Grumpy Old Drug Smugglers

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http://www.nytimes.com/2004/05/30/magazine/30DRUGS.html?th

 

May 30, 2004Grumpy Old Drug SmugglersBy ELIZABETH WEIL

 

I can be very frail if I need to be,'' Kate Stahl said recently as she unpeeled

the ripe banana she carried in her bag for lunch. Frailty is not normally prized

by political activists, but Stahl is an unlikely agitator. A retired medical

secretary with nine grandchildren and four great-grandchildren, she is 85 years

old, appears to weigh hardly that many pounds and spent much of her adult life

in rural seclusion as the sole female resident on Little Dead Horse Lake, a

small community about five miles outside Marcell, Minn. -- a town itself so

obscure that it once sold T-shirts asking ''Where the hell is Marcell?'' Only in

1995, when her husband's lung disease kept him from chopping wood to heat their

home, did Stahl and her husband move to an apartment in St. Paul. She describes

her life until her husband's death, five and a half years ago, as the opposite

of radical. ''I always had someone half a step in front of me,'' she said. ''My

parents, and then my husband, then the children.

I wouldn't have said boo to a turtle, literally.''

 

The first rumblings of Stahl's political awakening began shortly after moving to

the city, when she and her husband signed up for a bus trip to Canada, organized

by a local advocacy group called the Minnesota Senior Federation, to buy

prescription drugs. They learned that they could much better afford his war

chest of medicines by buying them abroad and smuggling them back across the

border. Stahl didn't like the fact that in doing so, she was violating federal

laws that prohibit anyone other than manufacturers from re-importing drugs, but

she couldn't see what was wrong with saving 40 percent on the same prescriptions

available at her local pharmacy. She soon began volunteering at the Minnesota

Senior Federation because, as she explained, having benefited from the bus ride,

it seemed the neighborly thing to do. ''If someone brings you a plate of

cookies,'' she said, ''you can't bring it back empty.''

 

Following her husband's death, Stahl became an active federation member, leading

to her two-year stint as president of the federation's metropolitan region. To

this day, most mornings she drives her 1993 Chevy Euro from her daughter's house

in suburban Shoreview, where she now lives, to the federation's office in

downtown St. Paul, to fight for fair pricing on prescription drugs (one of the

federation's three main causes, along with ensuring access to health care and

affordable housing). She also makes regular bus trips to Winnipeg, amusing her

fellow seniors on the way back by yelling out, Come and get me, boys! ''Can't

you see the publicity?'' she said, stooping over an imaginary cane. '''Frail old

lady put in jail because she couldn't afford her drugs in America and she had to

do it in Canada.' I even have an old cane that I got at Goodwill. Can't you see

it? 'Gee, Officer, I really can't afford a new one. They're too expensive and I

just don't have the money . . . honey.'''

 

Stahl's public emergence as a hell raiser came in July, when Gil Gutknecht, a

Republican congressman from Minnesota, seized on her as a political godsend and

invited her to Washington for a news conference announcing his sponsorship of a

bill to legalize drug re-importation. It was Stahl's first visit to the nation's

capital, and in the blinding light of the flashbulbs, on a trip she called ''the

adventure of a lifetime,'' she realized that being a bony, shrinking, widowed

old lady, far from a liability, is in fact a great strength. Seniors are the

fastest-growing voter bloc in the United States, expected to double by 2030,

when 1 in 5 Americans will be 65 or older. Politicians who don't respond to

those kinds of demographics don't stay politicians. Stahl, whose total income

consists of Social Security and her deceased husband's pension of $51.74 a

month, counts herself among the many Midwestern widows, ex-stockbrokers, retired

schoolteachers -- people with time on their hands and

dwindling savings -- who have found a galvanizing political cause in the high

cost of prescription drugs. Like the Vietnam War to so many college students in

the 60's and 70's and nuclear proliferation to mothers in the 80's, the issue is

so personal, so deeply tied to life, death and a sense of justice, that it is

driving otherwise private and conservative citizens into the first activism of

their lives.

 

 

The Minnesota senior federation was founded 31 years ago to give seniors a

rights movement of the kind then forming among women and minorities. The

federation occupies an old stone office building on a bleak stretch of

University Avenue in St. Paul, near a diner called Andy's Garage. As one of

three consumer groups in America to bargain collectively with Canadian

pharmacies for prescription drugs on its constituents' behalf, the federation

runs two Internet pharmacy services -- one if you want your doctor involved in

the ordering process, the other if you don't -- that offer hard-to-beat deals

for a $19.50 yearly membership. Last year, more than 4,000 members ordered more

than $2million worth of drugs. Six months ago, the federation removed all age

and geographic restrictions to joining, so that every state is now represented

and the youngest member is 6 years old.

 

The federation conceived and organized the first prescription-drug-buying bus

trip to Canada in 1995, after it sold a cut-rate storefront pharmacy that the

federation ran in Minneapolis. Originally the bus trip was intended as a form of

civil disobedience and a consciousness-raising event, but almost a decade later

the buses are still running. The seniors tend to be in a good mood when, at

around 7 a.m., they park their cars at the designated pickup points at Kmart or

Cub Foods and climb aboard. From there it's north on I-94, past St. Cloud and

Fergus Falls, everyone enjoying free munchies, and then they cross into North

Dakota, through the pine forests around Fargo. Lunch is usually at a buffet

restaurant, where the spread is wide enough to meet everybody's dietary

restrictions. Then it's back on the bus, comparing bills and trading in

nostalgia. Two riders once discovered that they were from the same town in

Eastern Europe and another two that they attended the same high school. As

they pass the vast wheat fields and feedlots of southern Manitoba, there's

always time for the perennial VCR favorite, ''Grumpy Old Men.''

 

Around 4 p.m., the group arrives in Winnipeg, checks into the Ramada Marlborough

and splits into two groups. One unpacks and has an early dinner. The other group

heads to the office of Dr. Craig Hildahl. A physician licensed in both Minnesota

and Manitoba, Hildahl spends 15 minutes with each person, taking vitals and

reviewing medical history, and looks over their American prescriptions. If

nothing alarms him, he rewrites and faxes prescriptions to a nearby pharmacy.

The two groups switch, and in the morning they all pick up their drugs. Loot in

hand and savings calculated, they make the obligatory stop at the duty-free shop

at the border, where the proprietor hands out free tins of cookies. After what

is usually a pro forma pass through Customs (which, like the Food and Drug

Administration, seems not particularly eager to go after senior citizens),

homeward they go.

 

The federation currently sponsors eight or nine trips a year, and they've been

extremely effective, both for penny-conscious seniors and for those looking to

raise the political profile of the issue. In the early days, the trips were

partly underwritten by Winnipeg casinos asking, in exchange, for a six-hour stop

by the seniors at the slot machines, but since 2002 they've been financed

entirely by Senator Mark Dayton, a Minnesota Democrat who ran his own

cross-border bus trips during his last campaign and now pledges his salary to

the federation program. (Dayton's official Web site currently displays a photo

of himself with Stahl.) Minnesota's Republican governor, Tim Pawlenty, credits

the federation with inspiring him to initiate MinnesotaRxConnect.com, the most

established state-run drug-importation service in the union.

MinnesotaRxConnect.com stops short of directly facilitating purchases from

cross-border pharmacies and thus, Pawlenty says, breaking the law, but that has

not kept

the F.D.A. from sending the governor what he calls ''snotty-grams'' -- heated

missives about aiding and abetting illegal and unsafe activity.

 

Almost every border state has felt the federation's influence. The bus trips

have been replicated from as far west as California, as far south as Arizona and

as far east as Maine. Congress, too, seems to have a newfound interest in the

issue, with a bipartisan group of senators announcing in April that they'd

reached agreement on a bill to allow imports of lower-cost prescription drugs

from Canada and some other countries, not just to individuals but to American

pharmacies as well. Many cite the federation, and Stahl in particular, as a

source of inspiration and courage. ''Kate's always going like this,'' Pawlenty

says of Stahl, putting out his hands, wrists together, as if to be handcuffed.

''So when they come for me, I'm going to send her instead.''

 

The new Medicare law, which President Bush signed last December, has only fueled

the sense of urgency in senior politics. Yes, the law did create a much-coveted

prescription-drug benefit, but many critics say the benefit is inadequate and

are especially outraged by a provision of the law that prohibits the federal

government from negotiating prices on behalf of Medicare beneficiaries. (By

contrast, the government currently negotiates such prices for its own employees,

members of the armed forces and inmates in the federal prison system.) When the

American Association of Retired Persons (AARP) endorsed the law on the grounds

that a flawed benefit was better than no benefit at all, 60,000 of its members

quit in protest.

 

Many of those who left AARP defected to the Alliance for Retired Americans

(A.R.A.). While AARP has long been associated with moneyed and corporate

concerns, the A.R.A., on the other hand, grew out of the A.F.L.-C.I.O. as a way

of encouraging retired union members to help create grass-roots campaigns for a

''progressive political and social agenda.'' The move from AARP to the A.R.A.

marks a shift in senior politics away from genteel, insider lobbying to a

scrappier set of tactics. One longstanding A.R.A. member is Bill Dodds, 82, a

former national political director of the United Auto Workers. In 1982, when he

was still working, Dodds told his bosses: ''Lookit, I'll take early retirement

and I'll become a leading advocate of the only minority group I'll apparently

ever belong to. I can't become a woman, I can't be black. I can be only a senior

citizen.'' Since that time, Dodds has worked on a wide variety of issues, and

currently he's also organizing senior labor groups, both blue-

and white-collar, around prescription drugs. Meanwhile, his colleagues at the

A.R.A. are plotting the mother of all drug-buying bus trips: an armada of motor

coaches to depart from 17 cities this summer, heading across the border to save

what the organizers hope will be a collective $1 million. One bus will then

continue onward to Boston for the Democratic National Convention.

 

On a smaller scale, local opinion-leaders are performing a kind of viral

marketing for the Web sites and storefronts that, in addition to the bus trips,

help seniors circumnavigate the high prices of meds. These kingmakers are

regular, spunky folks, often with no particular history in politics, like Donna

Scott, 67, one of the first construction forewomen certified in Michigan, who

finds herself answering questions for an awful lot of friends who are having

trouble keeping up with the cost of their pills. To Scott's mind, where you buy

your drugs not only makes a big difference to your bank account; it also makes a

statement about what's fair and just. ''I don't feel comfortable going down to

Walgreens,'' she says.

 

As an alternative, Scott has been telling anyone who asks or might benefit that

she orders her own prescription medicine through the American Drug Club, which

currently has 91 outfits spread across the country. The American Drug Club is

structured like Tupperware or Amway, with each club owner earning a commission

on the business he generates. Though the process for the consumer is simple --

fax in your order, wait for your drugs in the mail -- the business of

fulfillment is more convoluted: once the scrip arrives at the Point Douglas

Pharmacy in Winnipeg, it is verified and then sent to a Canadian doctor to be

rewritten, then filled and sent directly to the customer. This arrangement meets

the Canadian requirement that its pharmacies fill only prescriptions written by

Canadian doctors, and it also helps the drug clubs evade the F.D.A. by never

touching the pills.

 

Patrick Slater, 32, a former golf pro and current stay-at-home dad, owns the

American Drug Club operations in Grand Rapids and Livonia, Mich. He says that

he's been politicized by the enterprise. ''When I first started, this was a

business venture, pure and simple, and now it's become more personal,'' he says.

''What really changed it for me was that first day when all these people were

waiting for four hours without complaining just to hear what we do. It really

made me think: if they're enduring sitting there in a metal chair -- or, really,

we didn't have enough chairs, most of them had to stand for four hours -- if

they're enduring this, what are they enduring in their daily lives with their

medications?''

 

 

Whatever seniors are enduring today, William Hubbard, associate commissioner for

policy and planning at the Food and Drug Administration, says he is more

concerned about what might happen if Americans buy their medication abroad,

where the F.D.A. cannot guarantee the safety or reliability of the product.

''Many people, including some governors,'' he says, pointedly, ''believe that

these drugs are the same drugs that one gets from their corner drugstore in the

United States, and that's what these Internet sites and Canadian pharmacies

often claim. But the reality, from F.D.A.'s point of view, is that these are not

regulated products. F.D.A. has no ability to ensure their safety, we don't

regulate them in any way and the Canadian F.D.A. also will not accept

responsibility either.''

 

As for the pharmaceutical companies, they argue that the high price of

prescription drugs in the United States helps defray the cost of financing

research and design. ''Price controls reduce incentives for companies to

undertake huge investments in discovering new meds,'' says Lori Reilly, the

deputy vice president for policy at the Pharmaceutical Research and

Manufacturers of America, a lobbying group. ''We know that we need drugs for

Alzheimer's, for Parkinson's, for multiple sclerosis, and we know that

discovering them will be very difficult. A lot of these drugs take 10 or 15

years to develop. The money we spend now on research and development will

determine our health in the future.''

 

Kate Stahl has heard these arguments before, but to her it all sounds like hooey

in defense of the pharmaceutical industry's bottom line. Not long ago, she

showed up at the federation, wearing a lapel button that read ''old woman,'' to

debrief her colleagues on a second trip to Washington that she took earlier this

year to attend a drug conference at a recent National Governors Association

meeting. Among those seated around the table to hear Stahl's report were Miriam

Reibold, 87, chairwoman of the National Coalition of Consumer Organizations on

Aging; Mary Anderson, 76, coordinator of the federation's drug-importation

program; and Peter Wyckoff, 59, the federation's founder. As the others picked

at homemade poundcake, Stahl declared her trip a grand success, save perhaps for

one personal misadventure: she stayed in a motel in such a bad part of town that

no cab would pick her up, and someone whom she quaintly called a ''woman of the

night'' knocked on her door and then apologized,

saying, ''I have the wrong room, don't I?'' (Senator Dayton, hearing of this,

came to Stahl's rescue and put her up in a better part of town.)

 

In truth, there were other minor frustrations as well. In her two days in

Washington, Stahl managed only one proper meal, partly because of the lack of

restaurants on the mall and partly, she said, because she was so ''keyed up.''

In her meeting with Senator Norm Coleman of Minnesota -- an outspoken opponent

of drug importation -- Stahl had planned to stick to issues of senior-citizen

mental health and long-term care, on which she knew they had common ground. But,

she said, ''I sat down in his office, and out came five minutes of prescription

drugs.'' Adding to Stahl's agitation, the F.D.A. commissioner at the time, Mark

McClellan, failed to attend the governors meeting, and shortly thereafter he was

nominated to lead the Centers for Medicare and Medicaid Services and was also

named to a committee studying importation. Stahl shook her head at the memory.

''That is the worst case of a fox in a henhouse that I can think of,'' she said.

 

As the federation meeting broke up, Stahl's immediate task was to prepare for a

session the next day with the Minnesota State Board of Investment. Minnesota

owns more than $470 million worth of Pfizer stock, and Governor Pawlenty, who is

chairman, along with the Minnesota Senior Federation, had expressed interest in

pushing through a shareholder resolution that would pressure Pfizer to alter its

pricing practices. Contemplating the financial scale of such battles, Stahl

chuckled about her background in ''household finance'' but showed no sign of

being daunted -- not by Pfizer, nor by the prospect of being involved in a

class-action lawsuit against nine major pharmaceutical companies. (That suit,

filed on May 19, claims that those companies have kept drug prices artificially

high in the United States.) ''Medicare isn't the solution,'' she said. ''What

about young families who need drugs and can't afford prescription insurance?

What about them? Don't they count? We can't do this just

for seniors. We're just citizens. We're not that special.''

 

 

 

 

 

 

Elizabeth Weil is the author of ''Crib Notes: A Random Reference for the Modern

Parent,'' which will be published in July by Chronicle Books.

 

 

 

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