Hacker News Reader

Comment by CanSpice | Hacker News Reader

So? What does that have to do with anything? It's illegal in the United States to import these drugs into the United States. Amazon is based in the United States. What does it matter if they're legal or not in any other country? This story is all about importing these drugs into the United States.

View on HN

Amazon is available in hundreds of countries. Are they obligated to restrict trade based on the rules of each of those countries or just the US? At what point does a company that provides a platform for others to do things (e-commerce, content distribution, etc.) become responsible for policing how that platform is used? I suspect the answer is generally "at the point they are forced to do so".

If Amazon can tell if a film or music has the proper rights to play in a certain region, they certainly can be held accountable with respect to what drugs are legal in any given region.

Certainly they are aware of regional policy/infrastructure, so writing this off as "it's a global product," is not really productive.

In the case of video streaming, Amazon is the seller, not just the platform, so of course they're responsible for ensuring that what they're selling is legal. In the case of 3rd party vendors on Amazon, they're just a platform.

Nonetheless, platforms do assume some level of liability. Anyways, my argument here is not that Amazon is liable or at fault, but that the standards in the US have created a system where people are able to make assumptions about products they buy, and in this case, Amazon as a platform fails them to some extent. One could say it is our own fault for accepting the system we have, and I don't intend to put blame on Amazon, the seller, or the consumer, I only meant to point out that Amazon can and will make locale specific adjustments to their products and it doesn't seem completely insane that they do here. They can limit the sale of particular drugs with respect to the location of the purchaser without inhibiting the same to others where that product is legal.

> What does it matter if they're legal or not in any other country?

From a legal point of view? None. From a moral? Not so simple. A lot of drugs are prescription only in the US for really no reason whatsoever.

Two examples are Nystatin and Mebendazole.

I even emailed the FDA about Nystatin and they said that to become OTC it would need a sponsor, which is a stupid reason to leave them prescription only.

For a drug to make the switch from Rx to OTC, you need to prove a lot of things. Can consumers understand how to correctly diagnosis the disease it treats? Can consumers correctly dose themselves? Will consumers knows when to stop treatment and seek professional help.

You have to remember that not everyone follows directions or uses medications correctly. I don't blame the FDA for not making a drug OTC unless they can prove it will be used safely.

Both those drugs are very easy to use.

For Nystatin: Does your baby have a rash that looks like raised red dots?

For Mebendazole: Did you drink or come in contact with potentially infected water?

There are plenty of OTC drugs with far more complicated symptoms. It's really completely arbitrary - or more accurately, it's driven by companies wanting to expand their market into OTC (as soon as it goes off patent) rather than anything actually medical.

Take Nexium for example: It was prescription only (and very expensive) till the patent ended. The day the patent expired it turned OTC.

From wikipedia: "Mebendazole has been associated with a risk of agranulocytosis in rare cases."

Kind of a severe side effect, no?

Nexium was available OTC right after the patent expired because the company that made it went through the OTC approval pathway. It was actually a sales strategy because plenty of people will buy brand name OTC drugs where if the got an Rx most pharmacies require the generic be provided.

The thing about those two drugs is there are already OTC drugs that treat the same thing.

And surprisingly those OTCs have worse side effects!

How does that make any sense?

And what would you use instead of nystatin - a broad spectrum antifungal?

Mebendazole is OTC in almost all countries except the US - it's even given routinely without evidence of infection.

I guess my comment about it being OTC in other countries is that there have been plenty of drugs approved in other countries that were eventually pulled. Luckily the US never approved them.

athletes foot cream (which depending on the type there are 2-3 drugs to choose from. clotrimazole, tioconazole, Miconazole... When my husband had jock itch they just told him to use OTC athletes foot cream on it.

Nystatin is used for babies diaper rash, not athletes foot. It's a different organism - the stuff for athletes foot doesn't work as well.

There's also terbinafine which works better than the 3 you listead (but more expensive).

Diaper rash is not alway a fungal infection (and could potentially be a bacteria infection in addition to/instead of a fungal infection). It is usually a contact dermatitis and a fungal infection is only a secondary infection.

Guessing. Perhaps because both those medications list Stevens–Johnson Syndrome and other deadly skin reactions as a rare side effect?

> list Stevens–Johnson Syndrome

As does Acetaminophen (Paracetamol), Ibuprofen, and Metronidazole and those are OTC.

Plus there are many OTC drugs with far worse potential side effects.

>As does Acetaminophen (Paracetamol), Ibuprofen

Correct but those are "grandfathered" drugs so they don't count.

>Metronidazole

Doesn't look like its OTC except for cats and dogs.

>far worse potential side effects.

Have you looked at http://en.wikipedia.org/wiki/Stevens%E2%80%93Johnson_syndrom... ?

> Correct but those are "grandfathered" drugs so they don't count.

As I'm sure you know there are tons of other medications that can cause that too not just "grandfathered" ones, but it's extremely rare. It's not why those drugs are not OTC. I even asked the FDA - it's about money, and nothing else (like Nexium).

> Doesn't look like its OTC except for cats and dogs.

My mistake. But there are other azole's that are OTC.

> Have you looked at

I did, it was a poor choice of wording - I meant worse as in likelihood * harm.

Amazon is a global company, it matters because not all of their customers are in the United States and they have no need to obey US laws with non-US customers.

Reply on news.ycombinator.com