,200 of the $2,700 on these four items.  Here are the details of the savings in our case.

Example of savings delivered by Canadian pharmacies:

Validate per pill pricing:
Plavix (Clopidogrel Bisulfate)
Tricor (Fenofibrate)

This article is divided into four parts.

1. A strategy for abandoning AARP and using Canadian meds plus Wal-Mart $4.00 generic.

The subscriber expenses for the AARP plan are $2,151. If you’re total bill for meds is less then this it’s more cost effective to abandon the plan.  To determine if this is so in your case review your AARP billing and determine your big ticket items. Then see what these items cost from Canada. Our cost for getting everything from Wal-Mart ($4.00 generic) except the four big ticket items was $500. Our big ticket items from Canada cost $1,350.

Canadian only – abandoning AARP:

Canadian               $1,350              No AARP or part D.
AARP                     $   500              Wal-Mart $4.00 generic and other low priced meds.
Gap copay             $       0              Coverage gap pay 100% after $2,700.
Total year              $1,850              Save $2,000 over worst case.

2. A strategy for a mix of AARP / Wal-Mart and Canadian:

The subscriber expenses for the AARP plan are $2,151. We were getting a mix of generic $4.00 items from Wal-Mart and some expensive items from the AARP plan. By September we were $300 over the allowance of $2,700. Buying the four big ticket items from Canada for the rest of the year cost $350. If we did not go over the allowance we could have reduced our total spend by $200 and stayed within the allowance.

Supplement AARP with Canadian: (actual spend 2009)

Canadian               $   350             Off plan Canadian.
AARP                     $2,151             Total subscriber expense – see details below.
Gap copay             $   300             Coverage gap pay 100% after $2,700.
Total year              $2,801             Save $1,000 over worst case.

3. A case for not using AARP only:

This case is a based on our exceeding the allowance in September and paying 100% copay for the rest of the year. In our case we would have paid an additional $1,500 copay and never reached the stop loss threshold of $4,350.

AARP only – no Canadian: (pay 100% copay AARP coverage gap – to $4,350)

Canadian               $       0             Off plan Canadian.
AARP                     $2,151             Total subscriber expense – see details below.
Gap copay             $1,800             Coverage gap pay 100% after $2,700.
Total year              $3,951             No savings – worst case scenario.

4.  Details of the AARP plan as well as actual billing for 2009.

The AARP/United Healthcare insurance provides a drug plan which requires social security part D.  This plan is aggressively marketed by AARP/United Healthcare. Large segments of the senior population have signed up for this drug plan.

AARP drug plan structure:

Annual deductible                 $295
Initial coverage                     Up to $2,700 in total drug costs.
Coverage gap                         After $2,700 in total drug costs; up to $4,300 in copay.
Catastrophic coverage          After $4,300 in out of pocket (copay) no limit.

It’s important to recognize the following:

1. The primary benefit is $2,700 worth of drugs.
2. The $2,700 is combined copay and plan pay.
3. The coverage gap is $4,350 of copay only. – 100% your money.

The following represents the total of subscriber payments. There are four elements of expense to the subscriber. These are actual figures are from a family member’s plan.

• Premiums                                 Month              Year
• Medicare Part D                          $40               $   480
• AARP Rx Plan                               $23               $   276
• AARP Deductible                                             $   295
• Co-payment                                                     $1,100
• Total year                                                         $2,151

The actual benefit to the subscriber is as follows:

• Allownce                                   $2,700   Combined subscriber copay and plan pay.
• Co-pay                                     - $1,100   Subscrber copay.
• Actual benefit                           $1,600    Plan pay. 

• Plan benefit                              $1,600
• Plan expense                          -  $2,151
• Actual plan benefit                  ($ -551) – loss

The primary benefit of $2,700 allowance includes co-pay and plan pay.  Deducting the co-pay of $1,100 from the $2,700 allowance produces an actual benefit of $1,600 and a net loss of $551.

The following are actual bills we received. The 07/31/09 billing shows us $279 short of the $2,700 allowance. The 09/30/09 billing shows us $300 over the $2,700 allowance.

07/31/09 billing shows “Stage 2” approaching the $2,700 allowance.

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This bill shows us in “Stage 3” over the $2,700 allowance by $300.

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