“Consider the case of a patient who travels to India for major surgery. Upon discharge he receives a few days’ supply of pharmaceuticals from the hospital pharmacy and is told he can refill his medications over the Internet through the hospital’s mail order service once back home. It seems likely that this patient –who traveled halfway around the world for care— will become a loyal, long-term customer. In effect, a pharma manufacturer’s marketing practices in Asia or Latin America might have a demonstrable effect on U.S. drug consumption patterns.”