“Sir, please sign here for your prescription ordered by Dr Amazon”.

By Sophie Wright The world’s largest e-commerce retailer, Amazon, has launched an online pharmacy service called Amazon Pharmacy…

By Sophie Wright

The world’s largest e-commerce retailer, Amazon, has launched an online pharmacy service called Amazon Pharmacy in Bangalore, India. With online retail capitalising on the pandemic, Amazon has expanded its Indian customer base, recording a 35-50% increase in demand for items only available online during the height of lockdown restrictions. This resulted in a 40% year-over-year growth, boosting the e-commerce giant’s second quarter FY2020 net sales to a total of USD88.9 billion.

Amazon’s latest venture into the pharmaceutical arena is by no means a nuanced strategic approach. The company first began retailing pharmaceuticals in 2017 which was quickly followed by the acquisition of the American home delivery start-up, PillPack, in 2018. At the start of this year, Amazon applied to trademark the rebranding of PillPack to “Amazon Pharmacy” in the UK, EU, Australia and Canada.

The decision to launch Amazon’s pharmaceutical trading platform comes after Amazon boss, Jeff Bezos, invested USD 1bn in India in January 2020, as he declared that the 21st century is “going to be the Indian century”. Indeed, we may all benefit from taking heed of Bezos’ predictions considering India’s gross domestic product (GDP) grew by 3.1% in the first quarter of 2020, despite the mounting threat of COVID-19 restrictions. Evidently, India’s economic stoicism is not to be underestimated – we would do well to keep watch of the new and, perhaps, more thrifty kid on the commercial block.

However, as part and parcel in business, Amazon’s foray into a new economy comes not without significant competition and controversy. Flipkart, an e-commerce company headquartered in Bangalore, boasts the highest sales for commodities such as apparels, furniture, beauty and electronics, to name but a few. With a slick user interface and assurance of product tracking from warehouse to front door, Flipkart’s offering across a broad range of product categories poses a significant obstacle to Amazon’s usurping of Flipkart as the current dominator of Indian e-commerce.

Another more pressing concern from the consumer perspective hinges on the safety, regulation and scientific rigour behind Amazon’s new e-pharmacy arm. Amazon has acquired an impressive range of capabilities, including the license to sell prescriptions, over-the-counter drugs, health devices, and even Ayurvedic medicine – one of the oldest treatment systems in the world. Thought to have originated from India more than 3,000 years ago, Ayurveda medicine centres around the concept that disease is caused by an imbalance in the consciousness of a person. Indeed, Ayurvedic practice promotes holistic (and scientifically approved) values of a healthy diet and exercise to optimise health with a focus on prevention rather than cure. However, it must be noted that Ayurvedic medicine sometimes calls for the preparation of medications which can include harmful metals such as arsenic, mercury and lead.

A 2015 study engineered by Breeher et al. revealed that of the 115 participants who adhered to Ayurvedic practice, 40% had elevated blood lead levels of 10 μg/dl or above, with 9.6% of blood lead levels at or above 50 μg/dl. Furthermore, some participants had elevated blood levels of mercury which was later explained by the testing of some Ayurvedic supplements – almost half of them contained high levels of mercury* with a quarter said to contain high levels of lead**. In another 2015 report, the Center for Disease Control’s Morbidity and Mortality revealed an associated link between lead consumption and anaemia. This came following the story of a 64-year-old woman found to be suffering from anaemia after abnormal blood smear results and suppressed haemoglobin levels, alongside elevated blood lead levels. The woman in question had purchased a seemingly harmless Ayurvedic medicine via the internet.

Amazon’s overall track record of product safety and regulation does not provide much reassurance. In August 2019, the Wall Street Journal reported that 4,152 products deemed unsafe, banned and mislabelled were available for purchase via Amazon, with the company being the target of over 60 federal lawsuits concerning product liability. Amazon has maintained that the company merely acts as the interface between buyer and seller and, therefore, only facilitates any subsequent interactions. This has offered a loophole for the company in previous years to avoid liability in a variety of cases ranging from faulty ladders causing death, to teenage boys jumping from a second-storey building to escape a burning house due to a defective hoverboard.

** Of the 182 supplements, 27.5 % contained lead levels above California’s maximum allowable daily level (MADL).

* 47.8 % of the supplements had elevated levels of elemental mercury above California’s MADL.

Although many in the legal sphere are beginning to question this argument, no definitive decision over Amazon’s accountability in incidents of poor product regulation has been reached. Consequently, reports such as these would seem to reinforce the legitimate concerns many health professionals and consumers hold over the safety and regulation of medicinal treatments as Amazon expands into the healthcare vertical.

There is no denying that digitalisation of pharmacies seems to be the way ahead, with pharmacies such as Lloyds using the Echo app to offer free online repeat prescriptions. However, it is not just the health professionals who have objected to Amazon Pharmacy. The company has faced a backlash from many Indian trade groups who fear this strategic venture will leave them unable to compete in the consumer market. Although a study by health technology company, Medbelle, ranks India as having one of the lowest median prices for general and branded drugs, the same cannot be said for America where prices are far higher than the global median. From an optimistic perspective, Amazon Pharmacy may encourage competition to keep consumer prices low – a prospect which is particularly welcomed in countries where the availability of affordable basic healthcare is a luxury, not an expectation. However, while the coming age of e-pharmacies offering slashed prices for consumer drugs have traditional pharmacists quaking in their boots, will these reduced prices translate to reduced safety?

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