From...

by Angela Gunn

(IDG) -- It might be the digital age, but at Drugstore.com, pharmacists still don white lab coats and fill out as many forms as they ever did. Perhaps more.

	. MESSAGE BOARD
Internet medicine

Every Drugstore.com order is written down – you know, with a pen – and scanned into a computer. After a customer enters a profile and places an order, a pharmacist verifies it and starts a paper trail. The prescription is checked against other medicines the patient is taking, lest they react badly with one another. Then the order is filed in the system, and routed to a fulfillment house somewhere in Texas.

Only then does the automation begin, in a warehouse that handles fulfillment for all kinds of pharmacies, not just the online kind. With the push of a button, an automated assembly line pours pills into labeled vials. Before the prescription ships, it's vetted once more by an on-site pharmacist, who checks the vial against a screen that shows the patient's profile, the scanned prescription and a picture of the drug.

But back in Seattle, Jamie Kinar is handling the interactive side of the equation: She helps to field the 25,000 health-related questions that Drugstore.com has received from visitors since its March launch.

Kinar points out that dealing with the public on health questions over the Internet is different from communicating in person. In a real drugstore, pharmacists can read the faces of their customers; online, they have to rely on syntax, as do their clients. Two weeks ago, Kinar and fellow pharmacist Kathy Byun Lee were mulling over Byun Lee's response to a letter sent to the site's Ask Your Pharmacist section. In addition to using an internal style sheet for responses – not only does completeness and accuracy count, so does spelling, as well as the inclusion of reference citations for the information given – the pharmacists review one another's work.

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In this case, the correspondent asks about mixing two medications that Kinar and Byun Lee know produce nasty side effects. Kinar wants to make sure they get the message across loud and clear, and with the right tone: Should they begin with "You should not" or, more emphatically, "You should NOT"? They must also cite proof for all of their assertions.

The average response takes staffers 30 minutes – far longer than pharmacists usually spend face-to-face with customers – and 12-hour work days aren't uncommon. It is, after all, the Internet industry, even if these two are pharmacists. Cube after cube full of reference books and as many as a half-dozen citations per letter make the point: Not only will Drugstore.com not be undersold, it won't be underestimated.

Kinar started working at Drugstore.com last December, which makes her one of the more senior staffers at the year-old site. Previously, she worked in the international medicine department at Seattle's Harborview Medical Center. E-commerce has a way of sneaking up on some professionals, but in Kinar's case, her world has already started to change: Her husband, brother and sister-in-law are all involved with Net startups.

Being a pharmacist at the drugstore that's always open has stretched Kinar's workday. When Drugstore.com visitors send questions to Ask Your Pharmacist in the middle of the night, a page is sent out to the on-call pharmacist (they rotate the overnight duty). Recently, Kinar picked up a can't-wait-till-Monday question over the weekend: A woman was wondering whether the antibiotics she'd just started taking would interact badly with her birth-control pills. (Answer: Antibiotics can diminish the effectiveness of the pills; it's best to rely on a backup method of contraception for the duration.)

Fortunately, not all of Drugstore.com's clients are out mixing chemical cocktails. A number of the questions that come to AYP are from patients looking for clarification on what their doctor said, or for information on a medication they want to mention to their doctor. Kinar seems OK with this line of inquiry. "These are the skills I trained for, why I went to school, and I get to do those things here," she says. She finds the level of personal contact satisfying. In her last job, Kinar says, it was much more difficult, since most of the patients did not speak English.

The rest of the eight-person staff is mostly female, with backgrounds in everything from women's medicine to pain management to pediatrics. All are fairly young, with at least a few years of behind-the-counter experience. Indeed, the usual Internet age breakdown holds in this industry, as younger pharmacists are more open to the idea of doing business online, notes Kinar.

As Drugstore.com builds its reputation as a medical resource, it will need more standard offerings. Currently, the company is compiling a set of FAQs on various health-related topics, and pharmacists are working with the rest of the Web staff on buying guides covering topics such as sunburn and the cold-and-flu season. More important, Drugstore.com's recent VIPPS (Verified Internet Pharmacy Practice Sites) certification signals a vital step in differentiating it from the JoesViagraEmporium.coms.

That automated-fulfillment house in Texas is the norm in an industry where few pharmacists are now trained in the art of creating medicine, and where they're more likely to interact with other pharmacists than with actual patients. Kinar points out the irony: A place like Drugstore.com – where no flesh-and-blood customer ever enters the premises – offers one of the best chances a pharmacist has these days to actually work one-on-one with patients.