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Public Comment to the WHO About Online Access to Imported Medicines and SDG 3.8

One of the Sustainable Development Goals, 3.8, created under UN auspices is: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” Lower-income countries where majorities of citizens can’t afford basic healthcare are deserving of our urgent and generous help, but the pain and anguish faced by American families where people are dying because they can’t afford medicine must also be addressed.

Online access to safe and affordable imported medicine can improve and even saves lives of those who can’t afford medicine where they live. This is particularly the case in the United States, where over 30 million people have no health insurance at all, and approximately 87 million are not adequately insured [Commonwealth Fund, 2019].

Organized under the support of the World Health Organization (WHO), as part of the effort to achieve global healthcare goals, twelve multilateral global health and development organizations are seeking public comments to help them develop their “Global Action Plan for Healthy Lives and Well-being for All.” My comment is below.

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Do Google & Bing censor online pharmacy search results? Pharmaceutical companies have called for censorship.

Until we lower drug prices here at home in America, online access to affordable medication internationally is clearly essential. But what if we lived in a country where people were no longer able to find safe international options online?

In an ideal world, search algorithms empower consumers to find the exact information they are looking for on these search engines. In a recent Google algorithm update (March 2019), which affected the “natural” or “organic,” non-paid search results, we wonder if there was foul play involved in which Google was caving in to Big Pharma. The Electronic Frontier Foundation identified this problem in 2016, in “How Big Pharma’s Shadow Regulation Censors the Internet.

The results at the very top of your Google search are often ads, which are of course paid placement: a different problem.

Please check out our new video on this difficult and troubling topic of censorship of online pharmacy and drug prices content.

Those patients searching on Google for information about affording medicine through online pharmacies were significantly disadvantaged by the Google March 2019 Core Update. The reason is that results for PharmacyChecker ‘s verification and pricing information are now much harder to find than they were on March 11th, 2019— a day before the update.

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Bing is Promoting Dangerous Online Pharmacies, Says New Study

According to a new study published by the American Enterprise Institute, the search engine Bing, which is owned by Microsoft, has added pop-up warnings to search results that increase the chances that web searchers will click to rogue online pharmacies. As the reports shows, Bing’s action appears to purposefully thwart safe personal importation of more affordable medicines. It is one of the clearest examples of censorship resulting from “voluntary agreements” among Internet companies, “encouraged” by regulators, that will threaten the health of patients buying medicine online under the guise of protecting them. Bing has placed warnings on its organic search results of Canadian-based and other international online pharmacies, yet the search engine fails to do so for many rogue websites, ones proven to sell counterfeit drugs. Here’s how that happened.

The problem is Bing’s use of the National Association of Boards of Pharmacy’s (NABP) Not Recommended List (NRL). Many of the NABP’s programs involving online sales of medicines and educating the public about online pharmacies are funded by drug companies, and therefore supportive of the industry’s profit-protecting goals against importation.

Bing’s Backwards Partnership with the NABP

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Sheryl Sandberg Testimony on Drug Importation and Online Pharmacy

Sheryl Sandberg testimonyThe future of your ability to buy lower-cost medicine online from another country was indirectly discussed recently during congressional hearings with Facebook Chief Operating Officer, Sheryl Sandberg, and CEO and founder of Twitter, Jack Dorsey.

The issues on the table were much more grandiose-sounding than importation from Canada or buying medication internationally using the Internet. Russian meddling in our elections; political bias on Twitter against conservative and Republican ideas; personal privacy protection; and lots of discussions that affect 1st Amendment protections.

The takeaway by some experts is that Congress is getting ready to regulate the Internet.

As it applies to online access to safe and affordable medicine, Internet regulation could lead to access protections or access denied. In short, the pharmaceutical industry is actively engaged in driving safe international online pharmacies offline. The industry can often get what it wants from Congress and so the dangers of Internet censorship to block access to or shutdown international online pharmacies are real.

For a variety of posts on this, see our section on Internet Censorship.

Google’s top executives were invited to the hearings yesterday, but they declined to attend. Some accused them of being arrogant. But the company itself noted that search engines, like Google and Bing, are not the same as social media networks, like Facebook, Twitter, and Instagram. Google’s search engine was not used by bad actors in the way that occurred on Facebook, for example.

Google’s absence reminded me of Ms. Sandberg’s appearance at another Congressional hearing when she was vice president of global sales for Google in 2004. That hearing of the Committee on Governmental Affairs; Permanent Subcommittee on Investigations focused on Internet access to medication and importation. In prepared remarks, Ms. Sandberg stated Google’s position on importation and online pharmacies:

“As a provider of Internet-based information tools, Google has no position on the broader merits of the drug importation debate, or on the optimal mechanisms for regulation of online pharmacies; rather, our interest is to preserve the ability of Internet users to find useful and relevant information, including information about licensed pharmacies.”

That was then; this is now. Fast forward to last spring: Google has made a deal with the FDA that undermines its earliest and best principles as articulated by Ms. Sandberg. That deal is not about blocking Canadian pharmacy ads on Google. That’s old news in bad policy-making. The new deal is that Google will remove search results if asked by the FDA, based on its administrative decisions, without a court order. These are so called “organic” searches, not paid results.

To date, the FDA has yet to use this new permission from Google to censor safe international online pharmacies. And it continues to use due process through warning letters to rogue online pharmacies, as it did to combat sites selling tramadol without a prescription. I agreed with the FDA on that action because those sites have proven to harm people who are addicted to opioids.

But, you know, pharmaceutical companies have spent four billion dollars lobbying Congress over the last 20 years or so. And if Congress is legislating new regulations to control behavior on the Internet, Pharma won’t be far behind with its goal to stop Americans from buying more affordable meds online.

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Did Instagram Shut Down our Account as Part of its Crackdown on Opioid Drugs: Protecting Patients or Big Pharma Censorship of Lower Drug Prices?

Instagram shut down our account

The pharmaceutical industry, generally, does not like our company. As an extension of that feeling, the FDA doesn’t love us either. Basically, we are in Big Pharma’s crosshairs because the information we provide helps people find more affordable medicines from other countries and import it for personal use.

But is that a reason for Instagram to shutdown our account!? That action is nothing less than corporate-inspired, government-encouraged censorship. Mike Masnick of TechDirt refers to this as the soft underbelly of Internet censorship. Also, please read this background from the Electronic Frontier Foundation calling out Big Pharma on this issue.

Congress and the FDA are banging on the door of Facebook, Google, Instagram, etc. about stopping people from selling opioids on their platforms. We can debate until the cows come home about what content should be self-censored — meaning removed without a court order — but please hear me out on why Instagram’s dissing PharmacyChecker doesn’t even come close to acceptable and let us know if you agree or disagree.

First of all, PharmacyChecker.com does not sell or facilitate the sale of medication. Medications are not purchased on our site and we have no role in the processing of prescription orders. We verify credentials and publish information about online pharmacies and drug prices. That information is globally accessible on the Internet.

By the way, our Verification Program bans online pharmacies that ship controlled drugs of any kind into the U.S. This includes not only prescription opioids, but also Valium, Xanax, and Adderall. We’re with the DEA on strict controls and highly attuned to and concerned about the opioid crisis. I have friends who view our policy as too conservative. You get the picture.

We agree with cracking down against dealers of opioids, with Fentanyl being the greatest concern. On the other hand, we have seen Pharma and the government use a crackdown against addictive prescription drug sales online to veer into a crackdown against imports from Canada of decidedly regular meds that treat asthma, diabetes, depression, high cholesterol and blood pressure, etc.

We launched PharmacyChecker in 2003 to help people searching the Internet for lower medicine prices from real pharmacies, domestic and international. Our verification program is run by a licensed PharmD from Massachusetts, Dr. Shivam Patel. Pharmacies listed in our program must require valid prescriptions, sell only personal-use quantities, have a pharmacy license, and cannot sell controlled drugs of any kind internationally, into the U.S.

Feel free to read about our extensive protocols for verifying international online pharmacies.

In 2012, I was asked to write a chapter in a book called Hacking Politics, which is now published as an anthology about the battle to kill the Stop Online Piracy Act. My chapter was called the “Online Pharmacy Story.” In short, due to lobbying by the pharmaceutical industry, SOPA contained language that would have potentially made PharmacyChecker.com illegal at a maximum; at minimum, it would have increased our intermediary liability exposure. I strongly opposed it. And yet we see big industries moving SOPA by a thousand cuts.

I believe there’s some chance that Instagram dissed our account accidentally, based on a sweep of sites having to do with drugs, medicines, pharmacies, etc. But there’s also a small chance that Pharma’s influence led to the direct shutdown of our account as a slap in the face to PharmacyChecker advocacy efforts. I’m constantly criticizing Pharma’s propaganda about importation and online pharmacies our blog, in the New York Times, RightsCon, and directly to members of Congress in my testimony.

In fact, last year I caught PhRMA, meaning the big pharma trade association, placing Google ads using our name to dissuade people against importation of lower-cost medicines. As I wrote in our blog, that was a badge of honor but kind of disconcerting as well.

Late last month, the FDA called Instagram, Google, Reddit, and many others, to what was called the FDA Opioid Online Summit. I blogged about it beforehand mostly to note that groups funded by Pharma were well represented, ones that focus on opposing importation of lower-cost medicines and use the opioid crisis for that goal. Initially, the summit was billed as a public event, but it turns out that journalists were locked out and those that covered the public part did conclude that opioids were not the sole target, but cheaper meds were open season, too.

We want our Instagram account reinstated on principle, yet no one has responded to our multiple attempts at contacting Instagram’s customer support.

Anyone willing to weigh in on this?

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Google and FDA Shake on Censorship of Affordable Medication

Google FDA Handshake MedicationThis past month, Congress passed a flurry of bills dedicated to stopping the devastation of the opioid crisis. One focus is on stopping illegal opioid imports from coming in though the U.S. mail. The Synthetics Trafficking and Overdose Prevention Act, which passed in the House, is one such bill. But as I wrote in the The Hill last year, the STOP Act could also enable the FDA to more easily prevent Americans from importing lower-cost, safe and effective medicines from Canada and other countries.

The FDA is also fighting the opioid crisis by scrutinizing the Internet as a channel of illegal sales. That, too, could lead to the curtailment of access to lower-cost, imported medicines from pharmacies, ones which don’t sell opioids or controlled drugs at all, but do help people afford medicines.

Ideally, people who use a search engine, such as Google, find information based on an objective search algorithm. With tens of millions of Americans not filling prescriptions due to high prices here at home, many are Googling to find and order cheaper medication from international online pharmacies. (more…)

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