JanDrew: When visiting Hulda in Mexico .....
April 17, 2001
When Purchasing Medicine in Mexico, Buyer Beware
By SARAH LUNDAY
Robert Burroughs for The New York Times
Larry Hoffer of Mountainview, Calif., bought generic {*filter*} in Tijuana.
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Robert Burroughs for The New York Times
In Tijuana, Mexico, the number of pharmacies has risen to 1,500 from 500 in
1997.
Robert Burroughs for The New York Times
Joseph W. Misenhelter, a customs inspector at the port of San Ysidro,
examines {*filter*}, found in a storage locker, that are suspected of being
counterfeit.
NUEVO LAREDO, Mexico - On a breezy afternoon in late January, 64-year-old
Nancy Crofoot sat with several friends at an open-air cafe, sipping frozen
margaritas and comparing pharmaceutical prices. A bottle of the acid reflux
medicine Prilosec costs more than $125 in the United States. Ms. Crofoot
found a generic version in this border town for $30.
The number of older Americans coming to Mexico for discount medications has
fueled an industry that thrives off the ability of consumers to pass through
United States Customs with little or no hassle, and has raised safety
concerns on both sides of the border.
In Nuevo Laredo, Tijuana, Los Algodones and other communities, the number of
pharmacies has doubled, sometimes tripled, in recent years. Tijuana has
1,500 pharmacies, up from 500 four years ago, according to the city's
association of pharmacies.
Many of these have sprung up in a couple of days, medications filling the
shelves before walls are completed. Mexican laws allow stores to open with
just a business license and allow pharmacists to work with no training in
dispensing drug prescriptions.
"The pharmacies near the border are not worried about the {*filter*} helping
people," said Jos Snchez, the president of the Mexican Association of
Pharmacists.
American officials lack data on the quantity or the quality of medications
coming across the border, but they believe an increasing number of people
are heading south to buy. About 293 million crossings into Mexico were made
last year, 15 million more than in 1998.
Americans can legally transport medications for personal use with a
prescription from a doctor in the United States. The {*filter*} cannot be highly
{*filter*}ive narcotics or exceed 50 doses approved for use in the United States
by the cooking.net">food and Drug Administration, according to a revised pamphlet handed
out by officials at border crossings.
The F.D.A.'s most recent survey, conducted in August, found that 46 percent
of Americans returning with medication from Mexico were 51 or older and that
they most commonly bought antibiotics, as well as {*filter*} for diabetes,
estrogen replacement, arthritis, impotence and pain. Survey workers
interviewed 641 people at eight crossings.
F.D.A. officials say medications from Mexico are difficult to trace and may
be manufactured improperly, stored incorrectly, mislabeled or contain an
inaccurate amount of the active ingredient. The {*filter*} are manufactured by
Mexican pharmaceutical companies or American companies with plants in
Mexico, or they come from as far away as India.
"When you buy these foreign {*filter*} you could be getting anything from a
counterfeit to a sugar pill," said William K. Hubbard, the senior associate
commissioner for policy, planning and legislation for the F.D.A.
The Pharmaceutical Research and Manufacturers of America, which represents
100 of the largest pharmaceutical companies, said in September that chemical
analysis found some Mexican {*filter*} to be fake. Inspections of the {*filter*}
Fludac (an antidepressant), Omesol (an ulcer treatment) and Glipitrol XL
(for Type 2 diabetes) discovered that they contained too much active
ingredient or were impure.
American law enforcement officials said the amount of counterfeits and
substandard medications could be as high as 25 percent.
"There is a lot of money to be made, and there are a lot of desperate people
willing to buy the {*filter*}," said Vince Rice, a spokesman for the Drug
Enforcement Administration.
Nancy Crofoot does not consider herself desperate, just frugal. She travels
annually to Texas with her husband, Jim, from Bay City, Mich., to enjoy the
warm weather and to cross into Mexico to stock up on medicine and
cigarettes.
"It's the reason everybody comes here," Mrs. Crofoot said, motioning her arm
across the landscape.
Trash, mud and beggars line the cramped streets of Nuevo Laredo. A young
Mexican girl carries straw dolls for sale, sharing space with well-dressed
men in groups asking if people need medications. The men receive tips for
taking tourists to the three or four farmacias on each block.
Congressional staff members recently visited crossings near Laredo, Tex.,
and San Diego to investigate how customs and cooking.net">food and Drug Administration
officials were handling the increase in border traffic and what quality
checks were used. They found that officers at border crossings were too busy
to inspect every person. When prescription {*filter*} were declared, officials
followed a hodgepodge of federal and state laws.
Sometimes they allowed 50 doses of a drug without a prescription and other
times 90 doses. At some crossings, Mexican prescriptions were accepted; at
others, only American prescriptions were allowed.
One recent day, customs officials, who are expected to uphold about 400 laws
for 40 different agencies, spent more than 45 minutes inspecting one person,
referring to manuals and the Internet to determine if a drug was approved
for use in the United States.
"The rules are so inconsistent, it's meaningless," said Philip Anderson, the
director of drug information service at the University of California-San
Diego Medical Center.
F.D.A. and customs officials agree that there are inconsistencies.
"To some extent, people have to take responsibility for themselves," Mr.
Hubbard said. "But they probably don't have an appreciation of what the risk
is. I think the most the government can do is try to warn people and try to
protect patients as much as possible from dangerous {*filter*}."
The agency has been performing a balancing act as Congress tries to meet the
public's demand for inexpensive medications and protect people from
dangerous imports.
Congress approved a law in December allowing pharmacists and wholesalers to
import prescription {*filter*} at lower costs for consumers. Immediately after
the law was approved, Donna E. Shalala, then the secretary of health and
human services, said the program was severely flawed and refused to put it
into effect. Ms. Shalala's action still stands, although several members of
Congress have asked the new administration to reverse the decision.
"We're acutely aware of the fact that about one-third of the elderly in this
country don't have access to reliable prescription drug coverage," said
Representative James C. Greenwood, a Republican of Pennsylvania, who is on
the House Commerce Committee. "In this day and age, if you don't have access
to prescription {*filter*}, you don't have adequate health care. Some people are
in desperate straits."
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