Caught in the net

The perils of buying prescription drugs over the internet were illustrated graphically in the UK last month during the inquest into the untimely death of an intelligent young man who resorted to on-line pharmacies to ease his mental health problems. By the time of his death, Liam Brackell had tried 23 different types of prescription drugs.

A survey by the UK's National Audit Office earlier this year suggested as many as 600,000 Britons have bought prescription medicines over the internet, while in the US an estimated one million people buy their medication in this way. And with hardly a week passing without the launch of yet another site, it would appear to be a market with plenty of growth potential.

Buying drugs over the internet is alarmingly easy. Among those readily available for purchase without a prescription - and often without even an on-line 'consultation' - are Viagra (for erectile dysfunction); Xenical, Phentermine, Meridia, Bontril, Ionamin and Adipex, all for weight loss; the antidepressant Prozac; Celebrex for osteoarthritis and rheumatoid arthritis; Evista for osteoporosis; Tamoxifen for breast cancer; the antipsychotic Clozapine; Ritalin for hyperactivity; and Propecia for hair loss.

A recent report by Scottish trading standards officers found that many websites are breaking the law when it comes to selling over the internet as they do not comply with rules designed to protect consumers. In the UK, the penalty can be an unlimited fine and up to two years in prison. Yet so far there have been just three successful prosecutions.

Responsibility for regulating the e-pharmacies rests with the UK's Medicines and Healthcare products Regulatory Agency (MHRA) and it has managed to have seven websites shut down over the past few years. But every month it receives more than 10 reports of unlawful operations.

The problem is an international one and govern-ments - including those of the UK, US and Thailand - have started to work together to try to tackle it. The US FDA, for example, has written via the internet to a dozen operators of websites outside the US warning them they could be breaking the law by offering medicines to US citizens without a prescription or otherwise violating US laws.

The UK's ABPI says patients should using on-line pharmacies should treat them with caution, not only because they may not receive proper medical advice before prescription drugs are dispensed, but also because there may be question marks over the quality of the drugs they are given - have they been stored correctly? Are they within their sell-by date?

The consultation/prescription/pharmacy system is there for a reason: to try as far as possible to match patients and their diseases to the correct regime of medication. And if a GP refuses to prescribe a particular drug to an individual, there is probably a very good reason for his decision based on that individual's medical history and current state of health.

The system may not, as those US patients who unwittingly took fake Lipitor tablets found out, be a cast iron guarantee of authenticity or safety - but it is the nearest we are going to get.