Spam Nation (9 page)

SpamIt customers were motivated to purchase drugs from spam for a variety of reasons, but the number one reason I heard was affordability—particularly among customers who were purchasing medications taken to treat chronic conditions.

It is no accident that most SpamIt customers live in the United States, the country with the highest prescription drug prices in the world. Prices for pharmaceuticals in the United States are substantially higher than those in Canada, India, the United Kingdom, and many other countries, in large part because those nations have enacted price controls on drugs. In 2012, the price of generic medications in the United States rose an average of 5.3 percent, while the cost of brand-name drugs increased by more than 25 percent, according to a study by the Health Care Cost Institute.

Other factors that have increased the cost of prescription drugs include: a spike in demand for these drugs over the last decade; intense marketing to consumers and doctors of higher-priced brand-name drugs; drug manufacturers’ attempts to recoup the substantial costs of research and development; and the costly dice game that is the process of bringing a new drug to market in the United States. (According to a 2012
Forbes
article, the cost for a pharmaceutical company to get a new drug to market is now around $350 million.)

But there’s more to it. In a landmark 2011 study on the economics of the rogue Internet pharmacy business, researchers at the University of California, San Diego (UCSD) figured out a way to view countless purchase records from online pill shops tied to EvaPharmacy, another rogue pharmacy affiliate program that competes directly with the likes of Rx-Promotion and SpamIt. The researchers found significant differences between the drug-selection habits of Americans and customers from Canada and Western Europe. The analysis divided the EvaPharmacy pills into two broad categories: lifestyle drugs—such as erectile dysfunction and human
growth hormone pills—and non-lifestyle drugs, including those used to treat disorders including anxiety, sinus infections, high blood pressure, hair loss, cancer, and infertility.

The researchers discovered that U.S. customers selected non-lifestyle items 33 percent of the time. In contrast, Canadian and Western European customers almost always bought drugs in the lifestyle category—only 8 percent of the items placed in their shopping carts were non-lifestyle items. In other words, many more Americans were turning to these spam pharmacies for prescription drugs to treat critical medical conditions, not to increase their comfort or enjoyment of life.

“We surmise that this discrepancy may arise due to differences in health-care regimes; drugs easily justified to a physician may be fully covered under state health plans in Canada and Western Europe, leaving an external market only for lifestyle products,” the researchers wrote. “Conversely, a subset of uninsured or underinsured customers in the United States may view spam-advertised, no-prescription-required pharmacies as a competitive market for meeting their medical needs.”

Interestingly, dozens of SpamIt customers I interviewed said the pills they received were indistinguishable from the same drugs they had purchased from local pharmacies, except that the pills they ordered online cost far less. In fact, many customers were so satisfied with their orders that they went back to the same site month after month.

Henry Webb, a forty-two-year-old real estate agent from California, had been buying from online pharmacies for nearly three years when I first called him, though he said he had no idea who he was really buying from until I contacted him. Webb battled depression for much of his adult life, until about ten years ago when his doctor prescribed him Lexapro, a prescription antidepressant. For years, Webb paid close to $500 for a ninety-day supply of the drug.

And then one day he opened an unsolicited email that advertised Lexapro for almost one-quarter of that price. He’s been ordering from
a couple of different “Canadian pharmacy” sites ever since, and said he has yet to have a negative experience.

“The pills look exactly like the kind I paid five hundred dollars for at the drugstore—they’re in the same blister pack and everything,” Webb said. “The only comment I have is that it’s sad we live in this country and have to look outside of the United States for affordable medicine.”

Contacted a few months after that initial interview, Webb said he quit ordering online after he had bad experiences with some drugs that made him sick. Webb also experienced something that nearly all who purchase products advertised in spam will deal with at some point: incessant phone calls from aggressive online pharmacy merchants trying to refill his prescription or sell him other drugs.

“They won’t leave me alone and have been calling several times a day,” Webb said. “I can’t change my number because it’s attached to my business, but these guys do very devious stuff like spoof the caller ID so it looks like they’re calling from my local area. So I pick up, because I have to be reachable for my real estate clients.”

Exacerbating the pricing problem for consumers is the little-known but widespread practice among the major pharmaceutical manufacturers of paying generic rivals to delay the introduction of lower-cost medicines. According to the U.S. Federal Trade Commission (FTC), pharmaceutical companies struck an unprecedented number of these collusive deals in fiscal year 2010. The FTC found that the number of these deals skyrocketed more than 60 percent, from 19 in FY 2009 to 31 percent in FY 2010. Overall, the agreements reached in FY 2010 involved twenty-two different brand-name pharmaceutical products with combined annual U.S. sales of about $9.3 billion.

Craig S., a now-retired life insurance salesman from North Carolina, knows firsthand how it feels when a drugmaker or health insurer suddenly stops offering generics. Craig said his employer of twenty years previously offered a health-care plan with generous drug coverage benefits. Then a year prior to our interview, his employer
dropped the insurance provider and pushed all employees into health-care savings accounts (HSAs), which his employer contributed a mere thousand dollars annually. Craig’s doctor had long prescribed the name-brand drug Actos to help treat his type 2 diabetes, and Craig had been buying the generic version.

But he soon discovered that the generic version of Actos was not offered through the HSA program. Strangely enough, however, he was able to use his HSA credit card to buy a ninety-day supply from the GlavMed pill shop for $178 including shipping and handling.

“The drug my doctor wants me to take is $212 per month, and I told him that’s just not going to happen,” Craig said. “It costs me now about a third of what it would if I bought the brand-name version each month through my health plan.”

When asked whether he’s concerned about the quality, efficacy, and safety of the drugs he’s purchasing from spammers, Craig said, “Not really.” He said he still sees his doctor every ninety days, and that the drugs he’s been ordering from GlavMed appear to be keeping his diabetes in check.

His chief concern is that the pills he’s ordered may one day simply not arrive in the mail, noting that he had a close call once with an order that arrived a week later than it should have. But for now, the people supplying his drugs over the Internet appear to be getting their act together on the shipping. Craig said that every few months, when his prescription is about three weeks away from running out, he’ll start getting phone calls from people with Indian accents, asking if he’s ready for refills.

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Illinois resident “Steve” suspected his girlfriend had been cheating on him, but he didn’t fully accept the news until the day he received some jolting news via text message.

“I needed meds due to cheating girlfriend syndrome,” Steve explained sheepishly in our interview as to the reason for his purchase. “She texted me one day and basically told me she had gonorrhea and that I should get checked out, too.”

It had been a tough month for Steve. Not only had his girlfriend slept with a coworker, dumped him, and stuck him with a (mercifully treatable) venereal disease, but his employer—an environmental testing firm—had just laid him off, and he had no health insurance.

“I could have had COBRA insurance but that’s like three hundred to four hundred dollars a month,” Steve explained. “And when you’ve got no income, plus rent and a car payment and everything else, that’s not really an option.”

His ex-girlfriend helpfully texted the name of the drug her doctor had prescribed to clear it up—a full regimen of 500 milligram erythromycin tablets. So, Steve went online and searched for the drug and found exactly what he needed at a site claiming it was selling drugs from Canada. (The site Steve purchased from was actually hosted in China through GlavMed and the drugs shipped from India.) Seven days and sixty dollars later, Steve had received the antibiotics and was on his way to a VD-free existence.

Despite the circumstances that prompted his purchase, Steve said the overall experience with GlavMed was a positive one, and that he would buy from them again if he ever got another flare-up.

“Would I do it again? Sure. Why pay a copay and seventy-five dollars for a prescription when I can get it online for a lot less bother? I mean, I could have treated five people with [the number of pills] they sent me. So, for the price you can’t beat what they’re offering.”

As the stories of these buyers show, a great many Americans turn to drugs marketed via spam because the alternative is several times more expensive, or because their insurance doesn’t cover the drugs they’ve been prescribed. While Steve’s positive experience with pills ordered for a single use or regimen seems to be fairly common, repeat buyers
purchasing pills to treat chronic conditions are likely to encounter a bad batch of pills sooner or later.

As we’ll see in
Chapter 5
, this is because spam-advertised pharmacies tend to get their cheap pills from dozens of different sources around the world, some of which appear to have little—if any—accountability for the safety and efficacy of their drugs. Inferior and poor-quality medications may only make the customer sick, as in Henry’s case. In extreme cases, as we’ll see in
Chapter 5
, substandard pills may send the customer to the hospital—or worse yet, to the morgue.

A lawyer by profession, Washington, DC, resident “John” spent far too much time behind his desk and was looking for a quick and easy way to bulk up his muscles. After researching several online bodybuilding forums, he began taking some legally questionable steroids from one of the sites recommended by the seasoned meatheads. A few months and a short regimen of gym workouts later, the bulker pills had helped add several pounds of muscle to his lean frame.

But then one day in February 2010, John began to feel puffiness and sensitivity around his nipples. Worried that it may be a latent side effect from the bulker pills (and nervous about discussing his recent regimen of bulker pills with his doctor), John returned to the bodybuilder forums for advice from his fellow meatheads.

Forum members told him he was suffering from a steroid-induced case of gynecomastia, the development of abnormally large mammary glands in males that results in breast enlargement.

“The medical shorthand for the condition is pronounced ‘guyno,’ but most of the guys on the forums just call them ‘bitch tits,’” John said. “The guys were telling me that if you don’t get it fixed with medication, then you need plastic surgery to fix your chest and I didn’t want to do that.”

The cure for John’s condition—according to his newfound friends
on the forums—involved a regimen of additional drugs designed to counteract the hormones that cause guyno. Among them was a drug called “Femara,” which is most often prescribed to treat postmenopausal early-stage breast cancer patients.

John searched the web and ended up buying a two-week regimen of 2.5 milligram Femara pills for $136 from a GlavMed site called elitepharmacy.com. He waited three weeks for the drugs, but they never arrived. So John canceled his order with GlavMed and ordered them from another online pharmacy that was not affiliated with GlavMed. (John recollects that the two sites looked nearly identical.) The original site apologized for the delay and credited his credit card with the amount he’d paid.

The drugs that he received from the second site showed up in a manila envelope addressed from India, but the pills themselves were sealed in a blister pack with the brand name Novartis seamlessly printed multiple times across the silver foil on top of the pills.

According to John, the pills looked like the real thing, and they reduced the tenderness and swelling in his nipples, effectively nipping his pouty man-boobs in the bud.

“I was a little leery of the whole thing at first, but it worked,” John said. “I also thought I was wasting my time canceling my order. I sort of figured this was a shady operation…but they refunded my money.”

John’s experience highlights the lengths to which rogue pharma programs will go to ensure customer satisfaction. The goal here is not necessarily to keep the customer happy. Rather, the people running these operations will do next to anything to keep customers from initiating “chargebacks,” a process in which the customer reverses the charges, claiming fraud or some other misdeed on the part of an online store. Merchants that receive too many chargebacks pay much higher processing fees and may eventually be fined or have their accounts closed, or both.

Data from GlavMed’s customer database shows that the program
had dozens of customer support personnel working round-the-clock via phone and online chat, responding to customer concerns or questions about existing orders.

Vishnevsky, the spammer discussed in
Chapter 1
who worked with GlavMed-SpamIt to help bankroll the development of the Cutwail botnet, said in an interview via instant message that people who buy from pharma sites can always get their money back just by calling and lodging a complaint with the pharmacy program’s 800 number.

“The bank will screw every merchant that has chargebacks [that are] more than 1 percent of total sales,” Vishnevsky said. “So no one will risk to lose the [card processing account] by not returning money, and everyone who asks [the pharmacy affiliate program’s customer service department] for money back will get it.”