Alberta MDs warned not to co-sign American prescriptions
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* Lisa Gregoire

The College of Physicians and Surgeons of Alberta has deemed cross-border prescribing unbecoming conduct and is warning members they could face disciplinary action if they co-sign American prescriptions.

“That practice for Alberta physicians is not appropriate,” said Registrar Bob Burns. “In fact, we feel it's so inappropriate we think it's unbecoming conduct. It's not responsible. It's not a quality process at all and, therefore, don't do it.”

Mail-order pharmacies are not new, but their Internet-based cousins are. There are now almost 100 of them in Canada, and they have proliferated this past year to fill an increasing American demand for cheap Canadian drugs, said University of Alberta pharmacy management instructor John Bachynsky. Burns said the college examined its existing prescribing protocol and determined nearly 2 years ago that co-signing prescriptions without examining patients, reading their charts and making proper diagnoses did not meet quality-control standards. In February, the college's council decided to reiterate that position and remind members of potential penalties.

The Canadian Medical Protective Association (CMPA) has also warned members to steer clear of cross-border prescribing. If an American patient launched a lawsuit in a US court over an adverse drug reaction, CMPA coverage would not apply, said spokesperson Françoise Parent. “We do not defend physicians in the United States. It's a real issue, so we've told our members not to co-sign prescriptions on this basis. You're opening yourself up to the possibility of litigation.”

Canada has become a mecca for Americans seeking prescription drugs because the cost is regulated by the federally appointed Patented Medicine Prices Review Board. There is no similar pricing watchdog south of the border.

In order for American patients to save 20% to 90% by buying drugs in Canada, they need a licensed Canadian physician's signature on the prescription. Web-based pharmacies pay lucrative fees for this service, with doctors signing off on batches of prescriptions; some pharmacies actively recruit physicians online.

The Alberta College of Pharmacists recently circulated proposed new standards of practice and a code of ethics that would apply to all pharmacies, including those operating over the Internet. However, Registrar Greg Eberhart said it has not yet decided how to proceed. “It's evolving extremely rapidly. There are more questions than answers right now, and we have no specific position on it.” He said government silence and inaction has been discouraging.

Bachynsky wonders what all the fuss is about. “I don't see it as an issue as long as the people signing have a reasonable assurance the prescription is legitimate,” he said.

But by the time pharmacists and doctors across the country agree on new protocols, the issue of cross-border prescribing might be moot. GlaxoSmithKline (GSK), the second largest pharmaceutical manufacturer in the world, sent letters to Canadian Internet pharmacies in January warning that it will cease supplying producst to those selling its drugs south of the border. They have already done this to several Web pharmacies, including Winnipeg-based **canadameds.com**.

GSK, which reported nearly $50 billion in sales worldwide in 2001, insisted its actions are not motivated by profit. It says cross-border prescribing and delivery contravenes American Food and Drug Administration policy and is “poorly regulated” and “potentially unsafe.” — *Lisa Gregoire*, Edmonton.