Copyright 2000 The Seattle Times Company
The
Seattle Times
January 21, 2000, Friday Night Final Edition
SECTION: NEWS; Pg. A1
LENGTH: 1988 words
HEADLINE:
Plumbing the Internet prescription pipeline
It's very easy
to buy drugs online - too easy, feds say
BYLINE: Kim
Barker; Seattle Times staff reporter
BODY:
He is
one of three doctors in a Southern town of 1,100 people, and his patients come
from all over the world.
They come to Dr. Henry Jones not for his
specialty - he is just a simple family doctor, after all - but for his drugs,
available on the Internet at www.at-cost-drugs.com. So did we.
To test
how easy it is to get prescription drugs online, Seattle Times reporters ordered
drugs from six companies, including two types of drugs from Jones' company.
Jones prescribed us Acyclovir, a drug to treat herpes, even though on an
online form we told Jones we didn't have herpes. Jones also prescribed Meridia,
a weight-loss drug for clinically obese people, even though we said on the same
form that our weight was normal. The company also sent us a refrigerator magnet
and told us to tell our friends.
"I guess they felt it was OK to
prescribe it for you," said Jonathan Jones, the doctor's son and a former
building contractor, who helped start the company At-Cost-Drugs.com in
Sterlington, La.
Lose weight. Have sex. Grow hair. Dull pain. Be happy.
You don't need a visit to the doctor's office - sometimes, you don't even need
symptoms. With the Internet, you often just need to fill out an online pharmacy
form, which can be found faster than you can say "Viagra."
States and
the federal government consider many of the estimated 260 online pharmacies to
be "rogue" operations, and authorities are struggling to regulate them. Just
last week, the Washington state Medical Quality Assurance Commission accused a
doctor of behaving unprofessionally by selling Viagra online without a valid
prescription.
And President Clinton announced last month that he wants
the Food and Drug Administration to bolster the regulation of Internet
pharmacies and establish a $500,000 fine for selling drugs
without a valid prescription.
In all, The Seattle Times placed 11 orders
for prescription drugs with five domestic companies and a company based in Great
Britain's Channel Islands.
Within a week, we received eight sets of
prescription drugs. Only three of the requests were turned down: twice because a
woman was asking for drugs approved only for men, and once because the Seattle
company didn't ship to residents of Washington state.
From the Channel
Islands company, we ordered and received Prozac, an antidepressant with serious
potential side effects - with no questions asked about the reporter's health.
With online pharmacies, which usually require people only to fill out a
health questionnaire, it's easy to lie or mislead doctors. The sites are
difficult to monitor - doctors are sometimes in one state, pharmacies are in
another, the companies are in yet another. And it's difficult trying to stop
foreign companies from sending their drugs, including narcotics, into America.
Specializing in 'lifestyle' drugs
"You're only hoodwinking yourself if
you order from these," said Charles Inlander, president of the People's Medical
Society, a group that supports legitimate online pharmacies that fill
prescriptions from outside doctors. "It's buying on the black market as far I'm
concerned."
The Times ordered "lifestyle" drugs, which aim to improve
lives, not save them. These are the drugs many domestic online pharmacies
specialize in.
We ordered Celebrex, used to treat arthritis pain;
Viagra, for impotence; Phentermine and Meridia, for weight loss; Acyclovir, for
herpes; Propecia, for hair loss.
Compared with many prescription drugs,
these drugs are fairly safe.
But researchers say if a pregnant woman
just touches a broken orange octagon of Propecia, widely available on the
Internet, she risks birth defects.
Phentermine, a weight-loss drug, is
similar to amphetamines. It can be addictive, and people with even mildly high
blood pressure aren't supposed to take it.
Those with heart problems are
not supposed to take Viagra. A Chicago man who was denied Viagra by his doctor
later found a prescription through the Internet. He died in March of a heart
attack, according to the FDA.
"One of the concerns I have is if you take
a young woman who has bulimia or an eating condition, she can very easily lie on
the form she's sending back, say 'I'm 200 pounds or what have you and I need
this drug,' " said Don Williams, the executive director of the Washington state
Board of Pharmacy. "Whereas if she walks into a physician's office, the
physician can very easily see what she weighs." Some do follow the rules
Dr. Marcus Kuypers, a Dallas doctor who is licensed in Washington state
and works with a Seattle online pharmacy, argues that such prescriptions can be
as safe and thorough as one obtained during a traditional visit to the doctor's
office.
"There's lots of mills where you can go in to a doctor, and he
can take such an abbreviated history, you're in and out in two minutes," he
said. "Is that safer than something online? We review it in much greater detail.
I'm taking 10 or 15 minutes with each person."
Some online pharmacies,
such as Bellevue-based drugstore.com, send out prescription drugs only after
receiving a prescription from an outside doctor who has examined the patient.
But these companies, certified by the National Association of Boards of
Pharmacy, are the exception, regulators say.
The online pharmacies
reached by The Times didn't examine anyone in person. The companies called back
on only two of the 10 orders we placed - when a female reporter ordered Viagra
and Propecia, drugs approved for men only.
Instead, the sites required
us to sign liability waivers saying we wouldn't hold anyone responsible if
anything went wrong.
Online exams consisted of basic yes-and-no health
questions such as whether you have ever had surgery. In some cases, the correct
answers were already filled in. All of them required a fee - ranging from
$35 to $75 - for a doctor's "consultation,"
plus the cost of the drugs. Drugs arrived within days
Within days, the
drugs started arriving:
At-Cost-Drugs.com provided Acyclovir and
Meridia, although we told the company we had none of the symptoms.
KwikMed.com provided us with Celebrex, although we said we had asthma.
People with asthma should never take this arthritis drug, according to the
manufacturer. KwikMed also delivered Propecia, even though no one from the
online pharmacy wrote or called us to check on symptoms.
PrescriptionsQuick.com filled our order for Viagra and Phentermine, and
never wrote or called to check on our symptoms.
Dr. James Lemire, the
doctor who prescribed these two drugs, is being investigated by the Michigan
medical board for sending out Viagra without a prescription to a sheriff's
deputy.
We ordered Propecia twice from a Seattle site - PropeciaMd.com -
run by the Center for Men's Health. When a women reporter ordered the drug, Dr.
Kuypers called back and told us the prescription was being denied because the
drug is dangerous for women.
But when a male reporter put on his order
form that he wasn't balding and didn't have a history of male-pattern baldness,
Kuypers still prescribed the drug. "It could certainly have been an oversight,"
Kuypers said. "I don't claim to be infallible."
LifeStyleUSA.com - based
in Seattle - twice denied our orders for Viagra. In denying an order to a male
reporter, the company said it didn't ship to Washington residents. When a women
reporter submitted an order, a company representative called and said the FDA
hadn't yet approved the impotence drug for women.
"You should trick your
boyfriend into ordering it," she said. Regulating sales is tough
State
and federal regulators say prescribing drugs without first physically examining
someone and establishing a patient relationship is illegal. Some states, such as
Kansas and Illinois, have sued some of the domestic online pharmacies. Michigan
has ordered 10 companies to stop selling there.
The online companies say
they're perfectly legal. They say they're just establishing a new kind of
doctor-patient relationship.
Regulating them is tough. With many of
these companies, it's often difficult to know just who is prescribing the drugs
and who is filling the order.
For example, PrescriptionsQuick.com
doesn't provide an address or any details about the company on its Web site.
The doctor who prescribed our drugs is licensed in Florida and Michigan.
The pharmacies that sent our drugs are from Missouri and Virginia. But we were
billed by Stivercorp, based in Ocala, Fla.
Locally, the Washington state
Medical Quality Assurance Commission is trying to discipline doctors selling
drugs online without valid prescriptions.
In May, the commission accused
Dr. Leandro Pasos of Seattle of behaving unprofessionally by prescribing Viagra
online for a company called Performance Drugs. He agreed to stop and paid a
$500 fine.
Last week, the commission accused Dr. Howard
Levine of Seattle of behaving unprofessionally and ordered him to stop
prescribing drugs online for his company, ConfiMed.com. But Levine, known online
as the "Viagraguys," is fighting the commission. He has won the right to stay
open until a hearing.
If companies get in trouble in a state, they'll
often stop shipping their drugs to that state. ConfiMed.com, for example, will
no longer sell to residents of Kansas or Michigan.
After Pasos got in
trouble, the company he worked for changed its name. Now the Performance Drugs
Web site leads potential customers to LifestyleUSA.com, which promises "the
fountain of youth for the next millennium."
This company is based in
Seattle, according to state records. But it no longer sells to residents of
Washington state. Company officials didn't return calls for comment. Stiff
punishments proposed
The federal government is now proposing stiff
punishments for domestic online pharmacies that send out drugs without what it
considers a valid prescription. It is also hoping to increase the number of
investigators.
The FDA is particularly concerned about offshore
pharmacies, which will mail out narcotics, tranquilizers and drugs such as
Rohypnol - called "roofies" - a powerful sleeping pill that isn't approved for
use in the United States and that has been implicated in rapes nationwide.
"Eventually we're going to get them," said Tom McGinnis, the director of
pharmacy affairs in the FDA's office of policy. "We're going to close them down.
We'll be able to eventually root out those rogue operators."
Just how
that will happen is unclear, especially with the foreign pharmacies.
The
FDA is asking foreign companies and countries to stop sending drugs here, trying
to work with Internet service providers to block sites and trying to educate
consumers.
But officials with domestic companies say if the FDA really
thinks it can stop all the Internet prescription drugs, the agency might be on
drugs itself.
"Even if every single well-run legitimate site in the U.S.
is shut down, what are you left with?" asked Eric Thom of ConfiMed. "You're left
with a lower standard of care with drugs coming from places out of Gibraltar.
"I mean, the genie is out of the bottle here." What drugs? Just vitamins
here
In October, the FDA warned the 4nRx company's offices in New
Zealand and Hong Kong that its drugs "may not be legally imported" into the
United States. The agency also told the firm that its products would be
automatically detained and refused entry by U.S. Customs.
But its Web
site is still up and advertising drugs.
So we ordered Prozac, a
prescription drug used to treat depression and obsessive-compulsive disorder,
from 4nRx.
On the sender's declaration to U.S. Customs, someone named
"K. Bell" from an Auckland, New Zealand, post-office box signed off that the box
didn't contain dangerous or prohibited goods.
The sender said the
package contained "health supplements (vitamins)." Kim Barker's phone message
number is 206-464-2255. Her e-mail address is kbarker@seattletimes.co.
GRAPHIC: PHOTO; Photo by Tom Reese, Graphic by Mark
Nowlin / The Seattle Times: Selling prescription drugs on the internet
LOAD-DATE: January 22, 2000 
