Buying drugs from online pharmacies usually a bad idea

The e-mails touting Internet pharmacies and the drugs they sell pop up in an "in" box like dandelions in the lawn.

Unbidden and unwelcome, their blaring, often explicit subject lines promise no waiting rooms, no appointments and no prescription needed.

Some e-mails offer "Viagra shipped to your door!" or "Diet drugs without an embarrassing office visit!"

The e-mails usually are from a new breed of pharmacy -- one that operates online and doesn't require seeing a doctor before dispensing drugs.

So is getting and filling a prescription with a mouse click a good idea? The answer is a resounding "no" from doctors, pharmacists and other health professionals.

It's not clear how many online pharmacies exist or how many people use them. But type into a search engine the name of virtually any prescription medication and five or more online pharmacies typically will offer it for sale without a doctor's visit. Available is everything from the well-known impotence drug Viagra to the anti-wrinkle cream Retin-A to Cipro, the antibiotic used to treat anthrax.

"Some prescription drugs are ordered and dispensed over the Internet in a manner that clearly constitutes a dangerous medical practice," said Dr. Donald Palmisano, a New Orleans surgeon who is president-elect of the American Medical Association (AMA). "It raises serious ethical questions and puts patients at great risk. The AMA is very concerned about this."

So are many other organizations. The National Association of Boards of Pharmacy, the Federation of State Medical Boards and the Association of State Attorneys General have joined the AMA in calling for restrictions on online pharmacies' ability to dispense prescriptions. Officials from the U.S. Food and Drug Administration (FDA) have also testified before Congress about the need for regulation.

Attorneys general in at least six states (Minnesota not among them) have filed lawsuits resulting in several online pharmacies going out of business.

Restricting access

Access to prescription drugs is restricted for good reasons, said Palmisano and other experts. Many drugs are powerful. To be effective and safe, they must be used responsibly -- something that includes at least a hands-on physical exam by a doctor, a thorough medical history review and good teamwork between a patient and provider, they said.

Online pharmacies that dispense prescriptions circumvent these safeguards, experts said. Typically, the sites have customers fill out a questionnaire about their symptoms, vital statistics and medical histories. A doctor employed by the Web site reviews the questionnaire and writes a prescription, which is filled by the online pharmacy -- for a fee. Consultations typically run from $40 to $100. Some foreign online pharmacies ask only for a credit card number.

"This falls below the minimum standard of care," Palmisano said. The questionnaire gives little information about a patient and is no substitute for a medical history review or hands-on exam, he added.

"There is no mechanism to determine whether the individual has answered the questions correctly or truthfully," he said. "There is also no attempt to explain the risks of the drug."

Online pharmacy customers risk harmful drug interactions, side effects or allergic reactions, said Palmisano and other experts. Patients may not be told the limitations of the drugs or they could be misdiagnosed and treated for a disease they don't have. Patients also have no guarantee that they are getting the drug they ordered.

Calls to executive offices of three leading online pharmacies were not returned. For several other companies, the pharmacies' customer service representatives said they didn't know the location of the executive offices.

The FDA doesn't track how many people have been injured by drugs dispensed online. But it warns that an Illinois man died of heart problems -- a well-known complication of Viagra -- after he started taking the drug, which he had been prescribed through an online pharmacy.

"People who do this are really putting themselves at risk," said Dr. Jon Pryor, a urologist at the University of Minnesota.

Pryor said Viagra, which he has researched and prescribed, illustrates why online prescriptions aren't good medical practice. The blue diamond-shaped pill, made by Pfizer, is one of the most common drugs available through online pharmacies.

Impotence has many causes, he said. By just treating the problem with Viagra, it's possible that a more serious problem causing it -- such as heart disease or diabetes -- could be overlooked, resulting in serious harm.

A less serious health problem resulting in impotence -- low levels of testosterone -- could be missed, he added.

Even if the patient could benefit from Viagra, Pryor said, the drug needs to be used under medical supervision. In addition to heart problems, it can have dangerous interactions with common drugs -- such as nitroglycerin, used to treat heart disease.

Patients also need careful instruction on how to use Viagra, he said. Otherwise it might not work.

"Patients need to remember that these sites are interested in selling a product and not necessarily the health of the patient," he said.

Antidepression drugs

Experts in mental health also had similar reservations about getting and filling a prescription online for antidepressants. Prozac, Paxil and Zoloft are among the most common psychoactive drugs offered by online pharmacies.

"The [new drugs] are much safer than the old drugs, but they can still have some significant medical risks," said Dr. Eric Larson, a psychiatrist at Park Nicollet Clinic in St. Louis Park.

Depressed patients could need counseling or other help, said Larson and other experts.

Jackie Casey, executive director of SAVE, a Minnesota organization to prevent suicide, said she takes a physician-prescribed antidepressant because she has depression and has contemplated suicide.

"Finding the right medications and the right dosage is a tricky science," said Casey, who tried several antidepressants before finding one that worked for her. "I can't imagine having to muddle through on my own. I'd have never made it."

Seal of approval

Kansas Attorney General Carla Stovall sued online pharmacies to block them from operating in that state. But not all online pharmacies are a problem.

Mark Ohlemeier, a spokesman for the attorney general, said the legitimate ones are based in the United States, work only with a prescription resulting from a doctor's visit, and have a seal of approval from the pharmacy board.

Consumers who want to fill prescriptions online should look for pharmacies that carry the seal of approval, called VIPPS, the Verified Internet Pharmaceutical Provider System, which is issued by the national pharmacy association, he said. About 12 online drug stores, mostly affiliated with large chains, have the VIPPS seal of approval.

Ohlemeier said unapproved online pharmacies often are difficult to track down, making enforcement difficult. Unlike traditional businesses, many have no central location, he said.

"Consumers need to be very careful with prescription drugs. After all, we're talking about your health and what's more important than that?" he said. "You have to be careful about where you're getting the medicine and make sure what you get is what you need. These organizations don't have your best interests in mind."

-- Jill Burcum is at jburcum@startribune.com .