Pushing the Borders: The Moral Dilemma of International Internet Pharmacies
Bibliographic record
Abstract
W ^hen we think about drug access issues, typically we turn to the appalling lack of access in developing countries where, as the World Health Organization reports, one-third of the population does not have regular access to needed medicines. But the issue of drug access has also recently become a politically charged topic in the United States, the world's most lucrative pharmaceutical market. There have been several populist initiatives to buy pharmaceuticals over the border. Unfortunately, although these initiatives are well intentioned, once the rhetoric is cast aside and the purchases are analyzed impartially, it becomes evident that they are an unfair solution for the long term. Some people would benefit from them, but many more would pay. In the United States, pharmaceutical firms price their products at whatever the market will bear, atypical for an OECD country, resulting in inadequate coverage for many people. Moreover, an estimated 35 percent of Medicare beneficiaries lack drug benefits.1 The Congressional Budget Office (CBO) has projected that rising drug prices will continue to assume a large share of seniors' incomes. It also reported that for the lowest income quintile, the projected increase in drug expenditures, measured as a share of after-tax income, is about 25 percent from 2000 to 2013. American consumers are increasingly unable or unwilling to pay these prices and are seeking better government coverage of pharmaceutical products as well as relief from unaffordable medicines. Cross-border pharmaceutical purchases, particularly from Canada, have acquired political currency as a possible solution, and they became even more popular during 2003. Whether or not the recent Medicare reform will offer enough relief from high prescription drug prices for those in need and the middle class is uncertain at best.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.035 | 0.065 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.016 | 0.038 |
| Scholarly communication | 0.029 | 0.034 |
| Open science | 0.003 | 0.013 |
| Research integrity | 0.037 | 0.042 |
| Insufficient payload (model declined to judge) | 0.014 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".