THE BATTLE OVER imported medicines has a new target: Google, MSN and other major U.S. Web portals that carry ads for sites that peddle drugs from outside the U.S.Drugstore.com Inc., among the biggest of the online pharmacies, is pushing Yahoo Inc., Microsoft Corp.'s MSN, Time Warner Inc.'s America Online, Google Inc. and others to accept ads only from online pharmacies specially certified by state regulators. So far, only 15 pharmacies hold such certification -- including Drugstore.com.
Regulators who oversee drugs and pharmacies are also looking into the portal companies' role, though they have limited authority to clamp down on such advertising. The Food and Drug Administration "will he reaching out to the search engines," says Peter J. Pitts, the FDA's associate commissioner for external relations. The agency, he says, would like to talk with the portals about "how we can work together to stem the tide of these dangerous Internet drug dealers." The FDA says it is almost always illegal for companies to ship drugs from other countries into the U.S., but the practice is common and some lawmakers have voiced support for it.
The National Association of Boards of Pharmacy, which represents state regulators, has sent a letter to Google, offering to help setup guidelines to identify which drug sites are above-board. The group also plans to contact other major search engines and ask them specifically not to accept advertising from sites that offer foreign drugs or sell medicines based on prescriptions generated by online interactions with doctors, says Carmen Catizone, its executive director.
Drugstore.com, Bellevue, Wash., declines to provide details of its plans. But generally, says Peter Neupert, chief executive of the company, there is a "major public health concern" with Web sites that sell drugs to consumers that don't meet U.S. rules. He denies that Drugstore.com's moves are motivated by competition from cut-rate Canadian drug sites, arguing instead that the entire online drug business could suffer if consumers begin believing it isn't safe and regulated.
Drug advertisements from questionable online pharmacies are commonplace throughout the biggest Internet search engines. Searches for phrases such as "Canadian drugs" and "cheap drugs" turn up a variety of "sponsored sites" that promise drugs from outside the U.S. Sponsored sites pay to show up prominently when users type certain keywords into search engines.
Punch in the term "OxyContin" on Microsoft's MSN site, and links to more than a half-dozen "sponsored sites" will appear. One of the top sponsored sites on MSN, Mexicanpharmacyconnection.com, advertises 30 10-milligram pills of OxyContin for $89.99 and claims that customers can quickly obtain a free prescription through the site by filling out a short form. The link for the pharmacy appears next to links from sponsored sites like OxyContin-Detox.com and Detox911.com, which provide information aimed at people with OxyContin addictions.
Mexicanpharmacyconnection.com doesn't provide a phone number or address indicating where it is based. Web address records for Mexicanpharmacyconnection.com say the site is registered to a company in Reforma, Mexico. An e-mail to the company went unanswered.
Similar sponsored sites show up on search engines operated by America Online, Google and Yahoo. On Google, a search for "Vicodin" calls up a handful of links to online pharmacies where the painkiller can be purchased, including FastestRX.com. Calls to FastestRX.com customer support
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line weren't answered. A search for "valium" on AOL also calls up a sponsored link to FastestRX.com, among others. A search for "Vicodin" on Yahoo results in a sponsored link to 24hourmedications.com, a site registered to a company in British Columbia, Canada, according to records.
The state pharmacy regulators group estimates that there are 400 U.S.-based Internet operators selling pharmaceuticals, and that 200 of them offer legitimate domestic drugs, 75 peddle above-board Canadian products, and the rest operate in a gray area. The association says it can't estimate how many foreign-based sites may be offering drugs to U.S. residents.
Andy Troszok, who works for a Canadian pharmacy that has an Internet site at crossborderpharmacy.com and serves as vice president of the Canadian International Pharmacy Association, says his company does some advertising on major Web portals, but losing those ads wouldn't have a major effect. "Our biggest advertisement is word of mouth," he says. "Customers can still find us."
Executives at the Internet search engines differed in their responses to Drugstore's efforts. Larry Page, a co-founder and president of products at Google, called the campaign "highly commercially motivated" because the company is effectively trying to remove ads for low-cost competitors. While Google wants to obey U.S. drug laws, Mr. Page said it may be difficult for the company to determine whether an online pharmacy is based abroad and, even if it can, a Google user conducting a search using drug terms might be based outside the U.S.
"It might be easier for us to say we're not going to accept any pharmacy-related advertising, but that would mean consumers couldn't easily buy things and save money," said Mr. Page. "As a matter of principle, we want to have free choice for consumers ... even if we get some hassles for it."
AOL sees things differently. Andrew Weinstein, a spokesman for AOL, whose search engine and sponsored listings are operated in conjunction with Google, said AOL is "right in line with Drugstore" with regard to drug advertisements from questionable online pharmacies. He said AOL has asked Google not to deliver any sponsored links to AOL's search engine from pharmacies that aren't certified by state regulators, though he concedes that some such links are currently on the site. "We've found some and we're asking Google to take them down right now," said Mr. Weinstein.
Google's Mr. Page couldn't confirm that the company had received AOL's request.
In a statement, Yahoo's Overture division, which runs the company's sponsored links program, said it's currently evaluating a service from another company that will help it "identify legitimate online pharmacy advertisers that are appropriate for Overture's marketplace." While Yahoo has been talking to Drugstore.com about the matter, a company spokeswoman said the search for a method to remove questionable pharmacy advertisers began prior to those discussions.
Lisa Gurry, a group product manager at Microsoft's MSN site, said the company is working with Overture, which supplies sponsored Web sites to MSN, and "others in the industry to ensure any concerns regarding online pharmacies are addressed."
The rules surrounding online pharmacy practices are complicated, with some gray areas. Pharmacies are regulated by states, and must be licensed by the states they are in. They also nearly always must be licensed in other states to which they ship medicines. Doctors' activities are overseen primarily by state medical boards, and in every state but Utah, it's not considered legal for physicians to issue prescriptions to people based solely on an online consultation, said a spokesman for the Federation of State Medical Boards.
While the FDA has said it is nearly always illegal to ship drugs into the U.S. from other countries -- meaning that any overseas online pharmacy is probably outside the law -- some politicians support such sites as a source of cheaper Canadian pharmaceuticals.
To get state regulators' certification, which isn't legally required, companies have to be regularly inspected and observe federal and state laws for pharmacies. That means they can't sell U.S. residents drugs from other countries, including Canada, can only handle drugs if customers provide legitimate prescriptions from their doctors, and must abide by restrictions on addictive drugs such as Vicodin.
Offers for Vicodin and other controlled drugs, as well as imported medicines, are also common in unwanted junk mail, known as "spam." However, spam is a far more difficult problem to control than sponsored links on search engines because of the ease with which spammers can send out millions of messages to users.
© 2003 The Wall Street Journal, Dow Jones & Company