The recent headlines over counterfeit Avastin renewed yet again concerns about the supply chain and where consumers get their meds (seethis and this). In the midst of this ongoing debate, a new study reminds us of the vagaries of Internet pharmacies, where untold numbers of people turn to purchase drugs, with and without prescriptions.
So how safe and reliable are these online destinations? The researchers made a total of 370 purchases of five different brand-name prescription drugs - Viagra, Lipitor, Celebrex, Zoloft and Nexium - from 41 Internet pharmacies. The good news is that meds sold by sites with credentials from legitimate organizations were kosher, but unverified sites sold Viagra that was not.
"These findings suggest that the FDA guideline against any foreign website is most likely based on FDA lack of jurisdiction, and inability to oversee quality, outside of US, rather than a careful assessment between drug safety and price savings," write the study authors in the National Bureau of Economic Research. "The current illegal-but-no-enforcement approach on personal importation of prescription drugs does not stop consumers from buying drugs on foreign websites, but it does leave consumers in the gray area of searching for unofficial information on their own."
In other words, the bottom line is that consumers can purchase needed meds online with some assurance the drugs are okay, which contradicts admonishments from the FDA and the pharmaceutical industry that the risks of receiving unsafe meds is too great. Of course, consumers visit these sites in order to save money and that is unlikely to change.
As the NEBR study notes, a report issued by Forrester Research in 2007 found that just 6 percent of consumers purchased prescription drugs on the Internet the previous year. In 2008, Deloitte Center for Health Solutions found 21 percent of prescription drug users reported buying drugs online or through the mail in the previous 12 months and this number increased to 30 percent in 2009.
Consequently, the NBER researchers write that, while their findings confirm the FDA warning against rogue websites, a "blanket warning against any foreign website may deny consumers substantial price savings." By the same token, the study does make a strong point of distinguishing between sites that have credentials and those that do not.
So how to choose a site? The National Association of Boards of Pharmacy runs the Verified internet Pharmacy Practice Sites, which accredits US-based online pharmacies that comply with laws in both the state of their business operation and states to which they ship meds. As of last month, VIPPS accredited 30 online pharmacies. Reliable verification can also be found at LegitScript.com.
A so-called second tier of sites based in and out of the US are verified by PharmacyChecker.com, as well as the Canadian International Pharmacy Association, according to the study. The researchers also found that most meds sold by sites accredited by NABP and LegitScript cost, on average, 52.5 percent more than drugs sold by sites that are credentialed by these other two entities (here is the study). The upshot? Sites based outside of the US are often cheaper than those based in the US.
"This report provides balance to combat the media frenzy about counterfeit drugs that wrongly paints all foreign online pharmacies black when we know some of them are very good and help Americans afford their medication," Gabriel Levitt, a vice president at PharmacyChecker.com, tells us. "In fact, the good ones are a lifeline for those Americans who simply would go without their medication without them.”
Nonetheless, the NBER researchers do note that uncredentialed sites can be highly problematic. "The lack of physician-patient contact can be dangerous because the 'online physician' cannot examine the patient physically or ask probing questions to determine patient need of medication," they write. "Some rogue websites also aim to steal consumer credit card information for identity theft."
To illustrate, seven of 10 online pharmacies, which were not verified and mostly based outside the US, did not exist by last month, and all three remaining sites require an online questionnaire. Two offer 'discreet shipping' and one does not require a prescription. This is a small number of such sites, but creates "the casual impression that non-verified foreign websites are likely fly-by-night sellers, trying to lure customers by privacy and often without requiring a prescription," the researchers write.
As for the eight Viagra samples, all of them listed China as the source on drug packaging but it was not always clear where the drug was made and where shipping took place, according to the report. In one case, the drug was mailed from China (the bank account for this site was in Panama); in another, two samples the postal marks were from Austria and India, the researchers write.