Synopsis: Consumers who purchase medicines online for convenience and price are taking a big risk–experts say 97% of online “pharmacies” are rogue sites operating illegally. Often the medications they sell are counterfeit or substandard. Experts discuss the risks and how consumers can buy safely.

Host: Reed Pence. Guests: Carmen Catizone, Executive Director, National Associate of Boards of Pharmacy; Libby Baney, Executive Director, Alliance for Safe Online Pharmacies; Dr. Roger Bate, scholar, American Enterprise Institute and author, Phake: The Deadly World of Falsified and Substandard Medicines

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Online pharmacies, Fake drugs

Reed Pence: It seems as if almost everyone shops on the Internet. Last year, online retail sales in the United States totaled more than 300-billion dollars, according to the U.S. Commerce Department. And every year for the last five years, online sales have increased around fifteen percent from the year before. But buying some things on the Internet can be extremely risky. For example, if you’re shopping for medications online.

Carmen Catizone: our review of websites, which is a daily occurrence, it involves over 10,000 websites, shows us that 96% of the websites that are accessible by people on the internet are actually rogue or illegal sites.

Pence: Carmen Catizone is Executive Director Of The National Association Of Boards Of Pharmacy.

Catizone: We classify the pharmacies we look at as rogue or illegal based upon some very basic but important criteria. One is if they’re in violation of federal and state laws, and we look at some of the more significant federal and state laws which include dispensing drugs without a prescription, using non-FDA approved drugs, or failing to provide information about that site that would help identify that it’s a legitimate site, and that a pharmacist is actually involved in the site. We then look at the other components of it as whether or not they’re following certain standards that are important for consumer protection, such as do they have the right privacy systems in place to safe guard the patient information as well as any of the credit card or financial information that’s being provided? And do they allow and provide for access to a pharmacist or health care professional should an emergency occur, or should something happen with those medications.

Libby Baney: One in six Americans have purchased medicine online without a prescription. So,  people are really putting themselves at risk when they’re buying online. Trying to find, basically, a needle in the hay stack– that 3% of legal, and that can be awfully hard to do because there are sophisticated websites that are designed to dupe patients into buying medicines that are counterfeit or sub-standard.

Pence: That’s  Libby Baney, Executive Director Of The Alliance For Safe Online Pharmacies.

Baney: Most people are totally unaware that this is a problem. And when I say 97% of internet drug sellers are illegal, peoples jaws drop. How can that be, look I can do a quick search and find so many that are willing to sell me medicine. And look, it looks like it’s from Canada, and it looks safe, and it says it’s shipping from the U.S. Ninetyseven percent of those websites are operating illegally.  They’re not compliant. It is really easy to fake logos online. It’s really easy to copy and paste a Canadian flag. It’s really easy to say you’re operating from California, when you’re really operating from the (unintelligible) shipping drugs from Turkey that were manufactured in China. The internet is an amazing source of commerce and convenience, but there is also the hidden factor of you can be anonymous, or you could just flat out lie about what’s going on, and it’s very hard for consumers to check. And even sophisticated consumers who say “well, gosh, I’m gonna double check on my just call this number and ask where are you located.” They’re not, again, they’re criminals. They’re not gonna tell you the truth.

Dr. Roger Bate: The vast majority of websites that sell pharmaceuticals are not really pharmacies at all. In fact, some of them are owned by the Russian mafia some of them are there to steal your identity and sell you fake medicine.

Pence: Dr. Roger Bate is a scholar at the American Enterprise Institute and author of the book, Phake: The Deadly World of Falsified and Substandard Medicines.

Bate: The vast majority of the fake medicines or substandard medicines just simply won’t work either because they’ve been manufactured poorly or because counterfeiters have copied the appearance of a legitimate medicine, but not put any of the right active ingredients in it. So, their aim is not to kill you, but it’s not to cure your disease or condition.

Catizone: The primary problem with the counterfeit drugs that are coming from these sites are generally that the active ingredient is either too little or too much, which would be extremely dangerous for a patient. What we’ve also seen after that is the fact that it may not have any active ingredient whatsoever, or that the filler products that are used to constitute the tablet or capsule are dangerous substances. We’ve seen lead paint, we’ve seen the products concrete, we’ve seen rat poison. All these very dangerous products are going into these counterfeit drugs just so that they can sell them and make a profit.

Pence: People buy medications on the Internet for a lot of the same reasons they buy anything online. It’s easy and convenient, and often cheaper than buying from a brick and mortar store. But there’s one additional factor that online pharmacies capitalize on. Many people buying medications on the Internet don’t have a prescription from their doctor.

Baney: They don’t really want sometimes to go to the doctor and talk about this embarrassing medical condition, or one that they know they’ve had for a long time, chronic conditions as an example. If you have chronic allergies, like my sister did. She knew what she needed. She didn’t need to continue to see the doctor, of course in her case she had. Some people who have diabetes, or high blood pressure, or some other more embarrassing conditions they may not want to share, they’re more eager to self diagnose, or just buy online because they know what they need, and don’t feel that they need to benefit from the doctor-patient relationship.

Pence: The World Health Organization estimates that half of the medications sold over the Internet are counterfeit. Catizone says the tally is as much as 80 percent fake from some countries. And like with Bane’s sister, fake medications create treatment nightmares because everyone assumes they’re getting the real thing. Sometimes, Bate says, it can result in death.

Bate: You may be taking a medicine for, I suppose the classic would be a statin. Most people are taking statin to control cholesterol, and if you took statin month after month, and it had no effect, your cholesterol wouldn’t be as controlled as well, and you are more likely to have an incident –potentially a heart attack. And the reason this is so pernicious is that if you were to have a heart attack, no one would write, and die from it, no one would write on your death certificate “died from fake medicine.” They’d say “died from myocardial infraction,” and so the real culprit is often never found.

Pence: Other times, when a counterfeit drug doesn’t work, your doctor may increase the dose, and increase it again. Then if you get your next refill from your local pharmacy instead of online and take the real medication at that high dose, it can result in an overdose. All while you’re assuming you got a perfectly good medicine from a website in Canada, where most rogue sites claim they’re based.

Catizone: What the sites that are operating on the internet like to do, they like to capitalize on that safety factor that people associate with Canadian sites and so they’ll put a maple leaf on or put some other markings on their website to indicate that they’re from Canada when actually these products are coming from China, India or Russia, all over the world and everywhere but Canada. And people don’t take the time to research that, or cant find out where they’re coming from and therefore they’re exposing themselves again to some significant risk.

Bate: The countries most implicated are Russia, China. China because they produce most of the fake medicine in the world and Russia because the mafia there has clued into the fact that they can make a lot of money from this, and are not likely to get caught because it’s very difficult to even identify the owners of shell companies in other countries, let alone get extradition from somewhere like Russia or China, which you’re never gonna get, to the United States to prosecute them. So, when we did our sampling, we bought from a website that was allegedly Canadian, the drugs were sent from China, and the money at our first port of call–we couldn’t trace it further than that, was into a Panamanian bank. I mean, that’s just one example of the global scale that some of these crime syndicates will operate under.

Pence: Back in June, Interpol led a global crackdown on online pharmacies, seizing shipments and warning operators to shut down. Baney says that kind of international cooperation is difficult to pull off.

Baney: Tracing the operators and the affiliates that are working with those operators is really difficult. And even when you do trace them, then you have the added problem with having to have international law enforcement involved. So, you do have to have cooperation. Again, I was just at a conference this afternoon, talking with a number of stakeholders including international government, U.S. government officials, about the importance of international cooperation. Because to take out a criminal in Turkey, you’ve got to have Turkish government involved, you’ve gotta have international police involved, someone from Europol or Interpol involved, as well as, you know, FDA that may have identified the crime or other law enforcement officials. It takes global effort, and it takes everybody to be focused on it to take these Internet criminals down.

Catizone: And trying to deal with that outside the U.S. is a primary issue and very difficult to do. The second is, the minute we identify a site or identify a webpage, they take it down change that webpage and create a new one, so that its very difficult to try and track them down and try and stop them because they have a number of resources to just keep creating new pages and sites.

Pence: But if 97 percent of those sites are illegal or rogue sites that means three percent of websites are good. It is possible to reliably get medications on the Internet. But how do you find the proverbial needle in a haystack? Bate says first of all, follow some basic rules.

Bate: All of the good credential sites will demand a prescription, so it is a very good tell tale sign if a website is not asking for a prescription then they are not one of the ones to be bought from. The second thing is you should be able to have a physical address associated with that pharmacy; you should be able to speak to someone. The times that I have bought from these pharmacies whenever we’ve checked up on things, I have called to speak to people, and often you can never speak to anybody, that’s another dead giveaway.

Pence: But that’s not enough. Baney says it’s a good idea to check the site you’re considering on one of a couple of resources.

Baney: One is the National Association Of Boards Of Pharmacy, you can just Google or search NABP VIPPS you’ll find a list of approximately 32 gold standard pharmacies that have been approved by NABP, that’s the Good Housekeeping Seal of Approval for internet pharmacy activity. And then another way is if you’re just doing internet search, you stumble across a website like, or, you know, or whatever the website might be and you think, gosh, I cant tell if this is legitimate or not I just don’t know you can go and you can just plug in that URL. So, you can type in and it will come back with a yes or no. Is it legitimate or is it not.

Pence: One more tool has just been added to help people reassure themselves about a website. It’s a brand new web domain, dot-pharmacy. Websites have to be vetted as legitimate before they can use that domain.

Baney: Dotpharmacy is run by the National Association of Boards of Pharmacy which is a U.S. and international pharmacy regulator, and they’re an observer of the alliance for safe pharmacies and these partner lists of NABP over the years on various initiatives. And this one in patricular, there is a global community of stake holders who are involved in supporting the dot pharmacy initiative, because internationally this has really powerful ramifications for patient safety. Because dotpharmacy just like dotcom exist everywhere in the world that the internet exists. So patients in Europe, patients in Asia, Latin America, anywhere patients are looking for medicine, they can look for a legitimate, compliant seller on the dotpharmacy domain, which I think is breakthrough for patients. You can look right to the dot and buy from the dotpharmacy domain.

Pence: so even though the proportion of illegal websites is high, there are ways to protect yourself. You can find all of those crosschecking websites on our site, You can also find archives of our programs there, as well as on iTunes and Stitcher. I’m Reed Pence.


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