Illinois Attorney General Jim Ryan seeks to put the companies out of business in that state and force them to pay fines of $50,000 per offense. Kansas and Missouri have both taken similar legal action, and licensing boards in at least 10 states are investigating companies and doctors that prescribe and sell medicines on the Internet. Federal agencies also are investigating, and Pfizer, the manufacturer of Viagra, has asked the Federal Trade Commission (FTC) to look into the situation.

Law enforcement and health officials grew concerned about the potential dangers of these web sites when an Illinois consumer died of a heart attack after taking Viagra he obtained through a seller on the Internet. They were also alarmed by recent testimony in congressional hearings about Viagra being sent to a 16-year-old boy, to dead people, and, in one case, to a cat named Tom whose owner had typed in  "six inches" and "neutered" in the spaces where the company's questionnaire asked about height and recent surgery.

Viagra is not the only drug being prescribed over the Internet. Investigators found that some online sellers have focused on advertising and selling popular drugs such as the anti-depressant Prozac, the weight-loss drug Xenical, and the arthritis drug Celebrex, among others.

Legitimate Pharmacies Operate Online, Too

There are many legitimate pharmacies operating on the Internet that dispense drugs prescribed by patients' doctors. In those situations, the doctor has examined or knows the patient, has determined the right medication and dosage, and can follow up to see that treatment is effective.

The companies that are the focus of lawsuits operate differently. At some web sites, the buyer fills out an online questionnaire and pays a fee but does not see a doctor. Some sites also allow customers to pick the dosage and quantity of drugs. The customer clicks on a liability waiver, giving up the right to sue if the drugs cause harm or death.

"There are several concerns here," said Joseph Dye, RPh, PhD, a registered pharmacist and behavioral scientist at the American Cancer Society (ACS).  "Patients might be embarrassed by obesity, hair loss, or impotence, and hesitate to go to a local doctor. They may see a drug that is advertised on TV to treat such a condition, and go for it."

"But self-diagnosis is difficult," added Dr. Dye.  "Even doctors won't try to treat themselves or family members because they lack objectivity. Most consumers may not know which drugs could harm them if they have another condition other than the one for which they seek the drug. And a patient could self-prescribe a drug for a symptom -- pain, for instance -- that might actually be the result of an underlying condition such as cancer or heart disease that would then go undiagnosed and untreated."
 
Look for 'Seal of Approval'
The National Association of Boards of Pharmacy (NABP) issues a "seal of approval" to companies that follow safe medical and sound business practices. The seal appears on those companies' web sites, and approved sites are listed on the National Association of Boards of Pharmacy web site.

To get the seal of approval, an online pharmacy must be in compliance with the licensing and inspection requirements of their state and each state in which they sell pharmaceuticals. These web sites also must verify the legitimacy of prescriptions and provide safeguards for patient privacy as well as for the security of transactions. In addition, the approved sites must have recognized quality assurance policies and provide meaningful consultation between patients and pharmacists.

"If consumers protect themselves by using only those online pharmacies that meet the NABP standards, then the Internet can fulfill its promise of saving people time and money while increasing convenience," concluded Dr. Dye.