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Prozac Pipeline, Japanese Must Venture Into Cyberspace To Procure 'Lifestyle' Antidepressants

By George Wehrfritz

With Kay Itoi in Tokyo

The banner ad flashes like a neon marquee in Ginza: PROZAC…PROZAC…PROZAC. The tag line reads: "if you don't know about this you're behind the times." The Web site linked to the ad, run by a company with no obvious name or address, is one of hundreds that offer Japanese consumers mail-order drugs from overseas. They peddle everything from herbal elixirs to diet pills to St. John's wort. But their bread-and-butter trade is in "lifestyle" antidepressants, chiefly Prozac, Paxil and Zoloft.

This unregulated trade stems from a loophole in Japan's drug laws. While pharmaceutical products developed overseas must undergo extensive (critics say redundant) clinical trials prior to commercial sale in Japan, ordinary Japanese can buy almost anything for their own use. Typically, pharmaceuticals reach the Japanese market five to 10 years after they've appeared in the West. Prozac, an extreme example, debuted in Belgium in 1986 but won't arrive in Japan until 2003 at the earliest. Web-based "personal-importers" are capitalizing on that lag time by facilitating sales of drugs from countries like Cambodia, New Zealand and Mexico. Industry watchers estimate the booming Internet trade to be the largest.

Viagra, Pfizer's breakthrough remedy for male sexual dysfunction, created Japan's gray-market apothecaries when hundreds of personal import companies sprung up to sell it in the mid-1990s. Significantly, the online Viagra trade remains brisk nearly two years after Japan's Ministry of Health and Welfare approved it for commercial sale-a pattern repeated with antidepressants, for which patients also prefer the anonymity of the Internet. Prozac is one in a family of gentle depression medications called selective serotonin reuptake inhibitors, or SSRIs, that improve mood with few side effects. The first of these (fluvoxamine) appeared in Japan 1999. But some Web consumers are still willing to pay two to three times what Japanese clinics charge (about $2.80 per daily dose) because they're too ashamed to seek professional help for depression. Personal import companies, in fact, tailor their pitches to tap stigma and self-denial. The company 3c, based near Kobe, advertises that Prozac "is not just for serious depression, but for people who lack confidence, feel negative, experience panic or anxiety… or suffer various neuroses." Translation: you don't have to be crazy to buy it.

Mental-health experts and pharmaceutical companies alike worry about unregulated sales and patients taking inappropriate dosages. Over time, they hope, commerce will shift from the internet into clinics. In 1998, the year before SSRIs arrived, Japan's antidepressant market (comprising older drugs known as tricycles) totaled only $132 million. Analysts forecast that within a decade that could rise to $1 billion, making Japan the world's second largest market after the United States.

Indeed, the first name-brand SSRI approved in Japan, Paxil, is already a runaway success after less than a year on the market. According to its maker, GlaxoSmithKline, Japanese doctors prescribed it to about 100,00 patients in June. "we figured fifty, sixty thousand," says Jason Humphries, a GSK marketing manager in Tokyo. "We're surprised by the level of demand." An even larger surge could come when Eli Lilly launched Prozac. That should put the drug companies at least in a good mood.

From Newsweek, August 20, 2001 and © 2001 Newsweek, Inc.
All rights reserved. Reprinted by permission.

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