Blame Canada

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You should pay attention to New Hampshire over the next few weeks — and not just because there's a presidential primary coming up. The Republican Governor there has just brought the whole low-cost Canadian drug issue to a head by announcing that his state is going to start buying cut-rate prescription drugs for prison inmates and Medicare patients from Canadian Internet companies, perhaps as early as this week. A lot of Americans get their drugs this way, and some U.S. mayors have started doing the same for their municipal workers. But New Hampshire would be the first state to defy the Food and Drug Administration and openly break the federal law that bans such imports.

I would never counsel anyone to break a federal law, but I do wonder whether there are any medical risks in buying drugs online. It depends, it seems, on what sort of drugs you buy. The FDA has started cracking down hard — as it should — on companies that sell narcotics like Percocet and OxyContin on the Web. And the agency has been conducting spot checks on pills shipped from overseas that have not been approved for use in the U.S. Some drugs sent from Canada also may not pass FDA muster, according to Mary Wiktorowicz of York University's School of Health Policy and Management, who warns that Canada's system for vetting new drugs is becoming more like those used in Britain and France, where recalls of new drugs are four times as high as in the U.S.

But what about everyday drugs like Lipitor or Celebrex, which can be had on the Net for as much as 60% off? The FDA, to my surprise, is taking a hard line on those too, warning about the risk of counterfeits and contamination. Reached for comment on the New Hampshire plan, William Hubbard, associate commissioner of the FDA, said that all imported drugs could be considered "unsafe."

Whatever its legal problems, the New Hampshire plan is a careful one and offers a good guide for anyone considering an Internet drug purchase. The pharmacies that the plan uses must be licensed in Canada and approved by the state. Buyers must have prescriptions written by American doctors and approved by Canadian physicians. The drugs have to be FDA approved and must be shipped in their original packaging. Sounds pretty safe to me.

Sanjay Gupta is a neurosurgeon and CNN medical correspondent