Drugs Online: Are Your Patients Gambling With Their Health?
by Richard A. Sherer| Geriatric Times |  |
July/August 2000 | |
Vol. I | |
Issue 2 |
Nobody is predicting the demise of the corner drugstore, but consumers are shifting their medication purchases to online sites. Experts predict that the current trickle will turn into a torrent in less than five years.
The shift to online shopping represents a two-edged sword for seniors. On the one hand, advocates tout the ease of obtaining products, including drugs, without leaving home.
"Pennsylvania has a large rural population and is essentially an older state," explained Charles Territo, an aide to Congressman Ron Klink (D-Pa.), who has sponsored legislation to regulate online pharmacies. "Being able to order prescriptions online and have them delivered to the home could be very helpful to a lot of our [constituents]."
"The opportunity for people who have difficulties in going out or carrying packages to have their prescriptions delivered from their computer to their home is a pretty good option," added Mark Pine, director of public relations and public affairs for DrugEmporium.com.
A March study released by the American Association of Retired Persons (AARP), however, warns that a significant proportion of computer users age 45 years and older are potentially at risk in an increasingly technologically driven commercial environment.
"The demands posed by electronic financial record-keeping," an AARP announcement explained, "while probably within the capability of seasoned Internet users, may test the proficiency of sizable subgroups of the population with computers."
Even with the cautionary notes, however, it appears certain that more consumers, including seniors, will be getting drugs and other health-related products from Internet sources over the next five years.
"In the first six months of the so-called Internet revolution, all we heard from our members was 'Shut these guys down!'" said Todd Dankmyer, senior vice president of the National Community Pharmacists Association (NCPA). "We made a conscious decision in the association six to nine months into this that this was basically a marketplace reality: You weren't going to stop Internet pharmacies."
In May, the NCPA rolled out its own online presence, cornerdrugstore.com, which links sites operated by local independent pharmacists and offers optional same-day delivery service for prescriptions ordered online.
Last January, two well-known market research firms issued separate reports on the future of Internet health care. Jupiter Communications projected that online pharmaceutical sales will account for about $4.5 billion in 2004. Forrester Research pegged the number at $15 billion.
Most online sites decline to reveal the size of their customer bases, but the publicly owned PlanetRx.com reported its numbers with its first quarter financials. "Our membership was about 854,000," according to Dennis Joyce, vice president for consumer marketing. "That is the consumers who have registered at the site. The actual customer count grew to approximately 400,000, and our repeat rate was 35%. During the time when we are adding a lot of customers, we still have a ton of repeat business."
The promise of new riches has attracted worldwide attention. Hundreds of sites now offer Web surfers a complete range of drug products, including some that have been illegal in the United States for years. Some sites are operated by old-line pharmacy companies; others by new, start-up "dot.com" operators who hope to adapt the Amazon.com marketing model to pharmaceuticals.
Still another segment-perhaps the largest single group of Web-based drug vendors-includes sites of questionable provenance. These include offshore sites that attempt to reach Americans in spite of strict federal laws, as well as domestic sites pushing hot drugs like Viagra (sildenafil) and Propecia (finasteride). Often, these sites will even provide a prescription, purportedly issued by a physician after the customer submits an online questionnaire with a brief description of their symptoms and medical history.
"There are significant concerns if you procure both the prescription and the product from a site," warned Susan C. Winckler, group director of policy and advocacy for the American Pharmaceutical Association. "Those sites do raise some questions. Is the questionnaire sufficient to say, 'Yes, a certain product should be prescribed?' Most of those sites only provide a limited number of products, so using one pharmacy that keeps a record of everything you are taking becomes impossible. There are also some questions as to whether or not those sites are complying with the applicable laws."
Regulators on both the federal and state levels are, in fact, asking those questions. "I could work full time on this issue alone and not make much of a dent in it," said Fran Brunner, assistant attorney general in the consumer protection division for the state of Kansas. "We have sued six online companies that dispense prescription drugs. So far, we are settled with one defendant; we are negotiating with some of the others. We have taken a default judgment on one case and we are trying to collect on that. And we are still investigating other sites."
Other states-Illinois, Missouri, Wisconsin, Ohio, Texas and Colorado, among others-and the National Association of Attorneys General, are leading the charge against online pharmacies that dispense drugs in states where they do not have a licensed pharmacist and a pharmacy license. Because the states generally have jurisdiction over pharmacies and medical practices in the United States, pursuing online pill-pushers becomes a logistical nightmare.
"One site and the doctor who signed the prescriptions were in Washington state; at another, the doctor and the pharmacy were in Pennsylvania and there was another doctor in Hawaii, while the owners of the pharmacy were in California," Brunner explained. "In another case, the doctor and the owners were in Ohio and the pharmacy was in Virginia. We got a default judgment against one operation in Nevada, but the doctor was in Arizona."
Last December, President Clinton proposed adding $10 million to the U.S. Food and Drug Administration's budget to help increase enforcement efforts against so-called rogue sites. Federal regulators are working with state officials to help ensure that domestic Web sites comply with U.S. law, but the FDA's efforts are largely being aimed at offshore sites.
"We've been notifying international sites, sending them cyber letters that say, 'You are breaking U.S. laws and you need to stop doing that, and [you] need to notify us that you are stopping,'" said Tom McGinnis, director of pharmacy affairs for the FDA. "If we do not hear from them in two weeks time, the FDA notifies the Customs Service and puts the company on import alert. Customs will intercept any shipments from the company and call the FDA to come and look at them. Then Customs ships them back or destroys them. We also notify the FDA's counterpart in the foreign country. So far, we've had three responses. Two said they would cease and desist all shipments to U.S. addresses, and the third said it would stop shipping Viagra to the United States. Another 14 have been put on import alert with Customs."
The FDA also launched an educational program to tell consumers what to look for before doing business with an online pharmacy. That program includes a Web site <www.fda.gov/oc/buyonline/> that offers practical advice for shoppers.
Another source of information is the National Association of Boards of Pharmacy (NABP), which administers the Verified Internet Pharmacy Practice Sites (VIPPS) program. Site operators must submit a wealth of detail to NABP-including the names and addresses of licensed pharmacists in each state in which they want to operate, as well as a verifiable quality insurance program-and undergo a physical inspection by NABP evaluators to earn the VIPPS seal. This seal can be displayed on their home pages. A visitor to the site can click on the VIPPS symbol to go to the NABP database and read all the information provided by the pharmacy operators.
"VIPPS has been described as a seal of approval, but that is not necessarily true," said Mark Paulson, NABP editorial manager. "We are not saying this is a good site or this is a bad site. It truly is an informational program."
At the time this issue of Geriatric Times went to press, only six operators had received VIPPS certification: PlanetRx.com, CVS.com, Drugstore.com, FamilyMeds.com, Merckmedco.com and Tel-DrugRx.com. Paulson explained that several others are in the pipeline. "It is a very rigorous certification process. It just takes time. That really is the strength of the program."
Industry officials mostly endorse the VIPPS program and oppose adding any new federal regulations to control rogue pharmacies. "The ones that are breaking the law are going to continue breaking the law," stated Ed Spearbeck, senior vice president for corporate and pharmacy affairs in the retired persons services division of AARP. "They are not worried about [the law] now; why should they start all of a sudden?"
Gloria Rodriguez, president of Clickpharmacy.com, a network of independent pharmacies and physicians, disagrees. "There are a lot of insurance issues and regulatory issues that cross state lines. That is why we agree with what the President is trying to do, especially for offshore sites."