Author: Gunther Eysenbach
Position: Senior Scientist
Institution: Centre for Global eHealth Innovation
E-mail: geysenba@uhnres.utoronto.ca
Submitted Date: September 18, 2007
Published Date: September 19, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In their analysis of cyberpharmacies, the authors "forgot" to cite another earlier study (perhaps the first study in this field, conducted in March 1999) where prescription medicines were ordered from Internet sources and tested [1].

In this pioneering study, the World Wide Web was searched for companies who offer to issue prescriptions for Viagra online or sell Viagra without prescription. We pretended to be a patient in which the ordered drug (Viagra) is clearly contraindicated, and tried to obtain an online prescription for this drug on the Internet. We ordered a total of 66 pills from 10 companies.

Despite clear contraindications in the medical history of the alleged purchaser, three companies delivered within 6, 10, and 34 days respectively. One company sent an email warning to discontinue all other 5 medications when taking Viagra. A photocopy of the original Pfizer package insert was enclosed in 1 case, in all other cases incomplete package information was provided. Chemical analysis confirmed that all pills were original Pfizer products.

Two companies declined to deliver because of import restrictions, 1 declined to deliver without giving specific reasons, 3 declined to deliver because the drug is not approved for women (2 of them however claimed that they "know of the benefits for women"), and 1 did not deliver "because the doctor was concerned about your heart conditions and the medication you are on."

Other than in the PLoS Medicine study we found evidence for credit card fraud: Two of the companies which did not deliver nevertheless charged the credit card. The name of the consulting doctor was revealed in only 2 cases.

Reference

1. Eysenbach G. Online Prescribing of Sildanefil (Viagra) on the World Wide Web. J Med Internet Res 1999;1(2):e10. Freely available (OPEN ACCESS) at http://www.jmir.org/1999/.... doi:10.2196/jmir.1.2.e10