- The Washington Times - Tuesday, March 5, 2002

Internet sales of Viagra and other prescription drugs thrive almost unabated three years after the federal government drew a bead on Web doctors with help from a medical establishment sting operation.
The virtual absence of laws that govern online prescribing leaves medical regulators reliant on pressure tactics that produce inconsistent results and don't reach Web site operators that employ doctors and druggists.
In the first reported final decision by any state's highest court, Kansas Attorney General Carla Stovall lost an effort to discipline Dr. Howard J. Levine of Washington state and the now-defunct confimed.com for selling Viagra to Kansans over the Internet.
"Has the government been successful in regulating? The answer is no. Should it be? That's a medical judgment. I'm an attorney," said James R. Jarrow of Kansas City, Mo., who won the Jan. 25 Kansas decision.
Pressure is on, however, and a Viagra purveyor in Columbia, S.C., told The Washington Times that under pressure from the state pharmacy board, his neighborhood pharmacy quietly quit the business that earned him $450 a day.
"We could have challenged it in court," said the operator, who dispatched 80 to 90 orders of Viagra by FedEx five days a week for a flat $5 profit per order. "None of us here really saw anything wrong with it, but we knew it wouldn't be worth it to pay a lawyer for the very few scrips we were doing." The drug is sold for $10 to $12 per 100 milligram tablet.
That operator, speaking on the condition of anonymity, said urologists and other doctors prescribe Viagra to new patients in the office after an interview with no examination.
"The only thing the online doctors don't know is what you look like," the druggist said, echoing the Kansas Supreme Court's opinion that confimed.com provided clearer and more complete information than physicians generally furnish.
Mr. Jarrow predicts that states are likely to be ineffectual in governing Internet prescriptions by professionals elsewhere.
"Doctors who prescribe in the office don't examine your equipment, so what is the real medical issue that is not being addressed?" Mr. Jarrow said in an interview.
The Columbia, S.C., store filled prescriptions from a Florida physician identified as C. Levy, whose orders are also filled by a North Carolina drugstore. Dr. Levy did not return a call by this newspaper to his Sunrise, Fla., office.
Overall, one of every nine Web drugstores that come under scrutiny drops off the World Wide Web, said Dale Austin, chief operating officer of the Federation of State Medical Boards, which includes all 70 medical licensing boards in the United States and its territories.
"I certainly can't say there's been a halt, because many move on under other names. People can still get it this way. It's bad health care. It's not safe health care," Mr. Austin said.
On Dec. 27, 1999, President Clinton declared war on "rogue operators" and proposed a $500,000 fine for each sale of Viagra or other drugs from U.S. and foreign Web sites without a valid prescription.
However, Congress did not act, reportedly out of concern about interfering in state-licensing responsibilities.
Although the U.S. focus is on legitimate outlets selling real Viagra in original Pfizer packaging even among criminals caught by postal inspectors selling the drug by mail with neither a pharmacy nor a doctor's license buyers have been cautioned to take care.
Counterfeit Viagra has been reported on sale throughout the Far East, notably Singapore, Manila and Beijing. China's Drug Administration said Shanghai sex-health shops are selling pills in the exact shape, color and packaging as Wan Ai Ke, the Chinese brand name for Viagra. Look-alike herbal products with similar names have been offered by Web entrepreneurs.
The FDA does not use the word "illegal" to describe the practice of online doctors writing prescriptions on the basis of questionnaires, but it does say the practice is inappropriate and it advises consumers to shun Web sites that include a medical "consultation" and prescription at a typical fee of $75 to $85.
"Most of the sites we've found use legitimate physicians. We turned over information on 30 sites to medical or pharmacy boards. Some actions have been taken; others are in process," Mr. Austin said, expressing frustration that the practice is not clearly illegal across the board.
Among sources that fund the Federation of State Medical Boards' $50,000-a-year project is Pfizer Inc., which makes Viagra and sold $1.3 billion worth to about 10 million U.S. men in 2000.
Pfizer spokesman Geoff Cook said Pfizer discourages orders without a physical examination but leaves enforcement to others.
"That's a law-enforcement issue. We can't close down Web sites," Mr. Cook said.
It is computerized prescribing that is under attack, not online pharmacies that fill traditional prescriptions, a practice many people use to cut costs or simplify refills.
In 18 months of operation, Mr. Austin said, a Federation of State Medical Boards sting identified more than 250 online purveyors of such popular drugs as Viagra for impotence, Xenical to burn away fat, Propecia to grow hair on bald spots, and Fioricet for headaches. In the wake of the anthrax scare, the federation now also aims at the burgeoning number of sites peddling antibiotics such as Cipro.
"We've moved from lifestyle drugs to antibiotics, which pose a more serious danger. When a person might need those antibiotics, they might no longer be effective," Mr. Austin said.
He said the federation and the National Association of Boards of Pharmacy received no reply to a letter asking Health and Human Services Secretary Tommy G. Thompson to join efforts to outlaw prescriptions based on Web questionnaires or at least require Web sites to identify physicians by name.
"I can't tell you why it didn't happen," Mr. Austin said.

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