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Medical Forum / Diseases and Disorders / Prostate Cancer / September 2006

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Meds, Cialis, etc

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smw30342@yahoo.com - 31 Aug 2006 22:58 GMT
My doc has prescribed 20mg Cialis every other day.  My insurance won't
cover it.  Obviously, it is expensive.  So I have explored meds from
Canada, and many pharmacies that sell over the Internet sell generic
Tadalafil (typically made in India).  Does anyone know of a reliable
pharmacy where I can get the genuine article at a good price (Costco is
best so far), or is the generic OK?  And anyone have any pricing
suggestions?

Thanks,

Steve
NICK - 01 Sep 2006 00:14 GMT
Steve wrote and asked:

> and many pharmacies that sell over the Internet sell generic
> Tadalafil (typically made in India).

___MOST___  imports are fake and contain no drugs.

The few that do contain a drug are violating U.S. patents
and are subject to seizure by customs.   If a drug has
recently been patented, there are NO generic versions.

Those are the facts of life.

Either way, you've lost your money and are SOL.

Visit http://www.fda.gov  and get the lowdown on imports.
Alan Meyer - 01 Sep 2006 19:18 GMT
> Steve wrote and asked:
>
[quoted text clipped - 12 lines]
>
> Visit http://www.fda.gov  and get the lowdown on imports.

Nick,

I think your warning is justified.  There are a huge number of
sleazy operators selling fake Viagra and some other drugs
(though Viagra and related drugs are the biggest subjects
of counterfeiting.)

But the situation in India is a little different.  India does not
recognize U.S. patent laws on drugs.  So the Indian manufacturers
are not violating Indian law and they don't give a hoot about
U.S. law, just as our manufacturers don't give a hoot about
Indian law - except of course when they're trading in India.

A number of the Indian manufacturers are highly reputable
with excellent quality control.  In fact, a lot of the "U.S. made"
drugs are actually manufactured in India or other countries.
They are indeed making generic Viagra and other generics.
They're often perfect copies.

The importation of drugs from India is illegal in the U.S., which
means that the importer (the patient) is violating the law.
Drugs have been seized by customs upon occasion, though
most get through.  To my knowledge, I don't know of anyone
having been prosecuted for this "crime", and I would be
surprised if it happens.  Some states have publicly announced
their intention of importing drugs from Canada, and dared
the Justice Department to sue them.  So far, they are
getting away with it.

I would be willing to buy from a reputable Indian pharmacy.
It's not that I'm a scofflaw in general, but I think this is a bad
law, written for corrupt purposes.

   Alan
Doug Taylor - 02 Sep 2006 16:17 GMT
>I would be willing to buy from a reputable Indian pharmacy.
>It's not that I'm a scofflaw in general, but I think this is a bad
>law, written for corrupt purposes.

Me too.  I recommend this site for great prices on Indian imports that
are decidedly NOT placebos:

http://www.xlpharmacy.com
callalily - 01 Sep 2006 01:02 GMT
> My doc has prescribed 20mg Cialis every other day.  My insurance won't
> cover it.  Obviously, it is expensive.  So I have explored meds from
[quoted text clipped - 7 lines]
>
> Steve

Dear Steve,

I recommend that you use overseasrxdrugs.com which imports this drug
from India. You can get 28 5 mg pills for $60.  We have used them twice
and they were very reliable (they have a 5-star rating on
pharmacychecker.com).

Your concern about whether this drug is the real thing is very
reasonable but I think it is genuine because my husband's surgeon, who
is very reputable, said so. (His name is Dr. Tewari of New York
Hospital and he also happens to be from India).  .

Before I ordered these pills I read a very good book on how to buy
drugs cheaply (I don't remember the name of it).  The author, who
happened to be a doctor, said he was more concerned about buying drugs
from Canada than from India.  I suspect this is because there are so
many ca. pharmacies springing up every day and it makes you wonder how
anybody can regulate them.

As far as violating the law people do get away with it.  As I recall,
India ignored the patent on some AIDS drugs (AZT?) some years ago and
got away with it and this bold move undoubtedly saved thousands of
lives...

I would caution you to ask your own doctor what his opinion is of these
imported drugs and take his advice over mine.  However, I have to tell
you that the sildenafil (generic Viagra) my husband ordered from this
pharmacy didn't seem to have much effect on him but I don't think it
was because of the pills.

Good Luck,

Leah
NICK - 01 Sep 2006 04:51 GMT
Leah wrote:

> However, I have to tell you that the sildenafil (generic Viagra)
> my husband ordered from this pharmacy

There is no such thing as "generic Viagra".

The drug manufacturer (Pfizer) with the patent has not
licensed any other manufacturer to produce a generic.
Skids - 02 Sep 2006 00:55 GMT
> Leah wrote:
>
[quoted text clipped - 5 lines]
> The drug manufacturer (Pfizer) with the patent has not
> licensed any other manufacturer to produce a generic.

There are some countries that do not recognize US patent laws. The companies
there could care less if Pfizer has a patent.
NICK - 01 Sep 2006 05:11 GMT
Steve wrote:

>  So I have explored meds from Canada, and many pharmacies
>  that sell over the Internet sell generic Tadalafil (typically made
> in India).  Does anyone know of a reliable pharmacy where I
> can get the genuine article at a good price

Just found a news item a couple hours ago...........

FDA Says Some Canadian Web Sites Sell Counterfeit Rx Drugs
Thursday, August 31, 2006  13:26

WASHINGTON --  Testing revealed fake versions of Lipitor and
other widely used Rx drugs ordered through Web sites linked to
Canadian pharmacies, the Food and Drug Administration said.
Consumers who bought drugs through the 10 Web sites should
not use the medications because they may not be safe, the FDA
said.  The sites include rxnorth.com, canadiandrugstore.com
and rxbyfax.com.
U.S. official have intercepted and seized thousands of Rx filled
by the Web sites in recent months.  Subsequent testing has
reveald counterfeit versions of the cholesterol drugs Lipitor
and crestor, as well as the painkiller celebrex, blood-pressure
medication Diovan, baldness treatment Propecia, and 5 other
Rx drugs, the FDA said.
The FDA said it tests showed some of the drugs contained the
active ingredients found in genuine versions, but at much  lower
concentrations.  That could put patients at risk.
Canada's federal health department is investigating.  The RCMP
said the national police service was aware but could not comment.
Drugs ordered through the Web sites and intercepted by U.S.
officials were not shipped from Canada.
Importing drugs into the United States is illegal.  The FDA says it
cannot guarantee the safety and efficacy of imported drugs.
Heather - 01 Sep 2006 07:47 GMT
In the interests of telling both sides of a story, consider the
following.....and I am not saying that these cross-border pharmacies are
innocent, but there is definitely 2 sides to these stories.

1.  The drugs in question were not shipped from Canada according to your
article.  And I ask you, are the owners of the cross border pharmacies
actually Canadian??  They could be American, for instance.  How would
you or I know??

2.  Big Pharma and in particular Pfizer (not to forget the US FDA)
routinely warn Americans that our drugs are not safe......despite the
fact that many are made in the US (Lipitor in particular).  It is in
their best interests to scare people into not buying from Canadian
pharmacies.

3.  But the worst online article I just read (I googled 'counterfeit
drugs') was the 6 page MSNBC Dateline investigation into counterfeit
drugs that are sold in US pharmacies which aired in June, 2006.

They come in from China or India, etc....NOT Canada.  And Lipitor and
Viagra are the biggest sellers.  They are totally fake.  And so good
that even Pfizer was taken aback.  But one of the fakes was a cancer
drug called Procrit.

Here is the article.... http://www.msnbc.msn.com/id/13137839/

This is nothing new, btw.  I found articles from 3 years ago on this
problem.  Both here and in the US.

And Nick......people who are making the cheaper Viagra in say,
India....would not be worried that it is patented in the US.

Heather

> Just found a news item a couple hours ago...........
>
[quoted text clipped - 23 lines]
> Importing drugs into the United States is illegal.  The FDA says it
> cannot guarantee the safety and efficacy of imported drugs.
smw30342@yahoo.com - 01 Sep 2006 18:06 GMT
Thank you all for the good responses.  The Canadian Cialis "generics"
are made in India, and I would venture a guess that the "Canadian"
pharmacies are probably based in India.

With regard to legalities, this is a debate that has been going on for
a while, which we all know.  I don't defend or knock the profits that
drug companies make - especially considering their R&D costs.  And
while it is not legal, who can condemn people who desparately need meds
and can't afford them - and get them at discounts from CA?

BTW, the real deal Cialis from CA is more expensive than even Costco
here.  Go figure!

Finally, Nick - unless you work for a drug company you should consider
the other side of the medicine conundrum.

Steve
callalily - 01 Sep 2006 19:15 GMT
> Who can condemn people who desparately need meds
> and can't afford them - and get them at discounts from CA?. .  .
[quoted text clipped - 3 lines]
>
> Steve

This discussion on imported drugs has been very helpful.  However,
Steve is right: not everybody (including my husband) can afford to pay
$13 for a Viagra pill.  If the foreign pills are sugar pills they are
certainly not worth paying anything for (although I'm sure they have a
placebo effect!).  If these pills are not real my husband and I are
stuck without anything.

Re: "The other side of the conundrum"

My husband takes trimix which is not FDA-approved but has been
successfully used by men (and benefited women) for 20 years.  I believe
it is better tolerated than Caverject which is FDA-approved.

The FDA saved us from a thalidomide epidemic and does a lot of good
things but it is not perfect. In fact the relationship between the FDA
and the drug companies has never been more incestuous.  See article in
NY Times, July 24, 2006:

"FDA Will Regulate Experts [its own] Ties to Drug Companies" This is in
order to "appease critics who have long complained that those who sit
on their boards have such deep ties to the drug makers that their
advice is tainted."

The bottom line is that each person has to make their own cost/benefit
analysis.

Leah
callalily - 01 Sep 2006 19:15 GMT
> Who can condemn people who desparately need meds
> and can't afford them - and get them at discounts from CA?. .  .
[quoted text clipped - 3 lines]
>
> Steve

This discussion on imported drugs has been very helpful.  However,
Steve is right: not everybody (including my husband) can afford to pay
$13 for a Viagra pill.  If the foreign pills are sugar pills they are
certainly not worth paying anything for (although I'm sure they have a
placebo effect!).  If these pills are not real my husband and I are
stuck without anything.

Re: "The other side of the conundrum"

My husband takes trimix which is not FDA-approved but has been
successfully used by men (and benefited women) for 20 years.  I believe
it is better tolerated than Caverject which is FDA-approved.

The FDA saved us from a thalidomide epidemic and does a lot of good
things but it is not perfect. In fact the relationship between the FDA
and the drug companies has never been more incestuous.  See article in
NY Times, July 24, 2006:

"FDA Will Regulate Experts [its own] Ties to Drug Companies" This is in
order to "appease critics who have long complained that those who sit
on their boards have such deep ties to the drug makers that their
advice is tainted."

The bottom line is that each person has to make their own cost/benefit
analysis.

Leah
callalily - 01 Sep 2006 19:15 GMT
> Who can condemn people who desparately need meds
> and can't afford them - and get them at discounts from CA?. .  .
[quoted text clipped - 3 lines]
>
> Steve

This discussion on imported drugs has been very helpful.  However,
Steve is right: not everybody (including my husband) can afford to pay
$13 for a Viagra pill.  If the foreign pills are sugar pills they are
certainly not worth paying anything for (although I'm sure they have a
placebo effect!).  If these pills are not real my husband and I are
stuck without anything.

Re: "The other side of the conundrum"

My husband takes trimix which is not FDA-approved but has been
successfully used by men (and benefited women) for 20 years.  I believe
it is better tolerated than Caverject which is FDA-approved.

The FDA saved us from a thalidomide epidemic and does a lot of good
things but it is not perfect. In fact the relationship between the FDA
and the drug companies has never been more incestuous.  See article in
NY Times, July 24, 2006:

"FDA Will Regulate Experts [its own] Ties to Drug Companies" This is in
order to "appease critics who have long complained that those who sit
on their boards have such deep ties to the drug makers that their
advice is tainted."

The bottom line is that each person has to make their own cost/benefit
analysis.

Leah
callalily - 01 Sep 2006 19:19 GMT
> Very sorry for the multiple posts. I am still learning the ropes.
>
> Leah
Alan Meyer - 02 Sep 2006 20:14 GMT
> My doc has prescribed 20mg Cialis every other day.

One question no one has raised about this is whether this
actually does any good.  When I asked my urologist about
it he expressed scepticism.  He thought it was a urological
fad but he hadn't seen any evidence that it made a
difference.

This is one of those common medical practices that seems
to be in accord with common sense.  It seems to be
common sense that if a man gets no erections for a long
time it will be harder for him to get them later.  It seems
to be common sense that if the vasodilator drugs make
it easier to get erections then men who take them will get
more erections and hence be less subject to the use it or
lose it effect.

There's no doubt that the Cialis salesman convinced your
doctor of the common sense of this proposition.

But does it really work?  Or is it just a huge expense for
the patient and gigantic profit for the drug company?

   Alan
smw30342@yahoo.com - 03 Sep 2006 13:17 GMT
> But does it really work?  Or is it just a huge expense for
> the patient and gigantic profit for the drug company?

Alan:

Unless you're asking a rhetorical question - I can tell you that it
works for me.  I had robotic surgery on 7/3 and once I was mentally
prepared to see if I was "up-to-it" - I can tell you that I was.  I'm
amazingly lucky and blessed.  I feel the Cialis is working FOR ME,
since I have the same feelings that I had when I took Cialis before my
surgery.  At 62 I never woke up (in recent years) with even a semblance
of an erection without Cialis - that was taken the day before.  But -
on the other hand - I take Propecia to make my hair grow or stop
falling out.  I'm k pretty sure it isn't doing any good, but I'm
worried that if I stop I will get confirmation that it was working.

I want to think that my doc is not swayed by the pretty drug reps and
his medical conclusion is that this is good medicine.  My only
complaint is the cost - but that's life.

Steve
Alan Meyer - 05 Sep 2006 18:35 GMT
> > But does it really work?  Or is it just a huge expense for
> > the patient and gigantic profit for the drug company?
[quoted text clipped - 11 lines]
> falling out.  I'm k pretty sure it isn't doing any good, but I'm
> worried that if I stop I will get confirmation that it was working.

It wasn't rhetorical.  I have tried Viagra myself and it does seem to
work, but I haven't tried taking it every day.  That was what I was
curious about.  I had asked my urologist whether I should try
that and he said he didn't think it was useful - which is why I
have raised the question here.

> I want to think that my doc is not swayed by the pretty drug reps and
> his medical conclusion is that this is good medicine.  My only
> complaint is the cost - but that's life.

You might consider the Indian pharmacies.  They make sildenafil
in India without a license from Pfizer.  I don't know whether Cialis
or Levitra formulations are also made in India.  I believe that a lot
of the Indian pharmacies are selling perfectly safe and effective
drugs.

I wouldn't normally endorse buying things that circumvent copyright
or patent laws (though the laws don't apply in India), but I find it
disturbing that Pfizer charges such an enormous markup for their
product and that the price has NOT come down as a result of
competition.  It is clear that all three drug companies have either
an explict or implicit agreement not to undercut each other's
prices and kill the cash cow.  We used to call that "price-fixing"
and send people to jail for it, but the drug companies seem to
make it a regular part of their business practice these days.

   Alan
smw30342@yahoo.com - 07 Sep 2006 18:59 GMT
Alan:

I couldn't agree with you more on the pricing "scheme".  Granted there
are big R&D costs - a lots of wasted effort and money on fgailures.
BUT - they sure have figured out a way to keep prices up there.

FYI - I had tried Viagra a number of times prior to this whole episode
(in my pre-C life) and found that it really didn't do much for me.  On
the other hand, Cialis did and still does.  I don't know what it is -
excpet that it may be more potent (it definately lasts about 32 - 36
hours for me).  You might consider a try.  You can get samples, as I'm
sure you know.

I think I may order a few from India and give it a try.  This is one of
the first times I guess I will be an outlaw!

Best regards,

Steve
 
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