INTERNET Rx

November 17, 1999
		New Web sites are changing the way Americans buy prescription drugs. Susan Dentzer reports on the promise and problems of online pharmacies. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

Focus: Internet Rx Nov. 17, 1999: RealAudio extended excerpts with: Ron Klink, Carla Stovall and Eric Thom. Nov. 11, 1999: Hope for the Heart Nov. 9, 1999: What the Doctor Ordered Nov. 1, 1999: Patient Privacy June 26, 1997: Doctor-assisted suicide. Browse the NewsHour's coverage of health.   FDA testimony on e-pharmacies National Association of Boards of Pharmacy Corner Drug Store Web site National Community Pharmacists Association	SUSAN DENTZER: Getting a prescription filled at your local pharmacy usually looks a lot like this... SPOKESPERSON: And who's the doctor? SUSAN DENTZER: ...but increasingly, it's apt to look more like this. (Typing on Keyboard) SUSAN DENTZER: First there was e-mail, then budding e-commerce -- and now, there's e-pharmacy. Just this year alone, dozens of major pharmacy sites have sprung up on the Internet, with names like Drugstore.com, Soma.com and PlanetRx. They're trying to prove to consumers that getting a prescription filled online is more convenient than waiting in line at the local drugstore.
	The rise of e-pharmacies
	TOM PIGGOTT: I saw it as an exciting opportunity to create essentially a new type of pharmacy. SUSAN DENTZER: Just under a year ago, thirty-one year-old Tom Piggott founded Seattle-based Soma.com. Recently acquired by the drugstore giant CVS, it's since been renamed CVS.com. As Piggot explains, the site gives consumers Internet access to the same products they could obtain in CVs pharmacies across the U.S. Consumers simply call up the site, answer questions about their medical history, then enter their prescription and physician's name and phone number. TOM PIGGOTT: After it is submitted, the pharmacists at CVS.com will verify the information that you have entered, contact your physician if it is a new prescription. SPOKESMAN: Let me follow up with the doctor and I need to find out who called this prescription in today. SUSAN DENTZER: At the customer's behest, the prescription order is then routed to one of two places -- either the customer's local CVS pharmacy, or to CVS.com's own state-of-the-art dispensing facility in Westminster, Ohio. The order is then packed and shipped directly from the warehouse to the consumer's home. E-pharmacy is still just a fraction of overall pharmacy sales. But it's expected to grab an increasing share of the nation's drugstore business. In fact, Piggott says, since CVs took over Soma and relaunched the Web site as CVS.com in August, sales have been growing about 25 percent a week. TOM PIGGOTT: The estimates regarding the size of the e-pharmacy industry by the year 2005, we've heard from leading analysts quote up to $6 billion in annual sales. So it's a tremendous opportunity.
	A boon for consumers, but also a risk
	SUSAN DENTZER: Besides being a boon for the drugstore business, the convenience of ordering medications over the Internet can be a real plus for consumers. Dr. Jane Henney is commissioner of the federal Food and Drug Administration. DR. JANE HENNEY: Ordering over the Internet for your refill or your prescription drug that you need I think is very beneficial, particularly for people who have difficulty getting to the drugstore, people who are disabled, who are homebound, who are elderly, who live in rural communities. SUSAN DENTZER: But for all the benefits, there's also a serious, and even dangerous, downside. Buying already-prescribed drugs over the Internet doesn't appear to pose any safety problems. But health officials are concerned that drugs are also being prescribed over the Internet. Sometimes, legitimate doctors affiliated with the sites are doing the prescribing -- but sometimes not. A recent report published in the New England Journal of Medicine highlighted the problem. Researchers at the University of Pennsylvania Medical School examined 4000 Internet sites. They found 86 that were selling Viagra outright -- without requiring any visit to a physician or, in many instances, even a perfunctory online medical evaluation. Congressman Ron Klink, a Pennsylvania Democrat, is alarmed. REP. RON KLINK: We've talked to people where family pets, or people who had died 20 years ago were given prescriptions for various drugs. And they didn't lie about the information. When it said, 'What's your status?', well, family pet. Sex, neutered. And yet they were able to get Viagra. SUSAN DENTZER: At a recent Congressional hearing, Klink showed this news report gathered by a Michigan television station to make the point. NEWSCAST CORRESPONDENT: Believe it or not, Tom Cat got his pills...and - you know what else - this cat can get more. He has three refills left on his prescription.
	Drugs from outside the country
	SUSAN DENTZER: Phony prescriptions for pets are one thing, says Klink, but the risks to humans are far greater -- and growing. One reason is a rising number of foreign drug-selling sites, many of which operate out of places like Southeast Asia or Mexico. The sites are selling drugs unlawfully into the US, violating a number of federal and state laws in the process. What's more, the medications they sell may not be tailored to U.S.-approved specifications. REP. RON KLINK: There was just a story out a couple of days ago of the discovery of vast amounts of Viagra that were not Viagra. They had been counterfeited in India, and in fact, there was a possibility that they are lethal. SUSAN DENTZER: Although no recent injuries or deaths have been documented from counterfeit drugs, officials fear some may lie ahead. And they worry that this is just one way patients appear to be getting drugs that they shouldn't be getting without a prescription. For example, the FDA's Henney says some U.S.-based sites are routinely selling potentially addictive "controlled substances," and they're doing it without real physician oversight. Still other sites are selling drugs that are unapproved for use by the FDA. One is the drug GBL, advertised to help with body-building. In fact, once ingested, GBL is converted by the body into another substance, GHB. DR. JANE HENNEY: The consequences of taking this product can result in coma, can result in seizure, can result in death. This is a drug that has been sold over the Internet. It has many claims. The claims, I believe, are bogus. SUSAN DENTZER: Congressman Klink says that just underscores the risks to the public's health. REP. RON KLINK: If we do not do something about this problem, we may as well just dismantle the FDA. Everything that they do, every process for approving a drug, for inspecting where drugs are made, for determining how drugs are going to be distributed is undermined by what's going on with these illegitimate sites.
	Cracking down on illegal vendors
	SUSAN DENTZER: State officials are also concerned. In Kansas, the attorney general, Carla Stovall, is cracking down on sites that are selling prescription drugs to Kansas citizens -- almost always from outside the state's borders. So far, her office has sued six sites for breaking state consumer-protection laws and for violating licensing requirements for out-of-state pharmacies and physicians. CARLA STOVALL, Kansas Attorney General: We don't let people today write their own prescription and walk into a pharmacy on Main Street and get that prescription filled. You have to go through your physician. And because we have Internet and it makes things more accessible, doesn't mean that those rules should change and that I should be able to write my own prescription basically for a drug that I want to have that my own physician won't give to me. SUSAN DENTZER: To ensnare some of the sites that were operating unlawfully, Stovall set up an in-house sting operation. Recruited to help was the 16 year-old son of an employee in the attorney general's office. Under his mother's watchful eye, Stovall says, he went on the Net to the site operated by Confimed, a tiny Seattle-based firm that was advertising Viagra. He ordered the drug with his mother's credit card after clearly stating that he was only 16. CARLA STOVALL: What he said was that he wasn't able to have sex and that was sufficient apparently because even though his age was 16 they sent him the drug and he received it. There is no reason to think that someone younger couldn't have been able to get these drugs too. I think it is a tremendous concern. SUSAN DENTZER: Last June, Stovall sued Confimed, including its founder, a physician, Dr. Howard Levine. Levine would not appear on camera, so we interviewed Confimed's senior vice president, Eric Thom, at the Web site's small office in Seattle; he told us Confimed had seriously erred in selling Viagra to the 16 year-old. ERIC THOM: It was a mistake. We acknowledge that mistake and we respect Kansas's jurisdiction. SUSAN DENTZER: So what was it, the doctor just didn't notice that he was sixteen? ERIC THOM: He didn't see it. He literally didn't see it. He made a mistake. SUSAN DENTZER: Thom says Confimed, which does the lion's share of its business in selling Viagra, has since taken steps to make sure such errors don't recur. And in reality, Thom says, about one in five patients who try to get Viagra from Confimed are turned down. For the patients who are approved he argues that the site meets a real need. ERIC THOM: Viagra is a patient-driven lifestyle drug, that if someone feels they need it, they're the judge. And I would venture to say that the information that we make available for our patients to read is much more thorough than what you may receive in a 30-second or a 15-second counsel at your HMO pharmacy. SUSAN DENTZER: Stovall disagrees. She argues that Confimed and other sites aren't making patients sufficiently aware of the dangers that Viagra poses especially for people who have heart disease or who are taking certain heart medications. Kansas is now demanding that Confimed pay tens of thousands of dollars in penalties for violating state laws. Meanwhile, the Confimed site has posted warnings that it cannot lawfully prescribe drugs to anyone in Kansas. But Stovall and other state attorneys general say they also want Congress to allow them to obtain federal injunctions against the site's operations. That would all them to shut down the sites nationwide. CARLA STOVALL: It has been very difficult because of the shells involved, the layers of businesses, of corporations that have been developed to try basically I think to protect the individuals involved. And I think that would suggest that they are fly-by-night or they are here today to make some money fast and then disappear before perhaps the heat gets turned up too much. SUSAN DENTZER: That's one reason Henney wants consumers to be on guard when using the Internet. DR. JANE HENNEY: You're putting your own health, which is really fragile, at risk and that's the issue here. SUSAN DENTZER: Henney urges consumers to look for sites that post a special new seal-of-approval known as VIPPS. That's an acronym for Verified Internet Pharmacy Practice Site. The seal demonstrates that an online pharmacy has registered with a national pharmacy group and is complying with relevant federal and state laws. For his part, Congressman Klink is also sponsoring a bill that would require Internet sites to show clearly who operates them and where they are licensed to do business. Federal agencies recently formed a working group to look further into unlawful activity by Internet sites and to try to enforce all existing laws.