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Rapid Responses: Rapid Responses published:
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Accredited Online Pharmacies
- Brett Clark (10 July 2008)
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EAASM Report: Where's the disclosure?
- Krista Osmundson (16 July 2008)
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Brett Clark, Pharmacist - Managing Director Brisbane 4014, Australia
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I read your article with great interest being a pharmacist who has owned and operated traditional pharmacies over the past 18 years , as well as an online pharmacy for the past 8 years. Your findings do not surprise me and I agree with your comments with regards to the role of search engines to try and control these rogue operators. A comment I would like to make centres around the number of these studies / surveys performed over the years based on the "bad operators". I feel there does need to be more research into what does constitute "best practice" for online pharmacies. Having developed extensive back end IT operations based on both efficient and effective delivery of pharmaceuticals to consumers coupled with access and delivery of optimal professional counselling and care, I am fully aware of the difficulties and intricacies involved with getting the balance right. In addition, being one of the original accredited online pharmacies with the Pharmacy Guild of Australia's QCPP program for internet and distance dispensing, I have to confess it has not delivered the credibility one would have anticipated. Only when we can identify what constitutes Best Practice for online pharmcies, can the medical industry look to better regulate. The key to this is practitioner involvement opposed to just academic . Kind Regards Brett Clark
Competing interests: MD of an online pharmacy in Australia |
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Krista Osmundson, University of California, Berkeley School of Law, J.D. Candidate Berkeley, CA
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The prevalence of substandard medicines is a problem that places lives at risk. Unrestricted access to poor quality drugs via the Internet is particularly alarming. The recent study by the European Alliance for Access to Safe Medicines (EAASM) shows a significant number of online- purchased drugs are “substandard or counterfeit.” (1) While this study raises awareness of a critical issue, the report itself is problematic. It blurs the distinctions between counterfeit and substandard medicines, and does not reveal the full extent of the EAASM’s pharmaceutical industry sponsorship. The full EAASM report appropriately relies on the WHO definition of counterfeit, but in grouping counterfeit, substandard, and unapproved generic medicines into one startling statistic, the study is potentially misleading as to the actual danger of internet purchases. (2) Substandard medicines are products whose “composition and ingredients do not meet the correct scientific specifications and are consequently ineffective and often dangerous to patients”. (3) A counterfeit drug, on the other hand, is “deliberately and fraudulently mislabeled with respect to identity and/or source”. (4) Lastly, EAASM defined an unapproved generic as “manufactured by a company that does not have permission from the original developer”. (5) These distinctions are important. The latter does not imply a public health risk. Obscuring the difference could play into fears that all non-branded drugs are unsafe. With some difficulty, I investigated the EAASM’s funding sources using the organization’s website and those of its affiliates. Six of its nine funding partners are major pharmaceutical companies (Bayer HealthCare, Boehringer Ingelheim, Lilly, Pfizer, Wyeth and Johnson and Johnson). They produce twelve of the eighteen drugs investigated in the EAASM study. The three other funding partners also have strong ties to the pharma industry. Ahura Scientific, for example, profits from the sales of devices that identify “counterfeit” medicine. Its products were used by researchers and credited in the EAASM study. (6) Mayor describes the EAASM as “an independent, cross sector organization.” While she states three of its board members are drug industry representatives and that the drug industry contributes to funding its work, this does not reveal the extent of the pharmaceutical industry’s financial support. Undisclosed pharmaceutical connections with patient advocacy groups can be a problem. (7) Readers should be clearly informed of pharmaceutical industry support, especially in reports that will influence their purchasing behaviour. Should authors of reports of this type be required to fully disclose any conflict of interest, as required for publications in peer-reviewed journals? (1) Mayor, S. More than half of drugs sold online are fake or substandard. BMJ 2008;337:a618 (2 July.) (2) European Alliance for Access to Safe Medicines. The Counterfeiting Superhighway. 2008. http://www.eaasm.eu/Media_Centre/News/The_Counterfeiting_Superhighway (3) World Health Organization. Standard and counterfeit medicines fact sheet. 2003. http://www.who.int/mediacentre/factsheets/2003/fs275/en/ (4) Id. (5) EAASM. Counterfeit Superhighway. (6) Id. (7) Wibulpolprasert S, Moosa S, Satyanarayana K, Samarage S, Tangcharoensathien V. WHO’s web-based public hearings: hijacked by pharma? The Lancet 2007; 370: 9601:1754 (24 November.) Competing interests: None declared |
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