Internet Pharmacy Crackdown: Recognizing Suspicious Sites, Part I

Consumers are finding that the Internet is a great place to shop. Everything from clothing to electronics to pharmaceuticals can be bought online. But in addition to those sites that provide legitimate services, there are others that are just out to make money. While fraud is never harmless, it can be deadly when it comes to the online prescribing and sale of pharmaceuticals. The importance of recognizing and cracking down on these illegitimate Web sites is clear, as there has already been at least one documented case in which a consumer has been harmed after obtaining prescriptions for pharmaceuticals from online pharmacies.

"The business practices of many illegitimate sites make them difficult to identify," said Dyke F. Anderson, NABP president. "Many Web sites are established to be short-lived and to evade investigation. Rather than registering on search engines where most people find Web sites, many fraudulent sites prefer to broadcast 'spam' mail."

Knowing the characteristics of an illegitimate Web site is one way to battle those operators who are not properly licensed to sell pharmaceuticals via the Internet. Through its Web Watch program, which tracks possible illicit pharmacy Web sites, NABP has developed a list of characteristics that are common to most illegitimate Web sites. If a pharmacy site exhibits any of the following, consumers should be wary.

• The site does not carry a Verified Internet Pharmacy Practice Sites™ (VIPPS) seal.

The VIPPS seal is given to those pharmacy Web sites that are appropriately licensed, have passed the NABP's rigorous 17-point criteria review, and completed site visit by a VIPPS inspection team.

• The site has limited offerings, usually only lifestyle-enhancement drugs.

Legitimate pharmacy sites tend to offer a wide variety of prescription drugs, while illicit sites have limited offerings. Usually, illegitimate sites only offer lifestyle-enhancement drugs to treat conditions such as baldness or erectile dysfunction.

• The site offers online prescribing without a valid patient-prescriber relationship.

Online prescribing calls into question the very foundation of the traditional prescriber/patient relationship. Consumers are "counseled" by a doctor via the Internet and often are asked to answer a series of questions regarding their medical history, upon which the patient's prescription will be based. The American Medical Association (AMA) states that "a prescription solely on the basis of a simple questionnaire is not sufficient." Online prescriptions should be developed according to the guidelines that the AMA has for physician involvement in traditional prescription scenarios and in accordance with state practice acts for medicine.

• The site offers drugs without requiring a prescription, or indicating that a prescription is optional.
• The Web address indicates a site located outside of the United States.

Sites located outside the United States may have a country code located in the Web address. For example, some Canadian Web sites have "ca" at the end of the address.

• The name or address of the operator is not provided.

People operating fraudulent sites want to make it as difficult as possible for the law to find them. Therefore, if it is difficult to find specifics about the company, the operators of the site may have something to hide.

• Unsubstantiated or unreferenced claims for some products are often on illicit sites.
• Links to other health care Web sites are available in order to create an image of legitimacy to the general public.

Links to other health care Web sites can be provided without any authorization from the pharmaceutical company. Often, the link appears in the format of the company's logo, complete with a trademark symbol. Since it is impossible to know if the site has the support of the other site, it is important to remember that logos and links can, and do, appear on illegitimate Web sites.

• The Web address consists of a long number, with several redirects to other Web sites that are made without the visitor's knowledge.

As consumers click on the icons and links provided, they will be brought to several completely different Web sites instead of different Web pages on one Web site. Users will not be aware of these site redirections unless they are paying close attention to the Web-site address bar on their browser (i.e., Internet Explorer, Netscape, or America Online).

The above characteristics create confusion about whether or not a Web site is legitimate. The more ambiguous the information on and about the site, the more difficult it is for investigators to stop lawbreakers from doing business. Tip-offs from consumers often spark investigations into suspicious sites.

Like NABP, some state boards of pharmacy have launched programs to search the Internet for illegitimate sites. State board watchdog programs range from those that have part-time employees looking for fraudulent sites to those that rely on full-time trained investigators who find illegitimate sites and build a legal case against them. Through Web Watch, NABP investigates suspicious sites reported by the general public and state boards.

According to Anderson, a limited menu and simplistic approach to product sales are indicators of an illegitimate site. "Because these sites are fairly easy to identify they are readily found and used by the segment of the public who resist authority and laws that regulate dispensed pharmaceuticals for their safety," he said. "Reports on the sites usually come from concerned third parties rather than those people who are buying from the online pharmacies."

It is difficult to estimate how many online pharmacies exist, though the number cited most often is approximately 260. According to Anderson, however, this only includes English language sites. Other factors making exact numbers difficult to track are that Web sites may only be operational for a few hours, and that individual organizations may be operating hundreds of Web sites or pages.

While it is crucial to educate the public [one such campaign will soon be launched by the Health Care Financing Administration (HCFA) for Medicare beneficiaries and health care professionals at insurance agencies], NABP believes it is just as important to raise the awareness of pharmacists, doctors, and nurses. NABP plans to distribute information about online pharmacies to the medical profession through its member boards of pharmacy. The Boards will be asked to solicit the aid of other state boards, such as medical and nursing boards. The goal of this initiative is to educate licensees about Internet pharmacies and the VIPPS program, so they can inform patients and respond to inquires.

Once an illegitimate online pharmacy has been identified, it must be investigated. For information on investigating and developing cases against illegitimate online pharmacies, look in the upcoming February 2000 issue of the NABP Newsletter.

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