ONLINE PHARMACIES: Officials Cracking Down on ‘Rogue’ Sites
While state medical licensing laws protect patients when doctors prescribe medication, unlicensed, "unscrupulous" online pharmacies can often evade these laws -- leaving policymakers and law enforcement officials to grapple with the potential dangers posed by the ecommerce revolution, Hippocrates reports (Oppenheim, 9/00). These so-called "instant prescription" or "rogue" pharmaceutical Web sites have flourished in cyberspace, outnumbering legitimate online drugstores -- such as Drugstore.com and PlanetRx.com -- 400 to 6, according to Kansas Attorney General Carla Stovall (R). "The vast majority of online pharmacies are not following the law," she said. Although the FDA has received only a few reports of patients suffering "adverse effects" from Internet drug commerce, authorities warn that the potential danger of unregulated sales through instant prescription pharmacies, which often require little or no medical information from users, "could be catastrophic." In addition, even when sites ask for sufficient information, a physician may not review the application or even prescribe the medication to patients. "There's an assumption that there's a physician there, but it may just be Uncle Louie who owns the Web site and is operating out of his garage," Bernard Bloom, a University of Pennsylvania professor who headed a 1999 investigation of Internet drugstores, said (Perlmutter, Hippocrates, 9/00).
Feds, AMA Strike Back
To quash the growing number of rogue online pharmacies, the FDA has "dramatically stepped up its actions," developing an Internet Drug Sales Action Plan in 1999. The FDA's Office of Criminal Investigations also has targeted about 50 Web sites for civil or regulatory action, and agency officials have asked Congress for $10 million to support increased enforcement efforts. In addition to federal efforts, the AMA's Board of Trustees approved guidelines for online drug prescribing in June 1999. It recommend that doctors examine patients, check patients' medical histories and discuss potential treatment with patients before prescribing medication over the Internet. "It's not necessary to have a physical examination before every prescription, although it's preferable," AMA trustee Dr. Herman Abromowitz said, adding, "But that's very different from a situation where the doctor has never seen the patient. To me, anything that does not meet these minimum standards is inadequate." The Federation of State Medical Boards of the United States has also issued a statement on Internet prescribing. According to the FSMB report, "state medical boards consider it unprofessional conduct by a physician to ... issu[e] a prescription via electronic or other means ... [without] a history and physical evaluation of the patient."
Slamming the Door
While state medical boards can discipline doctors who "inappropriately" prescribe drugs, many authorities want to attack the root of the problem by putting instant prescription Web sites "completely out of business." Lawmakers have already introduced bills in at least five states that would "establish practice standards" for prescribing medication over the Internet, and at least 12 states have filed suit against physicians for such violations. Kansas has led the movement against rogue pharmaceutical sites, filing six lawsuits under Stovall, which forced offenders to pay fines and halt sales of products in the state. Still, those Web sites can operate in other states, prompting Stovall to lobby Congress for "nationwide injunctive relief," which would allow states to sue Internet sites in federal court (Oppenheim, Hippocrates, 9/00).