Nothing surprising in this. People are using an automated online marketplace to sell illegal goods. Online marketplace takes down products when they are reported.
It's a game of whack-a-mole and Amazon is doing the bare minimum. The company has no incentive to do otherwise.
Ebay actually has automatic flagging to keep illegal products off their site.
I know this because I once tried to sell a pulse oximetry meter there and it got autoflagged and taken down. Apparently you can't sell (some?) medical supplies on ebay even though I bought the pulse ox meter from the store.
until someone dies because of a drug sold through their website and the surviving family members feed the media a horror story with which they can create the black sheep, amazon, which profits from the deaths of its customers
Most of those people are still under a doctor's care, so while they may not need the medication that much and may pay the price later, there is at least some accounting/supervision going on. When/if someone dies in a case of overprescription, there is clearly someone to be held accountable. A possibly overly sensational case of this is Michael Jackson's doctor who was found guilty of manslaughter.
When you self prescribe foreign prescription medication, and die/suffer some massive side effect, there's no real recourse.
I got some topical clindamycin over-the-counter when I was in Thailand, and it worked better than any other acne drug I had tried. I couldn't find it in any pharmacies after returning to the US, however. I emailed the FDA about it, and they responded:
Clindamycin is an antibiotic, whereas benzoyl peroxide is not. Necessary characteristics for OTC drugs include an acceptable safety margin, low misuse and abuse potential, and adequate labeling. In addition, consumers must be able to self-diagnose, self-select the medication [self-selection is the decision a consumer makes to use or not to use a drug product based on reading the information on the drug product label and applying knowledge of his or her personal medical history], self-treat and self-manage the condition for which the OTC drug is intended, and additionally, a health care practitioner is not needed for the safe and effective use of the product. An OTC drug is considered to be safe and effective for use by the general public without a prescriber's authorization. At this point in time, FDA believes that clindamycin does not qualify as an OTC drug.
There are legitimate concerns with unrestricted access to antibiotics. If you misuse them, you're possibly not just hurting yourself. You might be hurting everyone, because you might be breeding resistance bacteria.
And thank goodness for that. Can you imagine if farmers could just buy antibiotics by the truckload and feed them to healthy livestock as a growth enhancer?
Note that "illegal" is always relative - there are many drugs that are prescription-only in some countries but available freely in others, illegal in some and not in others, etc.
So? What does that have to do with anything? It's illegal in the United States to import these drugs into the United States. Amazon is based in the United States. What does it matter if they're legal or not in any other country? This story is all about importing these drugs into the United States.
Amazon is available in hundreds of countries. Are they obligated to restrict trade based on the rules of each of those countries or just the US? At what point does a company that provides a platform for others to do things (e-commerce, content distribution, etc.) become responsible for policing how that platform is used? I suspect the answer is generally "at the point they are forced to do so".
If Amazon can tell if a film or music has the proper rights to play in a certain region, they certainly can be held accountable with respect to what drugs are legal in any given region.
Certainly they are aware of regional policy/infrastructure, so writing this off as "it's a global product," is not really productive.
In the case of video streaming, Amazon is the seller, not just the platform, so of course they're responsible for ensuring that what they're selling is legal. In the case of 3rd party vendors on Amazon, they're just a platform.
Nonetheless, platforms do assume some level of liability. Anyways, my argument here is not that Amazon is liable or at fault, but that the standards in the US have created a system where people are able to make assumptions about products they buy, and in this case, Amazon as a platform fails them to some extent. One could say it is our own fault for accepting the system we have, and I don't intend to put blame on Amazon, the seller, or the consumer, I only meant to point out that Amazon can and will make locale specific adjustments to their products and it doesn't seem completely insane that they do here. They can limit the sale of particular drugs with respect to the location of the purchaser without inhibiting the same to others where that product is legal.
> What does it matter if they're legal or not in any other country?
From a legal point of view? None. From a moral? Not so simple. A lot of drugs are prescription only in the US for really no reason whatsoever.
Two examples are Nystatin and Mebendazole.
I even emailed the FDA about Nystatin and they said that to become OTC it would need a sponsor, which is a stupid reason to leave them prescription only.
For a drug to make the switch from Rx to OTC, you need to prove a lot of things. Can consumers understand how to correctly diagnosis the disease it treats? Can consumers correctly dose themselves? Will consumers knows when to stop treatment and seek professional help.
You have to remember that not everyone follows directions or uses medications correctly. I don't blame the FDA for not making a drug OTC unless they can prove it will be used safely.
For Nystatin: Does your baby have a rash that looks like raised red dots?
For Mebendazole: Did you drink or come in contact with potentially infected water?
There are plenty of OTC drugs with far more complicated symptoms. It's really completely arbitrary - or more accurately, it's driven by companies wanting to expand their market into OTC (as soon as it goes off patent) rather than anything actually medical.
Take Nexium for example: It was prescription only (and very expensive) till the patent ended. The day the patent expired it turned OTC.
From wikipedia: "Mebendazole has been associated with a risk of agranulocytosis in rare cases."
Kind of a severe side effect, no?
Nexium was available OTC right after the patent expired because the company that made it went through the OTC approval pathway. It was actually a sales strategy because plenty of people will buy brand name OTC drugs where if the got an Rx most pharmacies require the generic be provided.
Amazon is a global company, it matters because not all of their customers are in the United States and they have no need to obey US laws with non-US customers.
The day doctors sold out and started accepting bribes from pharma reps is the day that I stopped trusting them, and I certainly don't care what they think as it relates to steroids, pain killers, and antibiotics.
These are drug dealers complaining that they are being circumvented. Boo hoo.
I have quite a bit of a problem with people ordering antibiotics, and breeding antibiotic-resistant bacterial strains both inside their bodies, and in our sewers once they feel better and flush the rest of the pills.
So instead they should go to the their local doctor, pay their $15 co-pay and then take their antibiotics.
Come on, we all know that if you have insurance and see your doctor with the sniffles, you can leave with a antibiotic prescription if you want.
I'm not defending the illegal online drug markets, but the problem of resistant germs is a much bigger problem and it has nothing to do with Amazon resellers.
I dislike your casual dismissal of medical expertise, it smacks of ignorance.
No offense, but "i don't trust doctors for arbitrary subjective reason X" is, to me, the exact kind of garbage I hear from non-scientific "global warming skeptics".
They find some arbitrary, subjective reason to validate their distrust of experts in a field they are a laymen in.
I don't see how you're not doing the same thing. Vilify an industry, smear doctors because of your subjective vilification, and then apparently come online and promote your false "skepticism" rooted wholly in what sounds like a laypersons understanding of their work and industry.
I humbly ask that you please reread my comment. I didn't say anything about not trusting doctors. Nor did I say anything about vilifying them. I certainly didn't mean to be offensive. In fact, I am very much aware that there's a real chance at some point in my life I will be in a situation where a doctor will save my life.
I said if you have insurance, you can easily walk into most doctors' office with the sniffles (my poor choice of words for an illness with symptoms, but most likely not needing antibiotics) and walk out with a script for an antibiotic. Perhaps my sample set is very abnormal, but I see this constantly among my friends and colleagues. When they get a cold, they go to the doctor after a few days and leave with a prescription. When I've asked folks about it, it seems mostly out of habit. You feel bad, you go to the doctor. I find it odd, because if I ever get really sick and need antibiotics to keep me alive, I want them to be maximally effective.
I agree that it's a bigger problem, but I believe this will make it significantly worse.
Right now, you have to go to a doctor and get a prescription - if you don't have a bacterial infection, or aren't likely to get one (e.g., post-oral-surgery stuff) they won't prescribe you the antibiotics.
If it's possible to buy it on amazon, people will end up 'abusing' them to try and treat non-bacterial infections.
Doctors throw antibiotics at viral infections as a placebo cure _all_ the time. Neither that activity nor these Amazon resellers make a dent in antibiotic use when compared to factory farms and traditional cattle operations. Like it or not, antibiotics are a staple in the diets of a large majority of this country's mammalian population
> Doctors throw antibiotics at viral infections as a placebo cure
That's actually not what doctors say. When they can't determine if an infection is viral or bacterial, they treat it on the chance that it's bacterial (since we have a known treatment for bacterial infections and don't usually have a treatment for viral infections).
Tonsillitis is a good example: About 50% of tonsillitis cases are viral and 50% bacterial. "Relying on clinical presentation and history alone is unreliable in differentiating streptococcal from viral tonsillitis."[1] And bacterial tonsillitis can be quite serious.
So it seems reasonable to go ahead and treat with antibiotics even when there's a 50% chance that it's wasted, because the other 50% chance was that the treatment was highly beneficial.
> Doctors throw antibiotics at viral infections as a placebo cure _all_ the time.
A fact pulled directly from your ass. Doctors never prescribe antibiotics for viral infections; antibiotics are for bacterial infections and no they don't just hand them out willy nilly.
Yes, but for placebos they proscribe low-level, relatively harmless antibiotics instead of nuclear-level drugs like clindamycin that decimate your internal flora and leave you with galloping diarrhea that can kill you.
Aside: I laughed at this because Im now under the assumption that Jimmy Johns is the goto for these things since my dentist mentioned it when sonicare was over.
I have no problem with this either. I don't believe it's a proper role for government to regulate what substances people can buy and ingest. I would happily shut down the FDA altogether. If you're stupid enough to buy and ingest something poisonous, well... so be it.
Note that none of this is mean to say that sellers should not be held liable for fraud if they ship something other than what they claim to be shipping. But that's a separate issue.
Just don't neglect people's right to store some antibiotics in their preparedness kit without wasting a doctor's scarce time and engaging in medical fraud.
You have the right to use whatever antibiotics you can get your hands on. But you can hardly claim to have a "right" to an antibiotic for every conceivable case, considering that such an antibiotic may not exist yet, or may not even be possible.
You are in the vast minority then. In the bad old days, nothing was certain because there was no standard. Look at China for a modern example of the endemic fraud in food and drugs.
The FDA was invented to solve a real problem. Its nothing to do with stupidity - its to do with accountability.
The problem is that the FDA/DEA went past solving a problem (opt-in), and into restricting behavior (can't opt-out).
Testing is good. Market standards and labeling are good. Completely prohibiting sales (by default!) between informed parties is bad.
Distribution of new antibiotics should probably be discouraged to avoid breeding resistant strains, but this is a rare exception (notice the title of this article mentions three classes of drugs, yet focuses on the only one that has moral standing). It can also be solved through less heavy-handed methods like manufacturer agreements, rather than an impermissive white list on every area the FDA sees fit for growing their clout.
1. Is it a proper role for government to solve that particular problem?
Who else is going to? There's no profit in it, so you can't expect someone to do it out of Smith-ian self-interest. And you certainly can't expect the pharma companies to police themselves; they hide studies that clearly show adverse, even deadly side effects, and otherwise outright lie, even with the FDA around. Imagine the hijinks that would ensue without it.
In general, I support your libertarian way of thinking. But on the other hand, drug resistance does have elements of a tragedy of the commons. Its often in our individual best interests to over medicate, but the group as a whole suffers with resistant germs. Just like it is in every individuals best interest to have the best value vehicle despite of the extra pollution that skimping on some components would cause.
Then again, this type of thinking can quickly extend too far. Vast numbers of drugs require prescriptions that have nothing to do with antibiotics. Heck, I can't even get contact lenses without a prescription. That kind of thinking strikes of nannyism.
Even if that's all true, the real issue here is that products are being sold to people who aren't informed about what they are ingesting. The article leads with the author's wife wanting to buy a cream for moderate acne, not severe acne. The cream they sent has potential serious side effects which I doubt are made very clear to the purchaser.
People often act on good faith, that is, they buy something assuming it's been tested and is safe. Yes, it's true, we could all spend all day long reading every ingredient on every label and reading all the scholarly research on it, but it's cognitive overload.
Having medications evaluated by a trusted source is something many people actually do want, the FDA does serve that role and while it means there are restrictions, I think most people are OK with that. Of course, nothing is true for all people, and there are plenty of places you can go where you can buy any drug you want.
Oh by the way "the informed consumer" just doesn't happen. 95% of people just grab something off the shelf and expect it to be safe and effective. Even if it isn't.
> Oh by the way "the informed consumer" just doesn't happen. 95% of people just grab something off the shelf and expect it to be safe and effective.
You're ignoring the informational role of retail brands. Consider toasters. I'm not a toaster expert, but when I buy a toaster at Kmart I can reasonably assume it won't electrocute me or catch fire in normal operation. I might only buy a toaster once every decade or so, but Kmart buys and sells tens of thousands at a time - it's definitely worth their while to hire an expert who looks very closely at what they are selling and responds appropriately to news about risks. Electrocuting your customer or setting their kitchen on fire is bad for business, so in order to minimize their legal/insurance expenses Kmart is quite likely to adopt such strategies as:
(1) sell mostly trustworthy brand names
(2) require 3rd-party certifications such as the UL seal in cases where those are worth what they cost
(3) run their own tests in-house as appropriate
(4) stop selling and remove from store shelves any brand that turns out to do notable harm.
Kmart decides what to sell attempting to achieve a particular balance of safety and quality, so I don't need to be informed on every specific brand I might find there - I just need to learn and know that Kmart either is or isn't generally trustworthy. If they are trustworthy, I can indeed "just grab something off the shelf and expect it to be safe and effective." (The same is true for specific name-brand product lines such as Craftsman or GE. In fact, the more a brand advertises, the safer it is to try that brand. Spending money on, say, a SuperBowl ad is equivalent to posting a performance bond - it involves spending a lot of money in advance that you can only get ROI from if the company expects to be around for a long time.)
Turning to supplements, I can be nearly certain that they are safe by that exact same logic - brands that clearly aren't safe tend to disappear pretty quickly from store shelves. (Because poisoning your customer is bad for business.)
I can't necessarily be certain supplements are effective and the FDA is, oddly enough, in part to blame for that. The problem is that supplements are not legally allowed to make health claims. They don't say on the bottle what the pill is for or exactly what outcome is expected. It's tricky for something like Consumer Reports to test whether health claims made for a product are accurate when no health claims are being made. So that one's tricky. It's possible we'd do better there with less regulation. A true free-for-all environment would let companies run ads and print packaging not only claiming their product had certain benefits but also (this is huge) comparing their product to competitors and pointing out that theirs works best. If a few large supplement companies are selling Resveratrol pills and the one called "Best" cuts corners using excess filler or a degraded supply, it's hard to think of anybody with more incentive to notice and tell us that "Best" is selling a crappy product than the competing firm "Nature Made". Open competition in which people can make any claims they can reasonably defend as true could solve a lot of the problem.
>brands that clearly aren't safe tend to disappear pretty quickly from store shelves. (Because poisoning your customer is bad for business.)
Obviously not.
> Almost a decade ago, experts were talking about how these supplements often contained “just a fraction of the ingredient on their labels–if any at all,” along with pesticide and heavy metal contamination. Just this year, news emerged that dietary supplements are tops in drug recalls for containing ingredients that pose a risk of “severe adverse health consequences or death.”
Plus only 2 companies from the study had 100% authentic ingredients. Pretty sure there are still more than two supplement companies still around.
Plus all the weight loss and body building supplements that contain drugs keep coming out and it doesn't effect sales of other products.
And anyways it is playing a game of whack a mole.
Plus you have a complete and total misunderstand about how supplement research is carried out.
And we have that on a lot of stuff, but I think what I meant in this context is that most people in the US don't expect prescription strength stuff to be available on Amazon, so assume the work has been done for them when they search. Thai pharmaceutical companies aren't likely to include any FDA related disclaimers :P
I'll have to disagree on shutting down the FDA. It's purview goes well beyond medication and into medical devices as well as food production, of course. Not having a trusted authority (central or not) to vet and evaluate products for human consumption can return things to the days of Snake Oil.
I do agree that the FDA is largely ineffective at preventing people from doing things to their bodies.
Ironically, the FDA would probably be able to better serve the public if it switches roles from enforcement to advisement. Keeping food, medication/devices and production methods to FDA standard, I believe, should get a UL type verification for things we use every day. Having that stamp brings trust that the FDA has verified the efficacy of whatever it is you put into your system, however there's nothing preventing you from going non UL if you're aware of the risks.
edit_
To the folks downvoting your post, I disagree with them as well!
It's worth considering that UL certification is an example of what happens when government doesn't regulate - it evolved initially as an entirely free-market mechanism to solve a real problem that regulators hadn't addressed. Get rid of the FDA and something kind of like the UL would probably spring up to replace it. But without the coercion, people would have the option to ignore it when they really need to.
The FDA stops companies from labeling things in a way that is technically correct but misleading. They make companies back up their claims with actual science. You would not be able to make an informed decision without the FDA. Stupid doesn't come into it.
>I have no problem with this either. I don't believe it's a proper role for government to regulate what substances people can buy and ingest. I would happily shut down the FDA altogether.
If others breed antibiotic resistant bacteria by regularly ordering antiobiotics for acne or whatnot, it doesn't just effect them it effects me.
Many of the steroids for sale on amazon are not explicitly illegal, as they are designed specifically to circumvent the current controlled substances list. This is why so many suppliers rushed to liquidate the supplement known as "Superdrol" when the active designer steroid was added to the federal controlled drug registry.
If we are to respect the law for legitimate public health reasons like antibiotic resistance, then its administrators shouldn't rot it from the top for misguided moral, economic, and bureaucratic reasons.
Until eminently self-prescribable things like Adderall and cocaine are retailed at the corner store, I'll cheer on any "illicit" package that gets through CBP.
It's a game of whack-a-mole and Amazon is doing the bare minimum. The company has no incentive to do otherwise.