The New Straits Times, April 9, 2000
By Prof Dzulkifli Abdul Razak
"Hair loss? Try Minoxidil and Finasteride (Propecia). Erection problems? Try Viagra, Yohimbine and Trazodone. Aging skin? Try Retin-A and AHA creams. Poor memory, I.Q.? Try Piracetam, Hydergine and Vinpocetine. Hormone replacement? Check out testosterone & Premarin."
"We guarantee to send your order discreetly packed, without any reference to the contents on the outside of the packet."
Such are the claims of an online company selling drugs that was recently closed down by the US authorities. The company even had a Web page on "customs problems", which told consumers what to do if an order was seized.
As in the US, e-health is slowly becoming a reality in Malaysia. Health services, products and information are being "dotcom-ed" locally in anticipation of the much touted e-commerce.
E-commerce is easy, cheaper, convenient - three main reasons why it is fast gaining popularity especially for patients who are disabled, who live far from traditional pharmacies or simply are too sick to go out.
While the Internet is a welcome development, it nevertheless gives rise to a number of concerns when it comes to healthcare as most products, for example, pharmaceuticals, are not ordinary consumer items. Internet users can be duped into buying something that are unsafe or incompatible to their needs.
According to the Commissioner of the US Customs Service, many of these Internet outlets, namely "pharmacies", are fly-by-night operations set up with little regard for patient safety.
Indeed, one of the key drawbacks identified in ordering online is the possibility that a site does not offer access to registered health professionals at all.
[An interim report issued recently by the Board of Trustees of the American Medical Association, estimated that at least 400 "instant prescription" websites exist, which usually require the buyer to acknowledge a liability waiver, select a quantity of the drug to be purchased, and complete a short on-line questionnaire. The report noted that issue drugs without prescription “falls well below a minimum standard of medical care.]
In at least 10 US state legislatures doctors who have prescribed in this way are being investigated, among them a Seattle doctor reportedly earning US $5000 (RM 19,000) a month from on-line sales of sildenafil (Viagra).
Clearly, unscrupulous professonals and sellers are threatening the public health.
A US Senate committee was told of a "test" operation, where a minor, acting under the direction of the Kansas Attorney General's Consumer Protection Division, was able to buy the diet drug sibutramine (Meridia) and sildenafil (Viagra) by filling out an on-line application, using his true age, 16, and his mother's credit card.
Recently. the US Customs Service joined Thai authorities to raid online pharmacies based in Thailand, said to be a major overseas source of powerful steroids, tranquilizers and other drugs that can be bought in the United States only with a prescription (Poison Control, NST, Apr. 2).
The joint Thai actions are the latest effort by the United States to deal with the explosive growth of electronic commerce in prescription drugs.
As Health Minister Datuk Chua Jui Meng noted recently in launching a new healthcare website, "current national and international legislations covering electronic commerce were insufficient to protect consumers".
While he urged "the pharmaceutical industry to uphold their code of ethics", (NST, Mar. 28) the FDA felt that any private effort towards this end does not go far enough because it is voluntary.
There must not only be a set quality standards of practice for e-health, but it it must also be enforceable.
Among the legislative proposal aimed at cracking down on illegal sales of prescription drugs over the Internet, is the call for Internet outlets and pharmacies to post on their sites information about their ownership, state licensor, name of the pharmacist in charge and a phone number where consumers can contact the pharmacist.
For the first time in the US, all Web sites that dispense medicine will be regulated and certified by the Federal Government.
Federal fines of as much as US$500,000 for Websites that sell drugs without first obtaining a valid prescription from the online buyer have been suggested.
The FDA will start verifying the quality of hundreds of online companies that have sprung up over the years, allowing consumers to fill prescriptions without going to a traditional drugstore.
It will be given the powers to investigate sites that are suspected of operating fraudulently. As part of that process, states or independent entities would inspect each site to, among other things, make sure that it had a state license and to monitor the pharmacists and physicians who work for the site.
Malaysia being a new player in this area has ample opportunities to learn from the experiences of others in protecting the health interest of the public while it keenly usher in the new IT era, e-health in particular.
It must harness this new industry that is allowing consumers to obtain medicine in a convenient new manner but could exposure the lay consumer to potential harm through unscrupulous operators.
It must make the investment in acquiring the staff and technology necessary to help root out illegal online sales. Only then can the public reap the full benefit of e-health.
