Bethesda, MdTo try to control increasing use of the Internet for obtaining prescription drugs without adequate physician oversight, the Food and Drug Administration (FDA) has called on physicians and pharmacists for help.

The agency views obtaining prescription drugs without the personal interaction of patient and physician as a significant problem but believes that it is one better handled by state licensing and medical boards than by the FDA.

The boards are willing to do their partat press time, three had taken disciplinary action against three physicians who had prescribed Viagra over the Internet to men who were not their patientsbut have not yet taken a formal position on the issue.

The use of the Internet for prescribing drugs, while legal, is open to questionable practices. For example, a Chicago television station recently aired a program on which a man received Viagra through an Internet pharmacy despite listing on his application several contraindications, such as existing heart disease.

"We are especially concerned where there is no proper patient-physician relationship and no proper pharmacy intermediary. This bypasses the usual safeguards," said Michael A. Friedman, MD, the FDA's deputy commissioner for operations, at a meeting the agency called for physicians and pharmacists to discuss the issue.

The problem, Friedman said, "is too big for any one organization to handle comprehensively, and the FDA doesn't have the staff, the resources, or even the authority to deal with it. We are interested in having the products available but also want them to be used properly and safely."

All the speakers at the FDA meeting agreed that the issue must be tackled. John O'Bannon III, MD, of Richmond, Va, a member of the American Medical Association (AMA) Council on Ethical and Judicial Affairs, said that, while there is nothing wrong with Internet prescribing per se, "any prescribing on the Internet or otherwise is wrong, illegal, and unethical if it occurs outside the context of a valid patient-physician relationship." O'Bannon said the council is planning to update an existing AMA statement on Internet prescribing.

George Barrett, MD, vice president of the Federation of State Medical Boards, said that a federation committee on professional conduct and ethics has drafted a recommendation to discipline physicians for unprofessional conduct if they prescribe drugs without conducting an evaluation of the patient. However, he said it was only a committee recommendation; it has not been considered by the federation's Board or House of Delegates. The federation could take a formal position on this issue by spring, he added.

Meanwhile, pharmacists have attempted to deal with "online consults." The National Association of Boards of Pharmacy, Park Ridge, Ill, is going to identify and make publicly available a list of Internet pharmacies that sell online prescription drugs and who are in compliance with existing state laws and rules.

At the Bethesda meeting, Carmen A. Catizone, RPh, executive director of the association, announced the development of the Verification of Internet Pharmacy Practice Sites (VIPPS). The plan is to set up a clearinghouse that will verify the legitimacy of Internet sites that are practicing pharmacy. "We will post these on our Web site," Catizone said. "The public, health care practitioners, and regulatory agencies will have free access to these sites. With the help of the other health professions and our colleagues, along with the press, we want to send a clear message: If a site appears on the VIPP Web site, the public should understand that this is a site they can visit and use to obtain their prescription medications and pharmaceutical care with a high degree of confidence.

"If the site does not appear on our list, we hope the public will do more research about this site and perhaps realize that they shouldn't use it for their prescription medications or pharmacy care because they can't be sure of its authenticity, the practitioners involved, and the prescription medications that may be dispensed. We are moving very aggressively to organize and develop this clearinghouse," Catizone said. "There will be a prototype developed by May, and the first site list will be operational and available to the public before the end of the year."