Buying Drugs Online: It's Convenient and Private, but Beware of 'Rogue Sites'

These legal businesses often offer privacy and convenience as well as the protections of traditional methods for prescribing drugs. These services can be used by consumers with the same confidence as their local druggist. While some of these legitimate businesses may be associated with large drugstore chains and other pharmacies chained nationwide, many are small, independent pharmacies that are set up to provide their customers online.

However, consumers should be cautious about the use of the internet by others to purchase products and practices that are illegal in the offline world. These "rogue" sites sell products that are not approved or they bypass established safeguards to protect consumers. Some sites only require customers to complete a questionnaire before they can order prescription drugs. This bypasses any face-to–face interaction with a doctor.

Jeffrey Shuren, M.D., Medical officer in the Office of Policy, Planning and Legislation at Food and Drug Administration, says that this practice "undermines safeguards of direct medical supervision and a physical evaluation performed by licensed health professionals." It is easy to bypass this safety network with the internet.

This way of skimming the system can lead to dangerous drug interactions as well as harm from counterfeit, contaminated or obsolete drugs. Shuren says that websites that offer prescriptions based on questionnaires pose additional health risks. Shuren says patients are at risk of receiving an incorrect medication and could be denied the chance to receive a proper diagnosis or to identify a contraindication.

FDA has only received a handful of reports about adverse events related internet drug sales. However, some of these cases highlight the dangers of purchasing prescription drugs based on a questionnaire. A 52-year old man from Illinois died last March of a heart attack after he purchased Viagra (sildenafil citrate) online. He had suffered episodes of chest discomfort and his family history of heart disease. Although there is no evidence linking the death of the man to the drug, FDA officials claim that the traditional doctor-patient relationship and a physical examination may have revealed any health issues such as heart disease. This could have allowed for proper treatment.

FDA is currently investigating numerous websites selling pharmaceutical products that are suspected of violating the law. If necessary, it will take legal action. The FDA has designated internet surveillance as a priority enforcement tool. This includes unapproved drugs, health fraud, prescription drugs that are not validly prescribed, and prescription drugs that are sold without a valid prescription.

Brave New World

The internet is becoming more popular for health reasons. Cyber Dialogue Inc. found that health concerns rank sixth in the top six reasons people use the internet for their health. However, internet pharmacies won't render "brick-and-mortar" pharmacies obsolete any time soon. According to industry figures, 2.97 billion prescriptions were dispensed in 1999. Although no reliable data is available on total online sales, sources within the industry believe that this number is still quite small.

Some people find that Buy Colombian Cocaine online has advantages that are not available at a local pharmacy, such as:

• Greater availability of drugs for those who are disabled or live far from the pharmacy
• The ease of comparing prices across many websites to find the best products and prices
• Greater convenience and variety
• Access to product information in writing and references to other sources is easier than traditional pharmacy counters
• Consumers can order products online and talk to a pharmacist from the comfort of their own homes.

Internet drug shopping can also be claimed to save money. This is sometimes true. In a survey by Consumer Reports, it was found that online purchasing of certain drugs could help buyers save up to 29 percent. Another study by the University of Pennsylvania, published in the Annals of Internal Medicine in 1999, looked at online sales of Viagra, and Propecia. It found that these drugs were on average 10 percent more expensive than local pharmacies in Philadelphia.

Researchers Bernard Bloom, Ph.D. and Ronald Iannocone discovered that 37 of 46 sites required a prescription from either a personal doctor or that they could prescribe medication solely based on a questionnaire. Nine sites, all located outside the United States, didn't require a prescription. Researchers also discovered that although websites promised a doctor would review the questionnaire, little was known about the qualifications of the doctor. Users could easily provide false information in order to get a prescription.

There are many websites that offer health products online, but FDA officials have warned them not to. Many of these sites specialize in selling drugs like Viagra ( finasteride) or the weight-loss therapy Xenical( orlistat). Other sites, which are based abroad, claim to be able to ship prescription drugs at a lower price than the domestic ones. However, the drugs could be different from the ones approved in the United States, or they may have expired. Other sites advertise false health claims and that customers can purchase drugs without a prescription. You can find online drug sites in almost any country or state that has a phone line.

Some believe that new laws are needed to remedy this situation. Rep. Ron Klink (D-PA), the sponsor of legislation on internet pharmacy, said that there is currently nothing to require drug-dispensing websites to make any information public. "Buyers don't have the ability to find out if a website is licensed, if it uses licensed pharmacists, or in which state they are located. Klink's bill would require internet pharmacies to list the address, phone number, and name of the principal location, as well as the names of all pharmacists and health professionals who provide medical consultation. It also lists the states in which the licensed pharmacy, pharmacists, or other health professionals are licensed.

Some pharmacy industry representatives are against legislation or adding more powers to regulatory agencies. They believe that the current laws are adequate to solve the problem. Mary Ann Wagner, Vice President of Pharmacy Regulatory Affairs at the National Association of Chain Drug Stores, says that "there are (controls already in place) for regulating pharmaceutical sale." "That hasn't changed."

Overseeing Online Sales

It remains to be seen if new legislation will enhance oversight of online pharmacies. FDA's Shuren says regulators are now in a "whole new game". This is because they have to cross the boundaries of many federal and state agencies. State pharmacy boards supervise pharmacy practice while state medical boards regulate medical practice. The FDA and Federal Trade Commission make sure that drug sellers can legally claim for their products. There are many other agencies, such as the U.S. Customs Service or the U.S. Postal Service. The laws governing the shipment of drugs are enforced by the Postal Service.

FDA oversees the manufacturing, safety, and effectiveness of pharmaceutical drugs. It also regulates prescribing. Shuren states that it is against the Food, Drug, and Cosmetic Act for a pharmacy to sell prescription drugs without a valid prescription. FDA has the power to take legal action against any site that violates this requirement. He also said that FDA involvement has the advantage that states are unable to enforce their laws across state borders. The site could still be sold in 49 other locations if it is shut down by one state. But, the federal government can close down any illegal website.

FDA announced last July that it would be joining forces with state regulatory agencies to fight illegal domestic prescription Lavada Cocaine for sale. These agreements were signed by the FDA and the Federation of State Medical Boards. They represent the commitment of these groups to enforce federal and state laws against illegal internet sellers and prescribers of drug in the United States.

Although regulation of internet sales of health products remains a relatively new concept, FDA has taken successful action against illegal sites in the past. Lei-Home Access Care, a California-based company, used the internet in 1996 and 1997 to sell a home kit that was advertised as a test for the AIDS viruses. The kit was not approved and the maker also faked test results for users who submitted blood. The FDA investigated the site thoroughly and Lawrence Greene was sentenced to over five years imprisonment.

The Federal Trade Commission announced Operation Cure.All last July. It aims to end bogus claims on the internet for products and treatments that claim they can cure various diseases. The program identified 800 websites and many Usenet newsgroups that contained questionable offers over two years.

Jodie Bernstein is Director of FTC's Bureau of Consumer Protection. She says that miracle cures once considered laughable have now found a new medium. "Consumers spend millions of dollars on deceptively-marketed, unproven products on the internet."

Four companies were charged by the FTC with deceptive claims regarding health. They included websites that claimed to cure arthritis using a fatty oil derived from beef tallow. FDA has been working closely with FTC in Operation Cure. All has also sent warning letters to ensure that misleading and false statements are not removed from the internet.

More than a dozen other states have also taken action against internet pharmacies. Kansas was one of them. It banned several pharmacies from running illegal online-based businesses in the state last year.

Industry polices itself

Professional organizations are also launching programs to clean house. The National Association of Boards of Pharmacy (NABP), which offers valuable information to consumers about online pharmacies' credentials, launched its Verified Internet Pharmacy Practice Sites program (VIPPS).

VIPPS is a voluntary certification program. To be accepted into the program, the online pharmacy must comply with the following conditions:

• Maintaining all state licenses in good standing
• allowing information about the pharmacy to be posted and maintained on the VIPPS website (https://www.nabp.net/vipps/intro.asp)
• Given reasonable notice, allow an NABP-sanctioned inspection team to inspect the operation.
• Displaying and maintaining the VIPPS seal, with a link back to the VIPPS site

VIPPS officials claim that the program is particularly beneficial for seniors. Kevin Kinkade (chairman of the NABP Executive Committee) says that there is a particular concern for the elderly, who are often the targets of unscrupulous advertising ploys. Consumers who want to ensure that their prescription medications are coming from legitimate online pharmacies will find VIPPS a tremendous advantage. Three businesses were certified VIPPS at press time: drugstore.com and Merck-Medco Rx Services.

The American Medical Association developed guidelines for doctors specifically addressing internet prescriptions at its June 1999 annual meeting. Although these principles were not finalized at press time by AMA officials, they are designed to ensure that internet-based doctors follow the minimum standards of care. This means that patients must be examined in order to diagnose or confirm that there is a problem.

Many people in the pharmaceutical industry support the AMA's actions. Martin Hirsch, Public Affairs Director at Roche Laboratories Inc. (maker of Xenical), stated that "the relationship between physician and patient" is crucial. We support guidelines to ensure that this relationship does not end.

It will still be difficult to keep an eye on illegal internet drug sales despite the availability of both regulatory and voluntary measures. Wagner, National Association of Chain Drug Stores, states that even if state boards, FDA, or other agencies do their jobs well, the issue will still be a problem for consumers.

FDA will help raise public awareness through an education campaign. This campaign informs consumers about legal, economic, and health risks associated with online sales of medical products. This campaign will also target industry and health-care professionals. Similar outreach is being conducted by other federal and private organizations.

"Consumers must be aware of the dangers of purchasing prescription drugs online in order to remain vigilant," FDA's Shuren says. "The public also needs to understand," he continues, "that there is a cost to operating an illegal internet pharmacy." Even just a few cases will be brought to the attention of the public, a strong message that illegal websites will not be tolerated.