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Patients with life-threatening diseases can legally order drugs available overseas and have them delivered to their local pharmacy. But what are the risks? from

Online ‘Dallas Buyers Club’ promises medications, fast

The Social Medwork, a new website that sells patients medicines they cannot easily access in their own country, has been dubbed an online Dallas Buyers Club.

In the movie, the character Ron Woodroof resorted to illegally importing medicines for himself and a “club” of patients dying from AIDS in the 1980s – medicines that the US regulatory authorities had not approved in the US.

Dr Eve Saks: None of those drugs have been approved by the FDA.

Ron Woodroof: Screw the FDA. I’m going to be DOA [dead on arrival].

Dallas Buyers Club was based on real life events surrounding AIDS patients’ access to medicine in the 1980s.

However, this is where the similarity between the movie and the new website ends.

The Social Medwork allows patients to order the latest overseas-approved medicines legally. It keeps the patient’s doctor and pharmacist in the loop by requiring patients to obtain a prescription from their doctor for the medicine, and only delivering it to the patient’s nominated pharmacy (community or hospital).

Medicines are available for a range of conditions, including various types of cancer and multiple sclerosis.

The website promises to bring medicines to those who need them, fast. But are there any drawbacks to this approach? And why are patients bypassing traditional ways of accessing the medicines they need?

Traditional vs online

Australians can access life-saving medicines through the Pharmaceutical Benefits Scheme (PBS), which lists drugs that are safe, effective, appropriate and cost-effective for particular conditions. The government subsidises the cost of PBS medicines so Australians do not pay full price. The Pharmaceutical Benefits Advisory Committee makes decisions about which medicines to list on the PBS using cost-benefit analyses to ensure there is a viable health system in the long term for all.

Patients can also obtain medicines that have not received approval in Australia via the Special Access Scheme, where a doctor can apply to import a specific medicine on a case-by-case basis.

However, there are a number of reasons why Australians may turn to organisations like The Social Medwork rather than using such schemes.

People may disagree with their doctor about how well some medicines work, and may choose to obtain the medicine against their doctor’s advice.

Doctors may also not be aware of existing schemes such as the Special Access Scheme, or of all the new medical treatments for every medical condition around the world.

Prompts discussions

The benefit of The Social Medwork is that it encourages conversations between the patient and their doctor about treatments that have been approved and are available in other countries.

By discussing treatments with their doctor, patients may find they do not even need to use the website because they can access the same medicine through the Special Access Scheme at a subsidised cost. They may also find there is an equally effective alternative already available on the PBS.

The Social Medwork provides prices for the various medicines available on its website. Patients can then determine their best treatment option with their doctor.

Another factor contributing to people turning to The Social Medwork is some life-saving medicines available overseas are not available in Australia.

This may be due to drug companies deciding not to apply for approval in Australia because of its small population and small potential market.

What are the risks?

The risk with websites such as The Social Medwork is that they inadvertently facilitate direct-to-consumer advertising. In Australia, drug companies cannot directly advertise their prescription medicines to consumers. This is because it may lead to unrealistic treatment expectations, and also encourage people to push for certain medicines when there may be equally effective or better alternatives available.

Australians also need to be careful about accessing medicines that the Therapeutic Goods Administration (TGA) has not approved in Australia.

Its approval process may seem lengthy but it is in the interests of public safety. The TGA is responsible for ensuring all therapeutic goods (including medicines) are safe and fit for their intended purpose via a variety of mechanisms.

These include assessing medicines before they go to market, monitoring and assessing them after they become available, licensing Australian manufacturers and verifying overseas manufacturers comply with the same standards as their Australian counterparts.

Once approved and on the market, the TGA monitors drugs to identify any previously unreported side effects or adverse events. The purpose of this pharmacovigilance is to prevent further tragedies like thalidomide.

While The Social Medwork benefits patients by facilitating access to medicines that would otherwise be unavailable in their own country, the first port of call for Australians desperately seeking a life-saving medicine should be the Special Access Scheme through their doctor. This just may save their life and their back pocket.

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