With spam from rogue pharmacies hitting our inboxes every day, Chris Chapman asks how the sector can protect patients while harnessing the potential for legitimate online growth
The one certainty about owning an email account is that, at some point, you’ll be sent an email promising drugs to enlarge your penis – whether or not you have one.
Last month internet giant Google launched charges against online rogue pharmacies, probably sending emails like these, slamming them as bad for “our users, for legitimate online pharmacies and for the entire e-commerce industry”.
And earlier this month the MHRA and UK Border Agency seized £570,000 worth of illicit medicines as part of a global crackdown, raiding premises linked to 12 websites.
The problem isn’t going away, with police currently trying to close down a further 183 websites in the UK. But what does this thriving cyber trade in knock-off medicines mean for community pharmacy, and how can patients know who to trust on the internet?
Online pharmacy is a popular area of expansion for pharmacy retailers, with multiples such as Boots, Lloyds, Rowlands and Asda offering medicines safely and legally. The internet is an area with big potential, and it could provide patients with a convenient new way to access their medicines and deliver care to patients who are housebound or unable to access a pharmacy.
But where there is potential for legal profit, there is also potential for illegal profit and for crime. And Pfizer estimates the value of the European illicit drugs market is around £9 billion.
The problem seems to be a lack of knowledge, says Pfizer medical director David Gillen. Around a quarter of patients in a survey the company conducted in 2009 didn’t consider taking medicines without a prescription to be risky. Dr Gillen says there is a “clear need” for greater public awareness and education. “People are not only unaware of the very real dangers of counterfeit medicines, but also that they’re fuelling an illegal and harmful drug market,” he said.
This lack of education puts patients at risk, exposing them to medicines with no quality control. And it’s bad for the sector, as the counterfeiters are also undermining public trust in pharmacy, creating a bad name for sites that provide appropriate, quality-assured healthcare.
“It’s bad, because this tarnishes all online pharmacy,” says Mitesh Soma, founder of online pharmacy Chemist Direct. “We do show we’re reputable with the green cross [linked to the regulator’s register], our telephone number, and a whole section to show we’re a real business. All of these things help to reinforce [the fact that] there are legitimate businesses out there.”
The General Pharmaceutical Council (GPhC) acknowledges there is “a great deal of confusion” about the regulation of internet pharmacies among the general public. In 2008, the RPSGB took steps to rectify the situation, introducing a non-mandatory logo for sites. However, a recent report by the Nuffield Council on Bioethics said patients were not sufficiently aware of this.
And the GPhC recommends patients should take additional steps to confirm the source of their medicines (see panel above).
But even where patients can distinguish between real and bogus sites, human factors come into play, too. According to the MHRA, the types of drugs counterfeiters thrive on are predominantly lifestyle drugs, such as those for erectile dysfunction and weight loss, or drugs open to abuse, such as pain relief and antidepressants.
“With prescription-only medicines, there are a lot of people who don’t want to get a prescription, because they are embarrassed,” says Kimberley Estenson, of online pharmacy Express Chemist. While this embarrassment exists, it’s going to create a hurdle to purchases and keep people going online. And it also creates a tightrope that pharmacists supplying online must walk.
For example, in May, Boots and Lloydspharmacy faced criticism from the BBC’s Watchdog, which showed an underage customer purchasing Alli at Boots’ online store, and an anorexic customer buying the drug online at Boots and Lloydspharmacy after lying about her BMI. But as Boots points out: “We cannot let the actions of a few individuals prevent the vast majority of customers who need and are entitled to purchase these products from accessing them.”
Pharmacists have a responsibility to put restrictions on purchases, and ask questions to ensure medicines are appropriate. However, the key advantage of online pharmacy is that it is accessible, so making access too difficult can drive consumers to unregulated sites, with no guarantees of the quality, safety or appropriateness of medicines. Checks must be carried out where needed, but not at the expense of making online purchases too restrictive.
The threat of counterfeit medicines and bogus pharmacies isn’t going anywhere – the trade is too lucrative – so trying to end counterfeit medicines online is a tough ask. Instead, perhaps pharmacy needs to use the hard-won relationships it has formed with patients to make sure they understand which sites are safe to use.
Making sure patients embrace the GPhC logo, in the same way that the Kitemark has become a recognised safety standard, could make a huge difference. Only then will pharmacy be able to capitalise on the potential of online pharmacy, and also safeguard patients against dangerous counterfeit medicines.