When I called last week to cancel an appointment I’d waited months for at a dermatology clinic, the receptionist reminded me that if I changed my mind, it would take months more to reschedule. But after a year of shelling out hundreds of dollars on doctors, labs and medicines to clear up the rough patches on my elbows that had gotten me nowhere, I’d come up with another approach.
Actually, a beautician giving me a facial in an Indian beauty parlor came up with it during my recent annual visit to India. Seeing my elbows, the woman dispatched a pedicurist to the drugstore next door to get me an over-the-counter ointment she said would bring signs of improvement in a week. And it did.
I bring this up not because my skin problems are of much consequence. On the contrary. If a beauty parlor employee can recognize symptoms and suggest a treatment that works after two doctors, a biopsy and several medications couldn’t, it suggests a larger problem with our profit-obsessed medical-care system and pharmaceutical industry.
After the skin on my hands started to peel last October, I wrote of my inability to legally get help from medical marijuana in Iowa, which friends have successfully used for skin problems. By my visit to India, the problem had migrated to my elbows, but all I knew was I had some type of dermatitis or eczema.
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I was prescribed a steroid cream costing $49.21 for a 60-gram tube (despite my prescription-drug plan). But, true to the warnings in the accompanying literature, it seemed to only make the condition worse. More sobering, the literature warned, among other things, of possible trouble breathing or talking, hives, fever, tightness in the chest, confusion, “breath that smells like fruit,” mood changes, passing out and “moon face.”
I discontinued the treatment before any of that could occur and turned to an argan oil concoction bought from an herbal doctor in Morocco over Christmas. That helped a bit, but I was still looking ahead to the clinic appointment. Then I got the facial and the Betnovate-N (betamethasone valerate) made by GlaxoSmithKline, with no doctor or prescription. A 20-gram tube cost less than 50 cents, and the box only warns “systemic absorption on prolonged use and sensitivity to the ingredient Neomycin may occur occasionally.”
Betnovate-N isn’t available in the United States. I learned from some visiting Italian friends that it used to be available in Italy until about three years ago, and they had relied on it for successful treatment of skin problems. They suspected the inexpensive cream was undercutting sales of more expensive products from other companies. So they were wildly excited to discover they could still get it in India.
Lyndsay Meyer, a spokeswoman for the U.S. Food and Drug Administration couldn’t tell me why it’s not licensed for use here, or even if the United Kingdom-based company has applied for a U.S. license. (My calls to various company spokespeople went unreturned.) It’s possible there was a problem with the cream, but if so, wouldn’t that have shown up in my online searches?
What Meyer could tell me was that, “In most circumstances, it is illegal for individuals to import drugs into the U.S. for personal use.” Those could get snatched at the border except possibly in the case of a three-month supply for personal use, and not for a serious condition. Exceptions can also be made if it’s for a serious condition and no effective treatment is available in the United States. But the medicine would have to have no “known significant health risk.” Unlike, say, the steroid cream I was prescribed here?
Asked if some drugs are excluded to enable U.S. companies to maintain a monopoly, an FDA official who declined to give her name cited a prohibition against a drug company offering substantially the same drug that another company has released within about 10 months.
Spending on legal drugs in America totaled $457 billion in 2015. Prices rose 12.6 percent between 2013 and 2014. The Affordable Care Act, which the new president and congressional Republicans are working to dismantle, required health insurers to cover prescription drugs. But it didn’t reduce drug prices. Drug companies are free to profiteer as much as they want, as evidenced by last year’s Epipen fiasco. Mylan bought the patent to the injectable drug, which counteracts potentially fatal allergic reactions, and hiked the price more than 500 percent in 10 years, to $609.
According to the nonprofit news organization TruthOut the drug industry lobby group PhRMA spent $238 million on lobbying in 2015, and spends up to $50.7 million a year on campaign contributions to lawmakers.
I couldn’t find out why Betnovate-N isn’t available here. But it bothers me that the average American consumer would have no way to even know of its existence, since not everyone goes to India for facials. What other drugs are out there that might give relief from persistent conditions at low cost? Though I’m personally grateful for the find, something is out of whack when it falls to random luck and an Indian beautician to deliver the relief that American doctors and medicines couldn’t.
Rekha Basu is a columnist for the Des Moines Register.
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