By Anne Federwisch, OTR
Illustration by Malcolm Garris/PhotoDisc
January 21, 1999

If you can type—and know your credit card number—you can get a prescription for Viagra without ever seeing a physician. All you need is a computer and an Internet connection.

"It’s a little harder than ordering CDs," said Eric Garris of his experience buying prescription medication on the World Wide Web. We asked Garris, who lives in Sunnyvale, Calif., and works on this site, to go online in pursuit of a prescription for Viagra.

Dozens of "medical consultation" Web sites are available that tout an easy, online prescription for drugs, most often Viagra, for as little as $20, plus the cost of the medication. Garris linked to The Medical Center (http://www.medicalcenter.net) through The Pillbox Pharmacy (http://www.thepillbox.com). He was charged $85 for the consultation, which resulted in a prescription, and $105.25 for 10 100 mg Viagra tablets. Had his request been denied, he would not have been charged anything.

All he had to do was answer a couple of questions on an online form, the most prominent feature of which was the section requesting credit card information. He provided information about known allergies, current medications, height, weight, date of birth, and sex. In addition, the form asked: Do you take any medication classified as a nitrate in any form? Garris answered, no. And, Do you have a problem achieving and /or maintaining an erection sufficient for sexual intercourse? Garris answered, yes. He was never contacted to verify his answers.

That’s because falsifying information on the form would be a felony for the consumer, not for the physician or the pharmacist, according to Bill Stallknecht, RPh, co-owner of The Pillbox Pharmacy and The Medical Center. "Patients can always lie," he said. "They can lie in doctors’ offices; they can lie in person; they can lie from afar. It’s a felony to do so."

The Pillbox is not the only online pharmacy with connections to instant prescriptions.

But it’s tough to quantify just how much prescribing is being done via the Internet, said Dale L. Austin, deputy executive vice president of the Federation of State Medical Boards of the United States. "With the advent and availability of Viagra, it’s become much more pronounced a concern," he said. "We believe the public is in danger."

But Stallknecht believes the public is in much greater danger from former prescription medications, such as Pepcid and Tagamet, which are now available over-the-counter.

Garris does not see much difference between online and offline prescribing practices. He was also able to procure a Viagra prescription just by mentioning in a phone conversation with a nurse in his physician’s office that he was having performance problems and would like to try the drug.

Pfizer, manufacturer of Viagra, does not think online prescriptions are a widespread problem. According to the company’s third quarter report released Oct. 13, 1998, a total of 5 million prescriptions were written or the drug in its first six months on the market, making it "the most successful prescription drug ever launched." Pfizer spokesperson Andy McCormick could not estimate how many of those scrips were generated online.

"Our view is that it’s probably more publicity-driven than an actual trend," said McCormick. "We don’t have hard numbers, but we don’t see a large amount of Internet prescribing." However, they do oppose the practice, he said, because underlying causes of erectile dysfunction are "often missed in a faceless consultation over the modem."

But it’s the confidentiality and anonymity inherent in that facelessness that is the draw to online consultations, said Stallknecht. "Famous people don’t want to go to a clinic where they’re going to be recognized and have to admit their problem," he said.

He said that his online operation garners about 30-50 prescriptions a day—only a fraction of his overall business that includes five pharmacies in and around San Antonio, Texas. But he declined to disclose how much money he earned from each Viagra tablet or his online pharmacy.

He said that they only started offering online consultations to remain competitive with other sites that began the practice. Stallknecht said his Internet pharmacy is licensed in Texas and all other states that require it. So far, about a dozen states require out-of-state pharmacies providing services to customers in their state to obtain a license.

Indeed, per regulations, the Pillbox prescription came with all the usual trappings of medication purchased through a conventional outlet, including the typical caveats. The accompanying three-page informational sheet about the contributing causes and therapeutic treatments for male erectile dysfunction warned "All patients should only use Viagra with their local physician’s knowledge and support." And neatly typed at the bottom of the receipt were the address, phone, and fax numbers of the Texas State Board of Pharmacy in case the consumer wanted to file a complaint concerning the practice of pharmacy.