The researchers bought the decongestant Sudafed and the alternative antidepressant St. John's wort from online pharmacies and found most failed to provide basic information about the products. Prices also varied widely, as did the time it took orders to arrive. And hardly any of the pharmacies flagged a potentially dangerous drug interaction.
"We were surprised about the lack of advice that was available and by the number of Web sites that didn't offer information about the products that they were selling," says Tracey Bessell, a researcher at Monash University in Victoria.
From July-August 2001, Bessell and her colleagues examined 104 online pharmacies from several countries, including the United States. According to the researchers, this is the first report to look at non-prescription offerings by online drugstores. Their findings appear in the April issue of Quality and Safety in Health Care, a publication of the British Medical Journal.
Fewer than half of the Internet pharmacies provided information about drugs, and much of what they did offer was poor, the researchers found.
Only 13 of 25 pharmacies offering information about Sudafed (pseudoephedrine hydrochloride) warned visitors about the risks of taking it. And of 27 online pharmacies that sent Sudafed or St. John's wort to the researchers, only two included information sheets.
Information about drugs should be clearly available to Web site visitors, says Michael Coyne, an associate vice president and director of pharmacology at Staten Island University Hospital in New York City. "A customer could decide not to read it, but it should be there," he says.
As part of their study, the researchers invented a customer who was already taking the antidepressant Prozac and wanted to buy St. John's wort, which is typically used to treat depression. Some doctors warn that taking the two together may lead to serious side effects.
Twenty-seven of the pharmacies agreed to sell St. John's wort, but only three asked questions and responded by warning the customer about the possible interaction.
"The take-home message is that the quality of the service is highly variable, and that if you're going to buy medicines over the Internet from pharmacies, they should offer not only the product but information and advice," Bessell says.
The study didn't say if any of the online pharmacies studied had been certified as licensed by pharmaceutical organizations. The National Association of Boards of Pharmacy, which offers such certifications, did not respond to a request for comment.
Michael Montagne, a professor at the Massachusetts College of Pharmacy, says the results aren't surprising considering that the prescription drug services offered by online pharmacies have problems of their own. "There are some systems and standards in place, but they're all voluntary," he notes.
He acknowledges that traditional brick-and-mortar pharmacies may have missed the interaction between Prozac and St. John's wort because the latter doesn't require a prescription. However, pharmacists at drug stores are more likely than those at online pharmacies to keep track of a customer's medical history and catch potential interactions, he says.
Even so, patients must ask questions, he says: "Consumers don't have a chance unless they are proactive."