US Pharm. 2006;2:3.

Not only was Truth or Consequences a popular 1950s television game show (and a town in New Mexico ), it has become an ongoing real-life event of the 21st century. What I am talking about is the ability for individuals to order drugs from the Internet. It is now painfully clear that many of the sites that tout low-cost prescription drugs are not telling the truth about where or how these drugs are manufactured. American citizens are paying the life-threatening consequences by taking subpotent or superpotent drugs--or worse yet--what amounts to a placebo, with no active ingredient at all. Despite widespread efforts by government agencies, pharmaceutical companies, and wholesalers to thwart the shipment of counterfeit and diverted drugs into the United States , these products arguably continue to flow into this country unabated. According to USA Today, the U.S. is not the only country dealing with this problem; "counterfeiting, theft and diversion of prescription medications jumped 16% worldwide last year, and the United States topped the list of countries with reported problems."

Last November, customs agents intercepted more than 50 shipments of counterfeit Tamiflu, the drug being stockpiled for a possible flu pandemic. The FDA reported that the drugs contained none of Tamiflu's active ingredient; instead, the fake capsules contained some vitamin C and not much else. An FDA investigation a month later uncovered a significant percentage of drugs shipped from Internet sites purporting to be Canadian pharmacies that were not located in Canada at all. Furthermore, the FDA revealed that 85% of these faux Canadian drugs actually came from 27 different countries, and nearly a third were counterfeit.

And yet, despite all this publicity, patients continue to play Russian roulette with their lives by ordering drugs from phony noncertified Internet pharmacy sites, lured by low prices and falsehoods regarding the products' potency and/or country of origin. While I have no hard data identifying who those patients are, it is not unreasonable to assume they likely are U.S. citizens struggling to make ends meet to be able to afford their prescription medication. One would hope that the newly launched Medicare Part D prescription program would alleviate this problem, but I am holding out little hope that Medicare Part D, with its modest savings and confusing regulations, will stem the tide of ordering drugs over the Internet.

Throughout history, retail pharmacists have unfortunately been on the front lines of defending the price of prescription drugs, despite their own decreasing profits and struggles to keep their heads above the rising tide of profit-eating third-party prescriptions. It's bad enough that pharmacists have to answer consumers' complaints about increased multi-tier copayments; they should not have to be bombarded by Internet drug pricing as well. It is imperative that pharmacists clearly communicate to their patients the dangers of purchasing drugs online. It is also vitally important that consumers have a clear understanding of the professional value their pharmacists can offer in ensuring the purity of the drugs they dispense.

There is no question that this country needs to do more to stop the influx of counterfeit drugs and eliminate the development of fake Internet sites that advertise them, but that task is daunting, if not impossible. The pharmaceutical community needs to continue its aggressive attack on illegal Internet sites that sell prescription drugs. The next time a patient comes into your pharmacy comparing prices of the drugs you dispense to those of drugs being sold on the Internet, remind them that they should not play the game of Truth or Consequences when it comes to their health.

Harold E. Cohen, R. Ph.
Editor-in-Chief

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