May 1, 2000 (Washington, D.C.) -- Pietr Hitzig, MD, never listened to Alvin Chernov's heart. In fact, he never even met him, let alone checked his blood pressure or pulse. Yet in March 1997, via his Internet web site, the Maryland physician diagnosed the 25-year-old Arizona man with stress-related depression and prescribed two powerful muscle relaxants for him, as well as the diet drug combination widely known as fen-phen.
Chernov received none of the careful monitoring routinely advised for patients on these drugs and, over the ensuing months, developed a pattern of behavior so bizarre that family members complained to both Hitzig and the Arizona Board of Medical Examiners. Six months later, Chernov committed suicide with a handgun. Family members attribute his death to the wild mood swings brought on by the drugs.
Last July, Hitzig, 56, was indicted on 34 federal charges of prescribing medicine illegally between 1996 and 1998. His indictment was just one skirmish in what many law enforcement officials say could become an all-out war on drug-peddling web sites. While some sites distribute drugs both ethically and legally, the vast majority of the estimated 400 online pharmacies are mailing prescription drugs, like Viagra (for impotence) and Propecia (for hair loss), to anyone with a credit card who is willing to fill out a simple questionnaire.
Medical experts complain that such practices expose patients to doses of drugs that, depending on their personal medical histories, could be lethal or cause them to become extremely ill.
Regulators point to the case of Robert McCutcheon, a 52-year-old Illinois man who had a family history of heart problems. Without seeking the counsel of his doctor, he ordered Viagra over the Internet. In March of last year, after drinking a few beers on the way home from work, he went to his girlfriend's house, popped a Viagra, and died of a heart attack while having sex.
Merck vigorously warns expectant mothers not to even handle its Propecia pills for fear of birth defects. But Lisa Meiners, an assistant attorney general in Missouri, was able to order the drug -- in a sting operation -- from a Texas online pharmacy despite being 26 weeks pregnant at the time. Missouri later barred the pharmacy from doing business within its borders.
Online buyers might also find themselves obtaining defective, potentially dangerous drugs. "Americans can, unwittingly, order prescription drugs from rogue web sites that appear to be American-based companies, but are actually overseas sites offering drugs that are unapproved, counterfeit, contaminated, expired, mislabeled, manufactured in unapproved facilities, or not stored or handled in a proper manner," says Sen. James Jeffords (R-Vt.), the chairman of the U.S. Senate Committee on Health, Education, and Labor.
A Cat Can Order Viagra
Government health officials are concerned that the ease with which consumers can now get prescription drugs over the Internet could lead to widespread misuse, with serious -- if not always lethal -- consequences for consumers. A reporter from Glamour magazine, for example, recently ordered a diet drug even though she indicated on the questionnaire used by one site that she weighed just 97 pounds. A Michigan reporter used her cat's name, acknowledged under "prior surgeries" that it was neutered, but successfully ordered Viagra for the feline.
"We had [the 16-year-old son of] one of our employees . . . order Viagra over the Internet and he received it," says Carla Stovall, Kansas attorney general. "Those are the kinds of things that I think concern everybody." The issue is gaining attention in Washington, where Congress and the White House are considering intervention. President Clinton has already proposed giving the Food and Drug Administration (FDA) sweeping new powers to regulate and certify drug-selling sites. "When medications are classified as prescription drugs, it is done so for a reason," says FDA commissioner Jane Henney, MD. "These drugs have been judged to have sufficient risks that they should not be provided to patients without a health professional's involvement."
Some states have already started investigating online drug peddlers. Earlier this month, New Jersey sued eight online pharmacies selling Viagra, charging that they failed to disclose that they lacked a New Jersey license and claiming that the use of an online questionnaire to diagnose patients falls short of the state's standards. In Oregon, a doctor was recently fined and placed on probation for 10 years by that state's Board of Medical Examiners for prescribing Viagra and other drugs over the Internet to patients he never examined. Last year, Illinois, Kansas, and Missouri also went after Internet drug merchants and the National Association of Attorneys General has said it is studying the issue.
Still, Harvey Jacobs, a Washington Internet lawyer, says the federal government should not develop special regulations for online pharmacies. Instead, it should ask the Federal Trade Commission and the U.S. Postal Service to work harder. "Those entities now regulate rogue operations and have sufficient tools to go and shut them down," he says.
Should "Rogue Pharmacies" Be Shut Down?
So-called "rogue pharmacies'' are a pain in the side of a burgeoning legitimate online industry expected to be worth an estimated $4 billion by 2004. Debby Fry Wilson, director of government relations for drugstore.com, says her company believes the rogue sites should be shut down because they are "a potential danger to the public health."
For its part, the industry is trying to help consumers determine when a pharmacy is legitimate. The National Association of Pharmacy Boards now offers its Verified Internet Pharmacy Practice Sites "seal of approval." To earn the mark, online pharmacies must agree to an inspection by the pharmacy board and show that all pharmacists filling prescriptions maintain the appropriate state licenses in good standing. To date just five sites have been acknowledged: cvs.com (a sponsor of WebMD); drugstore.com; familymeds.com; merck-medco.com, and planetrx.com.
Medical experts say that consumers should seek out Internet pharmacies that have earned the seal and steer clear of ordering drugs online unless their personal physician plays a role in writing the prescription. "Our challenge is to make sure that the same safety net that protects the consumer who purchases prescription drugs at the corner store is in place when the click of a mouse is used to purchase from a venue in cyberspace," says the FDA's Henney.
Until that safety net is in place, it's up to the individual consumer to observe caution. The responsible sites require and verify a prescription. (See Online, No Need to Wait in Line) Those that don't, undermine the medical supervision that protects you from the potential dangers inherent in most drugs.
Michael D. Towle is based in Chantilly, Va., and writes regularly on health and legal issues for WebMd.