The Virtual Pharmacy: Be Careful When You Click
Need prescription drugs? Grab a mouse. Hundreds of online pharmacies have sprung up offering convenience and competitive prices on the Web. But be careful: The Internet also provides easy access to potentially dangerous medicines.
In the Wild West of cyberspace, you may not even need a prescription from your personal physician. By logging on to www.at-cost-drugs.com, for example, I was able to order Xenical, a weight-loss medication. My own doctor had advised that my 15 excess pounds didn't merit drug therapy. But after I completed a $35 "online consultation" at the Web site, a physician in Sterlington, La., was willing to write a prescription without ever meeting or examining me, and without calling to verify that the questions I'd answered were true. I simply supplied my credit card number. Within a week, a small brown vial of blue capsules was delivered to my door.
FDA SCRUTINY. I ordered the Xenical as part of an experiment in buying medicine from online pharmacies--an endeavor that runs the gamut from being safe and easy to being downright illegal. "It's not as simple as buying books or CDs," says Tom McGinnis, director of pharmacy affairs for the Food & Drug Administration, which has made policing Internet drugstores one of its top priorities. "There are so many different kinds of Web sites selling prescription drugs that we're having a hard time keeping up with them."
Fortunately, there are plenty of reputable pharmacies among the estimated 1,000 Web sites selling prescription drugs. Some of the nation's largest chains, such as CVS, Walgreens, and Drug Emporium, have established a Web presence in recent years. Several Internet-based companies, including PlanetRx.com and Rx.Com, have been licensed to sell prescription drugs in all 50 states. Established mail-order prescription businesses, including the American Association of Retired Persons Pharmacy Service, have Web sites. Many mom-and-pop drugstores have also gone online. For instance, McKessonHBOC, a health-care consulting firm, maintains a Web site (www.healthmart.com) allowing a network of 4,600 independently owned Health Mart and Value-Rite stores nationwide to fill prescriptions online. You can pick them up at a drugstore or have them sent.
The nice thing about a Web pharmacy is that it offers conveniences that a brick-and-mortar retailer can't. A prescription can be phoned, faxed, or e-mailed at any time, day or night. Some doctors already have the capability to transmit prescriptions directly to drugstore sites, reducing the chance that a pharmacist will misread an illegible scribble. And many online drugstores keep track of patients' prescriptions, alerting them by e-mail about refills or dangerous drug interactions. You can also get immediate price quotes, 24-hour access to a pharmacist via e-mail or phone, and links to more medical resources than you'll ever need.
PRIVACY VIOLATIONS. There are some drawbacks. Not all pharmacies accept a full range of insurance; check first to see if your prescription is covered. Be sure to read the fine print about availability and delivery. If a pharmacy isn't affiliated with a retail store, it can take a week or longer for your drugs to arrive in the mail. Privacy is a concern as well. A recent report by the California HealthCare Foundation (available at ehealth.chcf.org) found that health-care Web sites are often unable to keep visitor information confidential, even when such assurances are offered. The problem stems largely from technology allowing banner advertisers access to information that a customer enters on the page where the ad appears. Other privacy violations occur when sites share information they've gathered with partners who haven't signed a privacy agreement.
Barely distinguishable visibly from reputable Web pharmacies are online drugstores whose practices and products can be risky or even dangerous. The Internet has widened access to illegally imported prescription products. At www.drugquest.com, for instance, you can, for a fee, "purchase virtually any prescription medicine for less, without hassles and without a prescription" from Mexico, Canada, and the Caribbean. Last year, the U.S. Customs Service seized 9,725 packages of prescription drugs, nearly five times as many as in 1998. The number of impounded pills jumped from 760,720 in 1998, to 1.9 million last year. That's believed to be just a fraction of the foreign drugs sold online.
Federal officials warn that illegally imported drugs often fall below U.S. quality standards, fail to comply with labeling requirements, or aren't approved in this country. "We have a good system in place for making sure prescription drugs sold here are safe," says the FDA's McGinnis, "but we have no way of controlling the quality of drugs coming in from offshore." Among potential problems: counterfeit medicines, contaminated or outdated ingredients, and improper storage. Even if the products are safe, consumers whose orders are confiscated stand a good chance of losing money. Most Web stores selling imported drugs won't provide a money-back guarantee.
Also risky are pharmacies that sell both a prescription and the medicine at the same time. Hundreds of sites specialize in weight-loss drugs, antidepressants, baldness cures, impotence treatments, and other "lifestyle" drugs. They do require an online consultation ($20 to $70), and there's a form to fill out about symptoms, health history, and medications you're taking, but the "right" answers are often preselected. "Doctors are being paid up to $5,000 a month to review these questionnaires and write prescriptions," says Carmen A. Catizone, executive director of the National Association of Boards of Pharmacies (NABP), an alliance of state regulatory agencies that has begun monitoring online pharmacies.
President Clinton has called for laws requiring Net drugstores to be licensed--like brick-and-mortar pharmacies--and has recommended fines of up to $500,000 per violation for selling drugs without a valid prescription. Several state medical boards have fined physicians for issuing prescriptions to patients they only know in cyberspace. And the FDA has set up a link on its Web site (www.fda.gov) for consumers to report online drugstores that don't seem aboveboard.
At the very least, consumers should make sure an online drugstore identifies itself and its staff, and provides an address and phone number. You can also check for a Verified Internet Pharmacy Practice Sites seal, an endorsement from the NABP assuring consumers that the site is licensed and abides by safe and ethical practices. To check the seal's authenticity, go to the board's site, www.nabp.net. Only four online pharmacies (cvs.com, drugstore.com, planetRx.com, and merck-medco.com) have a VIPPS seal, but approval for 15 more is expected in the next few months. Until stricter safeguards are in place, consumers should exercise skepticism, caution, and above all, good judgment when shopping for prescriptions online.