The Problem With Prescriptions

April 13, 2000

By Joanne Kabak
drkoop.com Health News

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There is a distinction to be made between getting a medication filled online, and getting a medication prescribed online.

"Certainly there are pharmacies online and that's very appropriate to call your doctor and say 'I'd like to have a refill from an online pharmacy.' Or the doctor prescribes and sends the medication online for you," said Dr. Thomas Reardon of Portland, Ore., president of the American Medical Association.

But the problem occurs when you initiate the prescription online by filling out a form on a Web site, describing your health concerns, and then getting a medication prescribed by an online doctor who has never seen you and has no real way to know that the information you are providing is accurate.

For one patient, it was a fatal mistake. According to Harvey S. Jacobs, an Internet attorney with Jacobs & Associates in Washington, D.C. , the FDA Consumer Magazine has reported that the FDA has received only a few reports of adverse events related to Internet drug sales. But one of them was a 52-year-old man who died of a heart attack last year after buying the impotence drug Viagra from an online source. He was only required to answer a questionnaire to qualify for the prescription. It appears the man took the drug despite episodes of chest pains and a family history of heart disease.

In general, there is oversight by several authorities over the regulation or licensing of the dispensation of medication online, Jacobs said. They are the National Association of Boards of Pharmacy (NABP), the FDA and the Federal Trade Commission (FTC). Also, the U.S. Customs Service maintains a list of drugs that may not be imported from overseas.

And more Internet-specific regulations may be on the way. For, example, Jacobs said the White House recently announced a $10 million program to protect consumers buying prescription-drug products over the Internet.

It is legal to get your prescriptions online, "assuming there is a licensed pharmacist doing so," Jacobs said. If you are hoping to get your hands on drugs not approved for use in this country by accessing foreign Web sites, you may have the electronic ability to do so, but not the legal right.

"If a drug is not able to be legally prescribed in the United States by licensed pharmacists, it cannot be legally prescribed to U.S. citizens via the Web," Jacobs said. The World Health Organization has produced a guide for consumers wishing to obtain medicines online globally. "However, the FDA is currently warning consumers not to buy from foreign Web sites at this time because import restrictions may prevent you from receiving the foreign drugs and the U.S. government can do little in the event of fraudulent foreign pharmacy sites," Jacobs said.

If you want to buy your prescriptions online instead of going to your local brick-and-mortar pharmacy, are there any assurances about who you're dealing with?

In 1999, Jacobs said the NABP created a program called Verified Internet Pharmacy Practice Sites (VIPPS). The program gives consumers a single place to check out an online pharmacy to ensure that it meets current standards. To become certified by VIPPS, an online pharmacy must meet the licensing and inspection requirements in the state where it is located and in each state to which it dispenses pharmaceuticals.

In addition, VIPPS online pharmacies must protect a patient's right to privacy, ensure authentication and security of prescription orders, and adhere to a recognized quality assurance policy. They also have to provide a mechanism by which patients can get their questions answered by a pharmacist.

The question of whether there is oversight over a doctor's ability to give advice online is still an open one. "Doctors are licensed at the state level, thus their ability to practice medicine would be limited to the states in which they are licensed," Jacobs said. But various national and state medical and licensing bodies are currently grappling with this. "These are thorny issues and I really do not know how far these accrediting bodies are going to go in allowing doctors to 'practice' globally," he said. The malpractice insurance industry, Jacobs added, will no doubt have significant input into the extent to which doctors under their coverage can practice online.

In the meantime, the Web does not eliminate current regulations. "The existing rules and regulations apply both online and offline," Jacobs said. "Doctors and pharmacists who are properly licensed and registered can and should freely use the Internet to expand their practice areas, assist their existing patients, and locate and service new patients."

Take note, however. According to ," said Doug Hastings, senior member in the national health law practice of Epstein Becker & Green in Washington, D.C. and president-elect of the American Health Lawyers Association, the federal government and the 50 states very heavily regulate healthcare. There are multiple rules for physicians, hospitals, HMOs and pharmacies. But, he said, a lot of regulatory agencies are saying that they can't really keep up with all the changes.

"It's going to be more important that industry leaders emerge with strong codes of ethics and appropriate protections that will set the right kind of modeling standard, Hastings said, so the government doesn't have to come in and say, "You guys are doing it wrong. You're going to have to do it this way."

Joanne Kabak is an established free-lance writer. She has an MBA and specializes in health and business-related articles. She lives in Connecticut with her husband and two daughters.

• Medem (Peer-reviewed medical information)
• Epstein Becker & Green
• Jacobs & Associates
• American Pharmaceutical Association