Background: A growing number of prescription medicines such as Viagra® are offered and sold directly to consumers on the Internet. Little is known about the structure and "quality" .
United States of America (Press Release) June 14, 2008 --
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Objective: To determine to what extent Viagra is sold on the Internet despite clear contraindications.
The World Wide Web was searched for companies who offer to issue prescriptions for Viagra online or sell Viagra without prescription. We pretended to be a patient in which the ordered drug (Viagra) is clearly contraindicated, and tried to obtain an online prescription for this drug on the Internet. Our test case was as a 69-year-old woman giving a sexual history of having "no orgasm," with obesity (165cm/78kg), coronary artery disease, and hypertension, and taking captopril, pravachol, atenolol, and erythromycin.
Results: You wll not beleive how many, Twenty-two distinct companies were identified, consisting of three different types: 2 required a written prescription by a "real" physician, 9 dispensed the drug without any prescription at all, and 11 issued an "online prescription" or "e-script" after an alleged physician reviewed the online order form containing medical questions. We tested 10 of the latter type, among them 8 based in the USA. We ordered a total of 66 pills worth US$ 1,802.84. Three companies, among them both European companies, delivered within 6, 10, and 34 days respectively, despite Viagra being clearly contraindicated. In 80% no complete history was taken, in 70% inappropriate medical terminology was used, and in only 2 cases was the order form reviewed by a physician who identified himself.Thats amazing!
Conclusions: Although a surprisingly high number of Internet pharmacies declined delivery, the public should be alerted to the risks involved with prescription drug prescribing and dispensing via the Internet. And read all the laws and rules of dea diversion etc.
(J Med Internet Res 1999;1(2):e10)
doi:10.2196/jmir.1.2.e10
All companies requested that customers waive the site's liability in the event that they experienced health problems. While all sites asked whether customers were currently taking nitrates, only 4 specifically asked about recent "myocardial infarction," and only 2 of those used the lay term "heart attack." Seven asked about hypertension, but only 3 used the lay term "high blood pressure." Only 3 asked about retinitis pigmentosa, another important contraindication of sildanefil.
One site offered to ship, together with Viagra, tablets of cimetidine (Tagamet®), as it causes "56% increase in plasma sildanefil concentrations when coadministered with Viagra. This would indicate that increased effectiveness would be noted with the same dose of Viagra taken with 800mg of Cimetidine."
Discussion
Although a surprisingly high number of Internet pharmacies declined delivery, the public should be alerted to the risks involved with prescription drug prescribing and dispensing via the Internet. In 30% of our cases, "prescriptions" were issued although clear contraindications existed, in 80% no complete history was taken, in 70% inappropriate medical terminology was used, and in only two cases was the order form reviewed by a physician who identified himself. Pharmacies claiming to "consult" consumers may be harmful, as the clients may rely on a non-existent "physician." However, even if doctors appear to be employed at the pharmacies, this is no guarantee for a safe drug-shopping experience for patients; in 2 out of the 3 cases where Viagra was delivered, physicians appeared to have approved the prescription, recalling the problem of the questionable credentials of "cyberdocs" [3]. Consumers should also be aware that Viagra on the Internet costs on average twice as much as in regular pharmacies, and that in our test 20% of the pharmacies charged the credit card without delivering a product. We estimate that at least 4,500-15,000 web pages offer online ordering of Viagra. Many dispensing companies run "affiliate" programs offering a commission to individuals who advertise and link customers to them [4], which is one explanation for the immense number of doorway pages, and another reason for incomplete and misleading drug information on the Internet. Future legislative action may target this lay-advertising practice. Consumer education and an international modus operandi for managing drug sales on the Internet are further steps that should be taken by the World Health Organization (WHO) [5] and other organizations.
References
1. InterNIC. Whois. URL: http://www.networksolutions.com/cgi-bin/whois/whois [accessed 1999] [WebCite Cache]
2. Cheitlin MD, Hutter AM, Brindis RG, Ganz P, Kaul S, Russell RO, et al. ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999 Jan;33(1):273-282. [Medline] [CrossRef]
3. Eysenbach G, Diepgen TL. Evaluation of cyberdocs. Lancet 1998 Nov 7;352(9139):1526. [Medline] [CrossRef]
4. KwikMed. URL: http://KwikMed.com/viagra/109275/webmasters.html [accessed 1999] [WebCite Cache]
5. WHO Executive Board, 101st Session. Resolution EB101.R3. Cross-border advertising, promotion and sale of medical products through the Internet. Geneva: WHO; Jan 23, 1998. URL: http://www.who.int/gb/pdfangl/angr3.pdf
If you would like the medications cheaper try http://www.enhancetabs.com
Objective: To determine to what extent Viagra is sold on the Internet despite clear contraindications.
The World Wide Web was searched for companies who offer to issue prescriptions for Viagra online or sell Viagra without prescription. We pretended to be a patient in which the ordered drug (Viagra) is clearly contraindicated, and tried to obtain an online prescription for this drug on the Internet. Our test case was as a 69-year-old woman giving a sexual history of having "no orgasm," with obesity (165cm/78kg), coronary artery disease, and hypertension, and taking captopril, pravachol, atenolol, and erythromycin.
Results: You wll not beleive how many, Twenty-two distinct companies were identified, consisting of three different types: 2 required a written prescription by a "real" physician, 9 dispensed the drug without any prescription at all, and 11 issued an "online prescription" or "e-script" after an alleged physician reviewed the online order form containing medical questions. We tested 10 of the latter type, among them 8 based in the USA. We ordered a total of 66 pills worth US$ 1,802.84. Three companies, among them both European companies, delivered within 6, 10, and 34 days respectively, despite Viagra being clearly contraindicated. In 80% no complete history was taken, in 70% inappropriate medical terminology was used, and in only 2 cases was the order form reviewed by a physician who identified himself.Thats amazing!
Conclusions: Although a surprisingly high number of Internet pharmacies declined delivery, the public should be alerted to the risks involved with prescription drug prescribing and dispensing via the Internet. And read all the laws and rules of dea diversion etc.
(J Med Internet Res 1999;1(2):e10)
doi:10.2196/jmir.1.2.e10
All companies requested that customers waive the site's liability in the event that they experienced health problems. While all sites asked whether customers were currently taking nitrates, only 4 specifically asked about recent "myocardial infarction," and only 2 of those used the lay term "heart attack." Seven asked about hypertension, but only 3 used the lay term "high blood pressure." Only 3 asked about retinitis pigmentosa, another important contraindication of sildanefil.
One site offered to ship, together with Viagra, tablets of cimetidine (Tagamet®), as it causes "56% increase in plasma sildanefil concentrations when coadministered with Viagra. This would indicate that increased effectiveness would be noted with the same dose of Viagra taken with 800mg of Cimetidine."
Discussion
Although a surprisingly high number of Internet pharmacies declined delivery, the public should be alerted to the risks involved with prescription drug prescribing and dispensing via the Internet. In 30% of our cases, "prescriptions" were issued although clear contraindications existed, in 80% no complete history was taken, in 70% inappropriate medical terminology was used, and in only two cases was the order form reviewed by a physician who identified himself. Pharmacies claiming to "consult" consumers may be harmful, as the clients may rely on a non-existent "physician." However, even if doctors appear to be employed at the pharmacies, this is no guarantee for a safe drug-shopping experience for patients; in 2 out of the 3 cases where Viagra was delivered, physicians appeared to have approved the prescription, recalling the problem of the questionable credentials of "cyberdocs" [3]. Consumers should also be aware that Viagra on the Internet costs on average twice as much as in regular pharmacies, and that in our test 20% of the pharmacies charged the credit card without delivering a product. We estimate that at least 4,500-15,000 web pages offer online ordering of Viagra. Many dispensing companies run "affiliate" programs offering a commission to individuals who advertise and link customers to them [4], which is one explanation for the immense number of doorway pages, and another reason for incomplete and misleading drug information on the Internet. Future legislative action may target this lay-advertising practice. Consumer education and an international modus operandi for managing drug sales on the Internet are further steps that should be taken by the World Health Organization (WHO) [5] and other organizations.
References
1. InterNIC. Whois. URL: http://www.networksolutions.com/cgi-bin/whois/whois [accessed 1999] [WebCite Cache]
2. Cheitlin MD, Hutter AM, Brindis RG, Ganz P, Kaul S, Russell RO, et al. ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999 Jan;33(1):273-282. [Medline] [CrossRef]
3. Eysenbach G, Diepgen TL. Evaluation of cyberdocs. Lancet 1998 Nov 7;352(9139):1526. [Medline] [CrossRef]
4. KwikMed. URL: http://KwikMed.com/viagra/109275/webmasters.html [accessed 1999] [WebCite Cache]
5. WHO Executive Board, 101st Session. Resolution EB101.R3. Cross-border advertising, promotion and sale of medical products through the Internet. Geneva: WHO; Jan 23, 1998. URL: http://www.who.int/gb/pdfangl/angr3.pdf
If you would like the medications cheaper try http://www.enhancetabs.com
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