According to a recent study by the Annals of Internal Medicine, high drug prices and low accountability are pervasive on Internet pharmacy sites. The report was slated for the December 1999 issue, but editor Dr. Frank Davidoff felt that the study’s public health implications warranted an early release.
The study was conducted by Drs. Bernard S. Bloom and Ronald C. Iannacone of the University of Pennsylvania in Philadelphia, who reviewed 46 pharmacy portals and Web sites during February and March 1999. The doctors found that Internet drug prices and physician consultations were higher than their offline counterparts. The report also questioned the safety of Internet pharmacies, claiming that nine of the 46 sites studied were outside of the U.S. and required no prescription or consultation with a physician.
Comparison Shopping Online and Off
Bloom and Iannacone compared the cost per pill of sildenafil (Viagra) and finasteride (Propecia) at Internet sites and Philadelphia pharmacies. The average price per sildenafil pill was $5.49 (US$) — plus shipping — on the Internet, compared with an average of $4.50 at Philadelphia pharmacies.
For finasteride, the Internet average was $1.94 (plus shipping) versus $1.83 offline. Shipping costs among U.S. Web sites averaged $18, while shipping ranged from $8 to $25 among Web sites outside of the United States.
The researchers also compared the cost of Internet physician consultations to Medicare and to primary physicians at managed care facilities. On average, online consultations were higher in cost.
The Safety of Online Pharmacies
Bloom and Iannacone also expressed concern about the quality of Internet physician consultations. Only 5 of the 46 sites would reveal the business location for the Web site, and none were willing to disclose the names, addresses, specialties or qualifications of their physicians.
“Nothing is known about the quality of the Internet consulting physicians, their training or the appropriateness of medical services provided,” Bloom and Iannacone said in the report. The researchers also noted that consumers were at risk of inadvertently contravening U.S. or other countries’ laws when ordering prescriptions from Internet sites.
Going the Safe Route
The FDA is also concerned about Internet pharmacies. FDA physician Dr. Jeffrey E. Shuren added an editorial to the article, stating, “Current laws provide safeguards against injuries from unsafe drugs and from improper practice of medicine and pharmacy. Illegitimate Web sites undermine this safety net.”
The FDA suggests that consumers use sites that carry the seal of the National Association of Boards of Pharmacy.