From...

June 29, 1999
Web posted at: 2:40 p.m. EDT (1840 GMT)

by James Ledbetter

NEW YORK (IDG) -- There's a pile of drugs on my desk. Dozens of pills of different shapes, sizes and colors, designed to treat obesity, baldness and erectile dysfunction. My doctor did not prescribe them, and – knock on wood – I have no medical need for any of them.

How did they get here? Through the magic of the World Wide Web.

It's no secret that online drugstores comprise one of the hottest categories in e-commerce. Prescription drugs make up a significant chunk of the $230 billion drug and health-and-beauty-aid market, and U.S. pharmacies dispense some 2.5 billion prescriptions a year. Hence the online blitz, from the multibillion dollar WebMD-Healtheon (HLTH) merger to Amazon.com (AMZN) 's 40 percent share of Drugstore.com. Even Rupert Murdoch has gotten into the act – in early June, a division of Murdoch's News Corp. was the lead investor in a $50 million investment round for PlanetRx.

Such well-known sites are rigorous about obtaining prescription and insurance data from customers before administering any medication more serious than aspirin. But dozens of obscure Web sites with lenient attitudes have popped up, too. As one typical banner ad puts it: "BUY VIAGRA ONLINE: NO PRESCRIPTION NECESSARY!"

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The pitch is true. By simply inserting the names of drugs into a search engine, The Standard easily found several Web sites that provided prescription drugs without a prescription, in some cases in less than 24 hours [see chart]. Most of the sites have a very limited selection; some sell just one drug.

The most prominent pills play off male anxieties like impotence – Viagra – and baldness – Propecia. Other popular drugs apparently available without prescription include the smoking treatment Zyban; weight-loss drugs Phentermine, Xenical and Meridia; and the herpes treatment Valtrex. Some published reports have indicated that antidepressants such as Prozac are available online, but The Standard was unable to locate any sites that would sell them to U.S. citizens without prescriptions.

Proponents of such sites – and even some drug manufacturers – argue that convenience and a lack of embarrassment are the main reasons some consumers prefer to purchase medicine over the Web. In the age of managed care, it can take as long as a month to make a doctor's appointment for a nonemergency purpose. And when responding to questions about delicate issues like sexual dysfunction, it can be a lot easier to type responses onto a computer screen than to tell them to an M.D.

The better-known Web pharmacies frown on such sites. Stephanie Schear, cofounder and VP of business development at PlanetRx, says her company absolutely requires a doctor's prescription based on a physical examination, adding that PlanetRx is working with regulatory authorities to develop standardized online practices. "We believe that it should be illegal to prescribe medicine this way," says Schear.

Increasingly, state authorities are showing their agreement by prohibiting casual dispensation. On June 9, the state of Kansas – the home state of Viagra poster-child Bob Dole – filed civil petitions against seven companies that were selling prescription-only medicines, including Viagra and weight-loss drugs, over the Internet. Kansas Attorney General Carla Stovall alleged that the companies violated a variety of state laws. Primarily, the alleged misdeeds stem from the distribution of prescription drugs by a doctor or pharmacist who was not licensed in the state.

Kelli Benintendi, an assistant attorney general, says the companies involved had acted in "a manner which is unconscionable under our statutes." She scoffs at the notion that it is sufficient to obtain acknowledgements from customers that they've read the warnings. Noting that certain diet-pill regimens require blood-pressure checks every 14 days, Benintendi says, "It's somewhat of a farce to include all that and expect the lay consumer to understand all the medical amifications of what they've agreed to."

Some of the shadowy activity goes beyond licensing omissions. The state of Kansas maintains that in four instances, individuals were doing business under fictitious names. The Standard was unable to find any representatives at any of the firms cited by Stovall's office who were willing to be interviewed. One of the businesses cited by Stovall's office is Focus Medical; a woman there named Heather who called herself the acting supervisor said she could not reveal the name of the company's owner.

The phone numbers of some supposed clinics were unlisted. Those answering 800-numbers claimed to be unable to take messages for the company's principals. When The Standard asked a pharmacist who'd filled a prescription for one of the cited companies where the prescribing doctor could be found, the pharmacist said simply: "Good luck."

While the Kansas lawsuits are thought to be the first of their kind, other states are cracking down, as well. In California, state regulators recently shut down two Web sites – www.drpropecia.com and www.deyarmanmedical.com – run by a San Diego osteopath who was using the Web to prescribe baldness treatments without performing a traditional medical examination. The state is likely to fine Dr. James DeYarman, who has been practicing medicine for nearly a quarter-century, and could take away his license.

The ultimate effect of Stovall's injunctions is not yet clear. Stovall's office is not currently seeking criminal penalties, but it has issued fines and obtained temporary restraining orders preventing the sites from doing business in the state. At least two sites have posted notices saying they do not ship to Kansas addresses.

Even less clear is how far legal liability should extend in such cases. In Kansas, the state went after not only the sites that prescribed the medications, but also three pharmacies that filled the prescriptions. The Web site CybRxpress.com is apparently run by individuals doing business in at least three states under the name DVM Enterprises, but it uses a pharmacy in Roanoke, Va., called Home Prescription Services, to fill its prescriptions. Robert Patane, who runs HPS, declined to provide details of his business relationship with DVM, citing an attorney's advice. He took pains, however, to say that "we're only a contract pharmacy" for DVM.

But if, following Stovall's logic, the pharmacist who fills the order is legally culpable, then why aren't the drug manufacturers themselves? After all, it wouldn't be very hard for Viagra manufacturer Pfizer to gather the names of Web sites offering the drug without a prescription and tell them to cease and desist.

Andy McCormick, a spokesman for Pfizer, acknowledges that his company is aware of sites where the "online interactions needed to purchase Viagra are pretty cursory." He said he was unaware, however, of any instances in which the company told an online purveyor to stop selling without a physical examination. "We sell virtually all of our drugs through large wholesalers," McCormick says. "Whatever third party ends up with them after the wholesalers is not something we could practically control."

The prescription drug sites raise broader questions of policy and commerce. Is the state-by-state licensing of doctors and pharmacists a necessary element of consumer protection or a cumbersome relic? And as "lifestyle" medications like Viagra and Propecia proliferate, is a doctor's examination always an absolute medical necessity or does it sometimes represent professional protectionism?

Obviously, the potential for abuse is immense, and it would be reckless to make truly dangerous drugs available without careful consultation. But not all the sites that The Standard examined were purely point, click and pop a pill. A day after The Standard placed an order with ConfiMed, for example, an e-mail arrived from "ViagraGuys@aol.com" stating that the questionnaire indicated "you have not had a routine general physical examination and been found to be in good general health in the last 12 months." The message continued: "You must understand that Viagra is a prescription medication and that we cannot prescribe it without that examination."

Similarly, CybRxpress.com sent an e-mail warning of a conflict between the antiallergy drug Claritin-D, which I take daily, and the weight-loss drug Phentermine that I had ordered. "Please provide a statement agreeing not to take Claritin-D while on the Phentermine program," said the cyberdoctor. I provided one, and the pills arrived the next day.

That may seem a bit easy, but people make pledges to doctors every day that they don't keep. A business based on individual health must always rely to some degree on individual responsibility. But the Web may make it easier to fib.

TAKE TWO AND E-MAIL ME IN THE MORNING

WEB SITE	DRUG ORDERED	COST, SAMPLE PRESCRIPTION	CONSULTATION FEE	PURCHASE IMPEDIMENTS
CybRxpress	Phentermine	$150, 30 capsules	Free	Would not prescribe without an e-mail guarantee not to take conflicting drugs
MaleClinic	Propecia/Proscar	$90, 30 pills	$50	None
ViaPro	Viagra	$60, 5 pills, plus $16 postage	$65	None; called to check credit-card number
ConfiMed	Viagra	$25, 3 pills	$75	Would not prescribe without an e-mail guarantee of a doctor's examination
Cyber Medical Group	Viagra	$129.50, 10 pills	$85	None