NEWS: AGE 27/5/06 "Caught in the drug web" (Online Pharmacies)

By Carol Nader May 27, 2006

It is not hard for a child to get his hands on a drug that could ruin his life. In this case the boy was 16 and the drug was a sedative, which he bought over the internet. The sedative was supposed to be obtained by prescription only, but that was no impediment for the online pharmacy that sold it to him.

As the boy's doctor, Bernard St George, tells the story, over the next few years the boy would sometimes take up to 20 tablets at a time. One day, he took a bunch of pills and tried to drive but fell asleep. The horrific car accident almost fractured his spine. Eventually the boy had trouble with the police, spent time inside four psychiatric hospitals and lost his relationship with his girlfriend.

"It was like a nuclear bomb in this kid's life," St George says. "I was really incensed by the way this kid's life was going down the tubes, and I couldn't get anyone to help me to stop this flow of drugs to him."

The young man is now in his early 20s, and St George, a private psychiatrist in Sydney whose area of expertise is treating children and adolescents, says his patient has realised the damage the drug has done to his life and has stopped his destructive behaviour.

But the case prompted St George to write an article about it in the Medical Journal of Australia two years ago, warning of the perils of buying drugs on the internet. It's an issue that still angers him. "There are more and more areas where kids are learning to solve their problems with drugs, and if they can't get those drugs from their normal sources they will access them through whatever they can get," he says.

Some turn to the internet because they can't find a doctor who is willing to prescribe the drug they want, in the quantities they want. Others simply like the anonymity. It is much easier to confide in a faceless person in cyberspace about, say, your (or your partner's) erectile problems than it is to have a tete a tete with your local GP.

Online "pharmacies" around the world are fully aware of this, and are capitalising. Most Australian online pharmacies are strictly regulated, and will only sell drugs if the buyer has a prescription. But it is their overseas counterparts, where the regulations are much more lax and sometimes no prescription is necessary, that have doctors and consumer groups here worried.

"There's no confrontation, there's no embarrassment, there's no shame," St George says. "There is an unseen email correspondence with a supposed doctor who then authorises the prescription of whatever drugs you're asking for. They will spam you five times a day about the new drugs that are available in different places. There's absolutely no check and there is no sense of responsibility taken, but the drugs are supplied as long as you have the money."

There are also concerns over the quality of drugs ordered from online pharmacies. "You wouldn't know what it was you were buying if you buy it over the internet," says Health Services Commissioner Beth Wilson. "It could be chalk, it could be mice poo, you just wouldn't know."

With the rise of spam bombarding inboxes, it is not necessary to be particularly internet-savvy to find a website that will sell you a cure - sometimes even before you have decided you have a problem. Diet pills, anti-depressants, antibiotics and even cholesterol-lowering drugs are easy to come by. And for the spammers, there is no better clientele than people who have lost that loving feeling.

One website, for instance, is offering a women's herbal product called "suregasm", to help women achieve "more frequent and more powerful multiple orgasms". Another claims to have helped more than 1 million men "gain inches", and promises to revive the sex life of the most modestly endowed man. "My power and pleasure has tripled," boasts one satisfied customer in one of 22 testimonials piled onto the website. "My wife can hardly keep up." And to help sway the sceptics, another grateful customer has apparently supplied before and after photographic evidence.

Australian Competition and Consumer Commission chairman Graeme Samuel says he cannot believe that people who are clever enough to earn high incomes are foolish enough to squander it on so-called cures. "What we're often bewildered about is the number of people who still fall for these scams," he says. "The health ones are particularly distressing because so often they're preying on people who are suffering and are therefore vulnerable, and they'll often take what's offered to them . . . and they can be lured into paying good money for basically scam remedies and they do so because they're so desperate."

Even if these products do actually work, there are fears they can be dangerous if they clash with other drugs. Doctors are usually careful to ask patients what other medication they are taking so as not to prescribe something that will do the patient more harm than good. But the rise of the internet has made it immeasurably easier for consumers to self-diagnose and self-medicate. When consumers buy their drugs online, doctors are often cut out of the picture and those checks and balances cease to exist. Drug interactions can render a medication ineffective. At worst they can be fatal.

"There are some risks involved because people aren't necessarily carrying out a differential diagnosis on themselves," says Pharmacy Board of Victoria registrar Stephen Marty. "They've got symptoms which they might enter into a search engine and seek information about a condition. The trouble is they are not able to differentiate between that and other conditions, where a medical practitioner is going to examine the alternatives, they're going to take their blood pressure, listen to their heart, their chest, and do any number of diagnostic tests to confirm their opinion."

DIY diagnosis is risky because several conditions can have similar symptoms. For instance, chest pain could mean a heart attack, angina or simply indigestion. Shortness of breath can be symptomatic of anything from asthma to a more serious cardiac condition.

Australian Medical Association president Dr Mukesh Haikerwal agrees there is a risk. "It's probably an unsafe practice to be using medication at whim without a proper prescription for it," he says. "There is a group of people that would prefer to do their own self-diagnosis and use the internet, and the internet is a great information haven, but within that there's some real dark spots of rubbish which is dangerous information."

The internet isn't only being used to buy drugs. Dr Tracey Bessell, a senior research fellow at the Victorian College of Pharmacy, conducted research five years ago that found that many people were turning to the net for health information, usually to confirm what they had been told by their doctor, rather than to self-diagnose. While there is some highly reliable information about medicine on the internet, she says, it is difficult to tell what is good and what is bad. She found that it was very easy to buy prescription medication online, but she believes Australians are more interested in using the internet to buy herbal products. "We certainly found one case where someone was buying diet pills online deliberately to avoid going to the doctor," she says.

It is hard to gauge the extent to which people buy drugs online, because international websites are difficult to track. Adam Biviano, from anti-spam company Trend Micro, says research has shown that 63 per cent of all emails that are created are spam. Commissioner Beth Wilson also believes there must be a market out there, otherwise the marketers wouldn't persist in flogging their products.

Laws relating to drugs are regulated by the Therapeutic Goods Administration. It is unlawful to personally import prescription medicines from another country unaccompanied unless a written authority has been issued by a doctor registered in Australia. A TGA spokeswoman says dispensing a drug without a proper medical examination is "undesirable" and websites that advertise that overseas doctors will prescribe medication online are of concern. But overseas websites are beyond the TGA's jurisdiction.

Spam is also difficult to regulate. Graeme Samuel says that while the ACCC can't deal with the existence of spam, it can deal with its misleading and deceptive nature - at least locally. But the problem is trying to get to the websites that are offshore. "Most often they're outside the jurisdiction of Australia, so it's very difficult for us to deal with it as an Australian regulator," he says. "The best way we can deal with them is to provide advice to consumers, and the best advice is press the delete button."

http://www.theage.com.au/news/in-de.../2006/05/26/1148524885503.html?page=fullpage#

Click to expand...