Online medicine

A pharmacist once convicted by a New Zealand court of illegally selling prescription drugs to customers who did not have valid prescriptions is running a Vanuatu-based firm selling medicines to customers around the world, the Daily Post has found.

Regulators in Europe have expressed concerns about the site.

Vanuatu-registered Inhousepharmacy.vu sells a wide range of prescription drugs, including anti-depressants, antibiotics, hormone-blockers, blood anti-coagulants and even anti-HIV medications.

The site claims to be the one of the world’s “original and longest standing online pharmacies established in 1996”.

The site lists the name and Port Vila address of Pacific Health Limited, a company legally registered with the Vanuatu Financial Services Commission. Pacific Health Limited was registered as a local company with the Vanuatu Financial Services Commission in 2009 and is currently active. In 2009, Kerry Donald Bell, was appointed a director of the firm.

Ministry of Health officials confirmed that Kerry Bell registered as a pharmacist with regulatory authorities in Vanuatu in the early 2000s.

However, in 2003, Kerry Bell was convicted by Auckland District Court “in respect of 51 offences under the Medicines Act 1981”, according to a publication by the official Pharmacy Council of New Zealand.

A New Zealand Herald report at the time noted that Bell received a heavy fine, after he pled guilty to charges “including selling prescription medicines from premises other than a pharmacy or a hospital, selling prescription medicines without a registered medical practitioner’s prescription and publishing a medical advertisement that failed to include information required by regulations”.

The New Zealand Herald report stated that the turnover of Bell’s company “was about $1 million a month”, with sales in August 2001 even exceeding that figure. It also noted that Kerry Bell was engaged in the pharmacy business in Vanuatu, from where he shipped medical drugs all over the world.

The newspaper claimed that Bell’s legal troubles only started when he moved some of his processing to New Zealand because of telephone system “difficulties processing transactions entirely in Vanuatu”.

Eina O’Donohue, a senior media advisor at the Ministry of Health, confirmed Mr Bell’s conviction to the Daily Post.

She said that Medsafe, New Zealand’s pharmaceutical regulator “took a prosecution against Kerry Bell in 2000 … Medsafe was unsuccessful in this prosecution. Another prosecution was taken in 2002 at which Mr Bell pled guilty…Mr Bell was sentenced on these charges in 2003.”

After his conviction, the Pharmaceutical Society of New Zealand removed Bell from its official register of pharmacists, after a damning report by its disciplinary committee. Extracts of the disciplinary report, published in a 2004 newsletter by the Pharmacy Council of New Zealand, which took over many regulatory functions from the Pharmaceutical Society, state “Mr Bell’s conduct …was completely inexcusable and constituted a flagrant disregard of the most basic tenets of the profession. The magnitude of Mr Bell’s ventures leaves no room for doubting Mr Bell chose to disregard his most elementary professional obligations … [and his] conduct was both cynical and calculated. Many of the prescription medicines in question have significant potential risks. The fact Mr Bell’s motive was financial greed merely underscores the Committee’s belief that there is no room in the New Zealand profession for Mr Bell”.

Dr Owain George, the Registrar of the Pharmacy Council told the Daily Post that he was unable to disclose the full disciplinary report to us for legal reasons “given that the Disciplinary Committee did not order further publication”.

Currently, InhousePharmacy.vu offers to ship its prescription drugs to numerous European and Asian Countries.

The Daily Post found that government medical regulators in many of those countries say InhousePharmacy.vu has no license to export medicines to their nations legally.

Valentin Bulard, a spokeperson for the French Agence Nationale de sécurité du Médicament et des produits de santé told the Daily Post “Only medicines for which a prescription is not necessary can be sold online”, and also noted stringent rules regarding the registration of these sites with French health authorities.

M Bulard added, “The website InhousePharmacy.VU will be registered on the PHAROS database (Plateforme d’Harmonisation, d’Analyse, de Recoupement et d’Orientation des Signalements). PHAROS takes in signals of illegal contents or behaviours that are then being dealt with by law enforcement officers attached to PHAROS. If it is concluded that the content is indeed illegal but originates from a foreign territory, the problem will be transferred to Interpol that will communicate with the judicial authorities of the concerned country.”

Lukas Jaggi, a communication manager at the Swiss Agency For Therapeutic Products, told the Daily Post “’InhousePharmacy.vu /Pacific Health Limited’ does not have an authorization from Swissmedic”, and made clear that no other Vanuatu based firm had one either. He also said that the “mail-order trade in medicinal products in Switzerland is generally prohibited and subject to strict conditions.”

He continued “During the last 10 years, a total of 120 illegal shipments with unauthorized medicines from Vanuatu were detected at Swiss customs and an administrative procedure leading to financial penalties was initiated by Swissmedic against the recipients of the confiscated shipments. Most medicines obtained via Internet mail order services are ordered by individuals who are not aware of the health risks involved.”

Mr Jaggi explained that it has been impossible to determine who was behind the shipments “as the mentioned shipments were sent by different addresses from Vanuatu, an assignment to a particular company was not possible, especially because the sender address contains mostly fictional company abbreviations and/or a post box sender address.”

Jaggi concluded “Swissmedic is concerned and reminds people – in Switzerland and elsewhere – not to buy and consume medicines or nutritional supplements from dubious suppliers on the Internet ... The illegal trade in medicines has reached the global dimensions of organised crime, so international collaboration by the authorities is becoming increasingly important”.

Asked about Inhousepharmacy.vu, Paweł Trzciński, a spokesperson for the Polish Main Inspectorate of Pharmacy told the Daily Post “our border control will pay special attention to packages from your country, Secondly, we plan to raise the issue at the global level of PIC/S, using the examples you mentioned, and finally — we will use the information in communication campaign against such a practices.”

Kertu Marie, a pharmacist at the Swedish Medical Products Agency told the Daily Post “You are not allowed to import medicine (for personal use) by mail into Sweden from countries outside the EU… We cannot investigate illegal activities in other countries, only here in Sweden where Swedish legislation applies. Usually when we encounter this kind of cases we send information to the authorities in the country where the person has his company, since it is their legislation that must be followed.”

Elin Maria Gustaffsen, an assessor at the Medical Productrs Agency commented further “I am not aware that we have had any cases with Vanuatu based firms at the MPA. The MPA does not know if shipments from Vanuatu has been seized in customs”.

A spokesperson for the Department of Health in Hong Kong told the Daily Post that in Hong Kong “all imports and exports of pharmaceutical products must be covered by import and export licences. According to our records, “InhousePharmacy.vu” and “Pacific Health Limited” are not licensed drug dealers in Hong Kong.”

Maria Papaioannou, a pharmacist at the Inspectorate Department of the Pharmacy Board of Cyprus told the Daily Post “InhousePharmacy.vu /Pacific Health Limited has no Licence to sell medicines in Cyprus”. However, she said she was not concerned about the issue, because “As far as we know nothing has been imported from Vanuatu. Maybe they come at the [Turkish controlled] North part of Cyprus which is the illegal so called ‘Republic of North Cyprus’ “. She also said importation by patients of small quantities of prescription medicine for personal use is legal.

A spokesperson for the Belgian Federal Agency for Medical Products told the Daily Post “This company has no license or permission granted by the Belgian federal agency for medicines and health products (famhp) to sell prescription drugs. The European legislation allows citizens to buy non -prescription drugs, also via mail, by any authorized pharmacy in another Member State. The citizen may not import medicines from third countries without authorization or prescription (that has to be given to the pharmacist). The authorized Belgian companies may import medicines from third countries if those companies have the right authorizations from their health authorities. Famhp has not investigated InhousePharmacy.vu. We have only seized two postal parcels coming from Vanuatu, 4 years ago. We are not going to get in touch with the Ministry of Health in Vanuatu.”

Australia’s Therapeutic Goods Agency would not comment specifically on InhousePharmacy.vu, but did say that importing a small amount of prescription drugs for personal use is legal under Australian law.

A former US White House Aide warned about illicit online pharmacy companies that are using Vanuatu as a base to export medicine to other countries, without applying for the required import licenses, safety approvals and permits there.

John Horton, a former US deputy district attorney who later served as the Associate Deputy Director at the Office of National Drug Control Policy, a White House Agency during the George W. Bush presidency, said it is about the principle of being a good neighbor in the international community.

He told the Daily Post “I do think that Vanuatu needs to make sure that its pharmacies are doing what they are intended to do — provide services to residents of Vanuatu, not serve as a conduit for illegal drug trafficking, which is what’s happening.”

Mr Horton currently is the President and CEO of the private sector regulatory organization Legitscript, which verifies the credentials of online health care businesses, and whose partners include Amazon and Google.

Allowing the unlicensed export of pharmaceuticals is a “black mark on Vanuatu’s international reputation and is very unfortunate”, Horton said.

He explained that government officials in other countries had expressed their private concern to him about Vanuatu not taking adequate action to regulate the internet pharmacy trade sector: “I’ve heard several comments over the years from government officials and people at major Internet and payment companies that Vanuatu seems to be turning a blind eye to illegal conduct on its own soil targeting other countries.”

He stressed that he didn’t desire to interfere in Vanuatu’s internal affairs. “If Vanuatu wants to let them sell these kinds of unapproved medicines to its own citizens, it can go right ahead — I don’t want to tell the people of Vanuatu how to govern themselves. But stop tolerating criminal activity that puts the rest of us at risk.”

Horton said that it was “entirely understandable” that the Government of Vanuatu was focusing on rebuilding the country after Cyclone Pam. However, he noted that there would be assistance available, free of charge, to Vanuatu’s health authorities from him and other designing fair and effective regulations for the pharmacy sector. “We’d be absolutely be happy to help, and I know others would as well”, he told the Daily Post.

Horton’s organization, Legitscript has drawn criticism from those who claim that a tighter regulation of the pharmacy import business in the US drives up prices for patients, restricting free trade and increasing the profit margins of the pharmaceutical industry in the US. So for example, Tod Cooperman, the president of rival verification service PharmacyChecker.com wrote in 2010 “We at PharmacyChecker.com think that shutting down ‘rogue pharmacies’ that sell narcotics, or any drug, without a prescription is right. LegitScript’s efforts in that direction are commendable. But shutting down access by Americans to safe and affordable prescription medication is bad policy, unethical and unfair”. Legitscript rejects the criticisms.

Legitscript has won plaudits from the US National Association of Boards of Pharmacy for its role in fighting the activities of rogue, unlicensed online pharmacies. Legitscript was also a partner for the prestigious, Europe-wide Fakeshare program, an effort by health care regulators and universities to coordinate the fight against pharmaceutical crime, which was financed by the Prevention of and Fight against Crime Programme of the European Union.

An experienced doctor who heads a non-profit organization that works to facilitate access to vital medicines for Americans who struggle to afford them told the Daily Post that that patients are turning to dodgy online pharmacies out of financial desperation.

Dr Richard Sagall, the president of US non-profit group Needymeds, said “Access to medication is a real problem for many Americans. As insurance deductibles and drug copayments increase, many find they can’t afford their prescribed drugs. Out of desperation they turn to web-based pharmacies.”

Some pharmaceutical companies that provide free medicines to qualifying patients, and other programs offer financial assistance with payments, Sagall explained. “But for many Americans it comes down to realigning priorities and foregoing paying bills or going without the medicines they need,” he continued.

Nonetheless, Sagall was critical of the offshore international online pharmacy trade: “I can’t speak for all web-based pharmacies, but I recommend people avoid them.” He said that “many studies have shown that the quality of the drugs provided by many of these pharmacies is unreliable. You may receive the drug you ordered at the strength you need, you may receive a different dose, or you may receive a different drug. The pills may contain no medicine, a different drug than what you ordered, or the right drug“.

An analysis carried out for major US news agency Reuters found that “U.S. prices for the world’s 20 top-selling medicines are, on average, three times higher than in Britain”, and also consistently far above those common in other key pharmaceutical markets in Europe and South America.

Last year scientists at the University of Liverpool in Britain found that one vitally-needed drug against the relatively common, but in many cases fatal, Hepatitis B disease could theoretically be mass produced for just 36$ for the equivalent of a patient’s annual need, as opposed currently common US price of over $15000 for that quantity of the medication.

Many critics have raised concerns that strict patent regimes for medical drugs, combined with limitations on drug importation, have driven up the prices of drugs for customers and give big pharmaceutical firms excessive control over the drug market. Even Donald Trump, the Republican candidate in the upcoming US presidential election, has advocated for the legalization of drug re-importation into the US to lower prices, despite his stern opposition to international free trade and championing of economic protectionism.

Members of the World Trade Organization that count as among the least economically developed are currently exempt from having to adhere to drug patenting rules, given them the freedom and flexibility to produce cheaper drugs. Vanuatu is believed to be in the group of nations that is exempt.

But the current exemption is slated to run out in 2033, after US diplomats opposed requests by developing nations to extent it indefinitely. At the time a respected humanitarian aid expert, Rohit Malpani of Medecins Sans Frontiers commented “The deal shows that the US government is more interested in backing the commercial interests of multinational drug companies in lieu of doing what’s fair for sick people in the world’s poorest countries.”

There is no suggestion that Kerry Bell or Pacific Health Limited broke any laws in Vanuatu.

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