Consumers Ordering New Prescriptions Online Are Asking For Trouble, UB Pharmacy Professor Says

BUFFALO, N.Y. -- When used judiciously, pharmacy Web sites can play an important educational role for consumers, but they never should be used for ordering new prescriptions, according to a professor of pharmacy at the University at Buffalo.

Karl Fiebelkorn, UB clinical assistant professor of pharmacy practice, says legitimate online pharmacies, such as those run by reputable community pharmacies, including Drugstore.com owned by Rite Aid and Soma.com owned by CVS, can be good sources of information for patients on their disease state and their drug therapies. They also can be good sources of referrals to other sites or information sources, such as drug companies, government agencies or patient-help organizations.

"Consumer education is critical to the success of a treatment," says Fiebelkorn, who for 16 years supervised a major community pharmacy. "But, as they say, 'A little bit of knowledge can be dangerous.' That's why it is always important for the patient to see a health professional face-to-face."

Some pharmacy Web sites, Fiebelkorn says, such as those that operate offshore and send to consumers prescription drugs without a prescription, are patently illegal and obviously should be avoided.

Reputable sites can be useful when a consumer is ordering a refill by email and picking it up at a local pharmacy, he says. Moreover, prescribers can email prescriptions directly to a pharmacy to be picked up, so long as the email system is secure.

But even ordering new pharmaceuticals from seemingly reputable sites can pose problems, like those that arise from using mail-order pharmacies.

According to Fiebelkorn, a trained pharmacist can glean quite a lot of information from an in-person conversation with a patient that is just not possible in cyberspace.

"Can you monitor a patient's success with their drug therapy online?" he asks. "Can you check the patient's blood pressure or blood sugar online or over the phone? Of course not. Real pharmacists in community pharmacies can do all these things. We can actually see the skin rash for which the patient is seeking treatment."

Case in point: a few years ago, while Fiebelkorn was working in a community pharmacy, a diabetic patient called to say that, according to her blood-glucose meter, her blood-sugar level was "out of control." Fiebelkorn asked her to come to the pharmacy and bring her glucose meter with her. It turned out she was getting inaccurate readings because the sensors in the meter needed to be cleaned.

In another instance, Fiebelkorn recalls, a patient told him she was using her inhaler more times during the day than was recommended and that she was having her medication refilled (through a mail-order pharmacy) about twice as often as is usually necessary. When Fiebelkorn asked her to show him how she used her inhaler, he saw at once that she was using it incorrectly, and he showed her how to use it properly.

It's also important for a pharmacist to be able to observe a patient's body language because it provides insight into a patient's mindset and whether something is bothering him or her.

"And what if the patient isn't telling you everything?" he asks. "Online, you can't know whether or not the patient is telling you all the facts."

For example, he describes a hypothetical patient who wants a prescription for Viagra. That patient could state in an email message to an online pharmacy that he weighs 150 pounds and is in perfect health, when in fact he is extremely overweight and has a heart condition, which normally would be contraindications for the drug. But in the online environment, the prescribing pharmacist would never know.

In addition, he says, there is no way for online pharmacies to comply fully with state regulations that require patients to receive detailed information about the drugs they are receiving.

"In New York State, for example, how would an online pharmacy counsel you?" he asks. "By sending you an email or putting you in a chat room?"

Confidentiality also is an issue, he adds. "Someone with AIDS or asthma, for example, may not want other people, like their employers, to know about their disease. But email is not secure. And with an online pharmacy, you don't know who the Webmaster is, and what they will do with that information."

Just last semester, a UB pharmacy student doing his internship in a community pharmacy saved a woman's life because he correctly suspected that the bad headache she described was actually a subarachnoid hemorrhage. Instead of selling her a bottle of painkiller, he insisted that she go to the doctor right away; she was admitted to a hospital, where she was treated.

"There are dozens of these examples," says Fiebelkorn, "and any pharmacist could give you similar accounts. But each of them did it only when they interacted with the patient. Face-to-face."