Originally created 08/07/99

Let online pharmacy clients beware



WASHINGTON -- If you recently bought an at-home AIDS test called EZ Med over the Internet, expect a letter from the government urging you not to use it. That AIDS test is illegal and, worse, studies show it can't detect the deadly virus as it claims.

Another cautionary tale: the 53-year-old Chicago man who died after taking the impotence pill Viagra he ordered over the Internet. There's no way to know, but the government wonders if asking his doctor instead for the little blue sex pill would have protected the man, who apparently had heart disease risks that make Viagra dangerous.

And if you bought another unapproved HIV test called Ana-Sal from the HIVCybermall Web site, the Food and Drug Administration is trying to contact you, too, seeking evidence in an investigation of that test's sale.

The Internet has opened a whole new world for Americans seeking better health. You can search topnotch medical journals for the latest advice, or e-mail your doctor. Your physician can fax a prescription to a legitimate online drugstore that ships your monthly medicine -- and a few computer mouse clicks lets you add some shampoo or toothpaste to the order without ever leaving home.

But the Internet also is a hot spot for virtual back-alley drug sales and snake oil, a Wild West where legitimate online drugstores face stiff competition from Web sites that don't require genuine prescriptions for legal U.S. drugs or that even sell illegal ones.

Consumers are enthusiastically embracing that freedom to play doctor -- but health officials and congressional critics say it could kill. You could order a drug that's dangerous for your condition. You might even get a counterfeit or contaminated drug -- there's no way to know, says Rep. Ron Klink, D-Pa.

So the government is taking new steps to protect and educate consumers.

"The key here is consumers need to beware," says FDA associate commissioner William Hubbard.

For consumers, that message may bring some unpleasant surprises. Part of the Internet's lure is anonymity. But when the FDA stopped sales of those two unapproved AIDS tests last month, it got names and addresses of the Web sites' customers, and is writing them to say don't trust the tests' accuracy.

Another lure is not having to make a doctor's appointment. Some Web sites don't require prescriptions at all. Others provide consumer questionnaires that a staff doctor supposedly reads to decide whether the consumer truly should get the drug, a kind of virtual prescription.

The problem: It's illegal to sell certain U.S. drugs without a valid prescription, defined under federal law as written by a doctor with a relationship with the patient. A questionnaire filled out by a complete stranger doesn't count, Hubbard says. Plus, it is illegal for doctors to prescribe for patients in a state where they're not licensed to practice.

For a year, states have been struggling to enforce those laws, revoking some doctors' licenses and suing to shut down illegitimate Web sites.

The FDA hopes next week to begin operating a $100,000 computer system to help by unveiling illegitimate sites to the proper authorities. Domestically, if states can't shut down a bad site, the FDA says it will use federal authority to do so.

Klink is sponsoring legislation to force online pharmacies to disclose who actually sells the drugs and where they're licensed to practice, just as your neighborhood Rite Aid posts its pharmacy license in the store, to help consumers and state regulators know who they're dealing with.

But everybody acknowledges the steps will do little to curb foreign Web sites, which ship everything from tranquilizers to steroids in unmarked packages that can slip past U.S. Customs. "Congress needs to step in there," Hubbard says.

Meanwhile, what's a consumer to do?

Read the Web site's fine print to see if the online pharmacy is licensed in your state. "Sites like drugstore.com are licensed in all 50 states -- they'd be fine," Klink explains.

Remember the importance of valid prescriptions.

And the National Association of Boards of Pharmacy just started a voluntary "seal of approval" for online pharmacies that meet certain quality criteria.

Watch for planned FDA advertisements and brochures to educate consumers that they know more about used cars than Internet drugs, something Hubbard says has to change. "There is some personal responsibility here."