It is too soon for online pharmacies to have a clear picture of their clientele, said Phil Schneider, managing director of public affairs for the National Association of Chain Drug Stores. But the Internet drug market is certainly propelled by an overall boom in prescription drug sales and a general trend toward self-medicating, he said. Additionally, the millions of Americans without health insurance may look to the Internet to save money.
Schneider's organization reported prescription sales in retail pharmacies of $102.5 billion in 1998, an increase of 15 percent over the previous year. The sheer volume of prescriptions was up 6 percent.
In February, Amazon.com, the pioneering giant of Internet book and music sales, inaugurated a link on its Web site to its new partner, Drugstore.com. This "virtual pharmacy" offers home delivery of over-the-counter health and beauty items and a prescription drug service, but customers must have a prescription from their personal physician to get the drugs. PlanetRx.com, a month-old online pharmacy, also requires customers to mail, phone or fax in their prescriptions.
But other pharmacy Web sites have customers fill out a health questionnaire -- and a liability waiver -- and pay a fee of from $65 to $85 for a faceless "consultation" with an online doctor, who may then prescribe medications.
Direct Response Marketing (DRM), a site located in the British Channel Islands, prescribes and sells so-called "lifestyle drugs," treatments that are not medically necessary but purport to enhance quality of life.
"You are about to discover the answer to every slimmer's dream!" is the message awaiting customers who visit the site (www.lifestyledrugs.com) and click on the word "Xenical," the anti-obesity pill that U.S. officials suggest be used only by people who are clinically obese.
To order prescription drugs such as Xenical, Viagra, Propecia (for male hair loss) and Zyban (a smoking cessation aid), DRM's customers begin by filling out a "medical declaration" that asks for name, height, weight, birth date and whether they suffer from about 10 different medical conditions that would prohibit them from taking the drug. The form is provided in six European languages plus Japanese. Customers must also affirm a statement that their answers are truthful.
DRM Managing Director Tom O'Brien says the company has two doctors who review the forms and issue prescriptions at no extra fee. Several applications a week are denied, he said, such as in cases where women order Viagra or men with heart conditions want the drug.
DRM has been highly successful in selling Xenical to customers in Great Britain, where the national health service supplies the drug only for the clinically obese. Since all pharmacies are run by the government, even non-obese people who are willing to pay for the drug themselves cannot get it through the national pharmacies. DRM will prescribe Xenical to people who are only slightly overweight, said O'Brien.
"It really is a cost restriction put on by the government," he explained. "It is a very expensive drug, and the sad thing is, it works very well for women who just have a stone (about 14 pounds) to lose."
As for prescribing drugs like Viagra to customers who have never been physically examined, O'Brien countered, "There is no physical test a doctor can do to determine if a person suffers from impotency. The only thing he would know from examining the person is what he looks like. If someone wanted to lie to get Viagra, they would get it one way or another."
While DRM provides its address and phone numbers on the Web, many sites give no indication of their location or personnel, and there is concern about fraud. This week, Spanish officials announced they had broken up an Internet fraud ring that was charging customers for Viagra but failing to send out the medication. "It's very, very easy to put a very professional page up on the Internet," said DRM's O'Brien. "People would be very silly to send their credit card information to an e-mail address with no contact number."
At the Pill Box Pharmacy, a group of stores in San Antonio, Texas, the pharmacists go so far as to display their photos and biographies on their site (thepillbox.com). Pillbox charges $85 for an online physician's consultation and offers prescription medications like Viagra, Propecia and Claritin, an allergy drug, and the popular hormone supplements melatonin and DHEA.
Pill Box requires customers to read an information page about the drugs they are ordering, agree to an extensive liability waiver, and fill out a medical questionnaire on known allergies, current medical conditions and medications being taken.
It's obvious, said pharmacist William A. Stallknecht, one of the Pill Box's founders, "that privacy is a real big issue" for people seeking drugs on the Internet. He fields online Viagra requests from local addresses and from doctors who themselves need the impotence drug. He said medical questionnaires are screened three times, including an automated initial rejection if a customer notes that he is also taking a medication that conflicts with Viagra or checks any illness that would be affected by the drug. "We really haven't had any problems" with fraudulent online applications, he said, adding, "You can lie in person."