Study finds problems with buying drugs on the Internet

PHILADELPHIA - (September 28, 1999) A new study of 46 Internet sites selling prescription drugs directly to the public (i.e., not portal or click-through sites) found that:
 

• Only five sites revealed the actual location of the business.
• None revealed the names, addresses, specialties or qualifications of their physicians.
• Nine sites, all outside the U.S., did not require a physician's prescription.
• Ten sites recruited physicians to become consultants for the sites.
• Online doctor consultations cost more than visits to primary care physicians.
• Two popular drugs cost more, on average, if purchased online than at a pharmacy.

University of Pennsylvania researchers studied many aspects of the pharmacy Web sites and collected prices of sildenafil (Viagra®) for male erectile dysfunction and finasteride (Propecia®) for male baldness. These drugs were sold by all sites and were the drugs sold most often. The researchers compared the Internet costs of the drugs and physician consultations with the median costs of the drugs in five Philadelphia-area pharmacies and with payments for physician visits by Medicare and managed care organizations in the Philadelphia area.

The article and editorial will be published in Annals of Internal Medicine in December 1999 but are available now on the Annals of Internal Medicine Web site (http://www.acponline.org). Editor Frank Davidoff, MD, felt the article and the accompanying FDA editorial were important public health messages that should be posted on the Annals Web site prior to publication in the print journal. Annals of Internal Medicine, a peer-reviewed journal published by the American College of Physicians-American Society of Internal Medicine in Philadelphia, is the largest medical specialty journal in the U.S.

"The Internet holds great promise for improving access to and quality of health care," says Bernard S. Bloom, PhD, research professor at the Department of Medicine of the University of Pennsylvania School of Medicine and lead author of the article. "But you often don't know what's in the drug you order, who made it, where it came from, where the online physician is who is prescribing the drug or even if he is a physician at all." According to Bloom, people who buy drugs on the Internet should ask themselves if they are willing to pay more for easier access and convenience to obtain the medication and the physician consultation but be exposed to uncertainties about the prescribing physician, the appropriateness of the prescription and the actual medications they're getting.

Food and Drug Administration (FDA) officials, in an accompanying editorial, describe how a patient in the U.S. traditionally obtains a prescription drug for the first time. The patient sees a licensed health care practitioner, who issues a prescription for an appropriate, FDA-approved drug that the patient gets from a registered pharmacist working in a licensed pharmacy. "Current laws provide safeguards against injuries from unsafe drugs and from the improper practice of medicine and pharmacy," says Jeffrey E. Shuren, MD, JD, of the FDA team. "Illegitimate Web sites undermine this safety net."

The FDA editorial cites potential problems with some Internet sites, such as sale of prescription drugs inappropriate for the patient (e.g., diet pills for an anorexic), dangerous drug interactions, contaminated drugs, drugs with subpotent strengths, counterfeit drugs and undelivered products. The risk of such outcomes is greater when buying from an illegitimate foreign company. The FDA advises consumers interested in buying drugs online to check with the Verified Internet Pharmacy Practice Sites (VIPPS) of the National Association of Boards of Pharmacy (www.nabp.net) to see if the pharmacy has a valid license and has met state practice standards. The FDA also advises consumers not to buy drugs from Internet sites that:
 

• offer to prescribe a drug for the first time based solely on a questionnaire.
• sell prescription drugs without a prescription.
• sell drugs not approved by the FDA.
• require a link to another Web site to purchase the drug.
• lack a mechanism to ask a registered pharmacist questions.
• do not provide a U.S. phone number and address.