Wellbeing
on the web 1: finding the best links
Wellbeing
on the web 3: the best portals
You have a persistent headache or a fever. Where do you go for advice? A
decade ago the answer was straightforward — to your GP and then, probably,
to the pharmacy, where you would join a queue for your prescription to be
dispensed. Now, though, a growing number of people choose to obtain both
diagnosis and prescription at the click of a mouse from an e-pharmacy. A
report by Envision, a web analysis company, estimates that worldwide there
are 2,300 sites selling medicines direct to consumers, while National Audit
Office surveys reveal that one person in 100 gets prescriptiononly medicines
online — even though the practice is riddled with safety issues, from the
sale of potentially lethal fake drugs to dodgy diagnoses by bogus online
doctors.
So concerned is the Royal Pharmaceutical Society of Great Britain (RPSGB) that
this week it launches a pilot scheme to protect the public from unscrupulous
drug-pushing on illegal websites. The aim is that, within a few months,
buyers will be able to identify credible online pharmacies taking part in
the trial by a logo attributed only to bona fide, RPSGB-registered
pharmacies. If successful, the scheme will be rolled out nationwide. Lynsey
Balmer, head of professional ethics at the RPSGB, calls it “a significant
step” towards policing an industry that is growing by the day.
Regulating the online drug industry, she says, is fraught with difficulty.
Selling prescription-only medicines online is not illegal, she says, but is
not permitted without a doctor’s prescription. However, that prescription
need not be from your normal GP. A loophole in the Medicines Act 1968 means
that although many drugs can be dispensed only after a patient has consulted
a doctor, the consultation need not be face-to-face — which makes brief
online “ consultations” with cyber doctors on websites perfectly legal.
Sites registered with the RPSGB, though, require a copy of a prescription
from a UK GP before medicines are dispensed. In future, says Balmer, doctors
may be able to send prescriptions electronically to registered websites.
The British Medical Association opposes online consultations, although it
concedes that they are legal. Paul Cundy, the BMA spokesman on computers and
general practice, calls them “very dangerous”. He says that online doctors
are “operating blind” and that the phrase “online consultation” is a
nonsense because the GP “cannot see, speak to or enter into proper dialogue
with a patient”.
Medical professionals are concerned by the relative ease with which patients
can obtain potent drugs. Whether online GPs take a full medical history and
thoroughly assess a patient’s need for a particular drug is almost
impossible to check.
In fact, patients whose GPs refuse to prescribe them Viagra, or a slimming
drug such as Reductil, or antidepressants such as Prozac, can simply buy
their supplies online. “Internet pharmacies registered with us must adhere
to the same codes of practice and the same regulations as bricks-and-mortar
pharmacies,” says Balmer. Which is why websites that offer to sell drugs
directly to the public, or that offer diagnosis from an online doctor, will
not feature the RPSBG logo.
Balmer points out that there are many reputable online pharmacies, and that
the ability to obtain medicines online can help people — for example, those
with mobility problems and those who are embarrassed by their medical
problem and prefer the faceless anonymity of the internet. But until now
there was no way of telling which sites were ethically and commercially
sound.
Overseas suppliers are not subject to the same rigorous controls as British
pharmacies, yet it is often impossible to tell where a site is based (web
addresses ending in co.uk can still come from abroad). This year the Trading
Standards Institute (TSI) conducted a survey of online drug suppliers from
countries including Canada, India and Peru, and reported that many were
selling powerful prescription-only medication, bypassing UK law. Of the
pills purchased by the TSI, most arrived without instructions and three out
of five orders contained no details of the manufacturer. An order for ten
Viagra tablets, costing £54, failed to arrive. “It is most inadvisable to
seek to obtain such drugs without proper medical guidance and prescription,”
says the TSI’s Nigel Strick. “They are playing a dangerous game if they do.”
An awareness campaign by the Medicines and Healthcare Products Regulatory
Agency (MHRA), the government authority that oversees the licensing and
supply of medicines in Britain, is also trying to weed out unscrupulous
suppliers. The agency is investigating more than 100 internet-related cases,
including up to 15 in which counterfeiting is alleged, and dozens of others
where the supplier is selling prescription drugs without the necessary
pharmacist’s licence.
Last April an MHRA “internet day of action” led to 27 sites being closed down
by service providers or by enforcement officers who visited their UK
addresses. “We carry out random tests on medicines, including those obtained
online,” says the MHRA’s Stephen Hallworth. “Anyone who self-medicates and
buys from internet sites could be in danger of receiving counterfeit or
substandard medicines. At best counterfeit medicines will be a waste of
money, at worst they can kill.”
This year a 64-year-old woman from Sunderland went blind after taking drugs
that she bought on the internet for four years. Reporting in The Lancet,
Dr Philip Severn and Dr Scott Fraser, consultant ophthalmologists at
Sunderland Eye Infirmary, explained that the woman had selfdiagnosed chronic
fatigue syndrome and, on the advice of a neighbour, bought oral steroids
from an online pharmacy based in Thailand. When she was admitted to the
infirmary complaining of a loss of vision, Severn and Fraser found that she
had cataracts in both eyes and signs of glaucoma — both side-effects of
long-term steroid use. She will need treatment for glaucoma for the rest of
her life. “Buying drugs in this way is a gamble,” says Dr Fraser.
The drive to control a burgeoning and dangerous market has come too late for
others, too. Three years ago 24-year-old Liam Brackell threw himself under a
train after becoming addicted to a cocktail of powerful prescription drugs
that he bought on the internet. A talented musician and maths graduate from
East London, Brackell received up to 300 antidepressant and other tablets in
the post every day, and had tried 23 types of prescription drug by the time
he killed himself. It was later discovered that what he thought were tablets
of codeine — a common painkiller — were in fact counterfeits that had been
cut with morphine.
“If people want to get medicines online, they must be able to do so safely,”
Balmer says. “They should be able to get the same rigorous standard of
service that they expect from their high street pharmacy, and should not be
open to commercial enterprises that put their lives at risk.”
How to shop safely for online medicines
- Until the RPSGB logo is up and running, the easiest way to find a trustworthy
online pharmacy is to make sure that the RPSGB has it listed as a
registered premises (ie, a bricks and mortar pharmacy).
- Enter its name and address, as listed on its site, into www.rpsgblist.org
(click on “registration and support”, then “registration”
and then “search our register”).
- Avoid websites that sell medicines without a prescription, and those with an
“online doctor”. With RPSGB-registered sites, you will be asked for your
prescription before medicines are dispensed.
- Never self-prescribe medicines.
- Avoid sites that are clearly based overseas — there may be no legal comeback
if things go wrong.
