Pubdate: Thu, 02 Jul 1998
Source: San Francisco Chronicle
Contact:  http://www.sfgate.com/chronicle/
Author: Carl T. Hall, Chronicle Science Writer

PEDDLING VIAGRA ONLINE

You Can Get Hot New Drug, And Others, On The Net - Without Ever Seen A Doctor

Viagra and the Internet appear to be ushering in a new brand of high-tech
drug abuse.

Authorities in California and Colorado said yesterday that they are
beginning investigations of an online pharmacy operation, Performance Drugs
Inc., which has been supplying Viagra and other medicines through the Web
without traditional prescriptions.

The investigations were prompted in part by inquiries from a Chronicle
reporter, who had ordered 10 tablets of Viagra, the wildly popular new
anti-impotence pill, and 10 doses of ``Stimula,'' a purported ``female
erectile cream,'' through the Web site.

Performance Drugs is just one of a growing crop of Web-based pill mills
exploiting the phenomenal demand for Pfizer Inc.'s impotence remedy. A
record 2.5 million Viagra prescriptions have been filled since the drug was
approved by the U.S. Food and Drug Administration.

Pfizer has issued statements decrying loose prescribing of Viagra -- a
potentially dangerous medicine linked to 174 reports of side effects and 31
deaths, although it's not clear whether the drug itself or underlying
health problems were to blame.

However, the New York-based pharmaceutical giant conceded that it has
done nothing to stop questionable sales through the Internet. Nor has the
company been systematically monitoring the Internet.

A company spokeswoman said Internet sales appear to be legal in many
states, ``so there's not much we can do about it.''

State regulators said anyone, including the manufacturer, could prompt an
investigation simply by filing a complaint.

The pills received by The Chronicle appear to be genuine -- blue-colored,
oblong tablets stamped with Pfizer's logo. The newspaper is having the
pills tested for authenticity.

To get them, the reporter was only required to fill out a short ``medical
history'' online through an easy-to-find, well-promoted Web site. Besides
agreeing to a $99.50 charge on a credit card, he also agreed to pay a $50
``physician review charge'' for first-time customers.

The form did not ask whether the reporter was suffering from impotence --
the only condition for which the Food and Drug Administration has approved
Viagra. He did not even have to reveal his age or gender. No doctor or
pharmacist contacted him.

Since The Chronicle submitted its order, the online form has been revised,
and customers must now provide more detailed information.

Calls to Performance Drugs were answered by Mike Takano, who identified
himself as president of Alliance Marketing in Seattle, which he said has a
partnership with Performance Drugs to handle the phone calls and other
business generated by the Web site.

He said the drug company was founded by a Colorado physician, Dr. Benjamin
Taylor Johnson. Johnson, 31, is a 1994 graduate of Creighton University in
Nebraska who practices at a clinic in Denver called the Center for Body
Enhancement. Records of the Colorado medical board indicate that Johnson
has a valid license to practice in that state and has no record of
disciplinary action against him.

Bad Practice

Johnson's name appeared on the drug packaging received by The Chronicle as
the prescribing doctor. He did not return repeated telephone calls this
week.

Physicians and regulators said it is bad practice, and possibly illegal,
for a doctor to order prescription drugs for patients he has never met or
examined. Nor does Johnson have a license to prescribe medicine to someone
in San Francisco, according to a record check by the Medical Board of
California.

``It is absolutely not legal unless there's a good-faith examination by a
doctor licensed to practice medicine in California,'' said Doug Laue,
deputy director of the state board.

Susan Miller, program administrator of the Colorado Board of Medical
Examiners, said, ``The board may have problems with what he is doing and
certainly we will be investigating that.'' Regulators said the willy-nilly
sale of Viagra and other prescription drugs over the Web is a growing
problem.

``We have this on our radar screen,'' said Carmen Catizone, executive
director of the National Association of Boards of Pharmacy, which is
developing a ``seal of approval'' for Web sites that follow what are
considered sound guidelines.

It `Won't Pass Muster'

``It's against the law to dispense a prescription drug to someone without a
legitimate prescription,'' he said, adding that filling prescriptions based
only on Web questionnaires, without any semblance of a patient-physician
relationship, clearly will not pass muster.

One Web site in Wisconsin jumped on the Viagra bandwagon soon after the
drug was approved but promptly closed under pressure from state medical
authorities. Another site with a sponsor based in Arizona also has
apparently come and gone. In California, however, officials said they had
not looked into the matter until questioned this week by The Chronicle.

State telemedicine statutes and other provisions traditionally allow
physicians to conduct business over the phone or by fax, as long as they
exercise sound judgment and act in good faith.

Few doctors consider it good judgment to fill a telephone prescription
requested by someone they have not physically examined before.

Issuing Viagra prescriptions to total strangers, even if they fill out
detailed forms on the Internet, ``is not a good idea,'' said Dr. Tom Lue, a
nationally known urologist on the faculty of the University of California
at San Francisco.

Although Viagra is by far the main attraction, Web sites also are
advertising baldness treatments, female ``sexual enhancement'' creams and
other drugs that usually cannot be purchased legally without a prescription.

`Worldwide Access'

Performance Drugs, one of the more visible Viagra-peddlers on the Internet,
has made no secret of the business. The company even issued a press release
in May advertising ``worldwide access'' to Viagra, even though the drug has
been approved only in a few countries outside the United States so far.
Takano said the service is extremely popular with customers all over the
country. He declined to offer details other than saying that the Web
service has received no complaints. As for the legalities, Takano said the
Web service employs plenty of lawyers to make sure no laws are broken.
Still, he added, ``this kind of falls into the frontier; it's in uncharted
waters.'' ``There are no real statutes for or against it,'' he said. ``We
meet with doctors. We pay doctors quite a bit of money to review
prescriptions. The doctors can reject every order if they want. We're
relying on the physician's judgment.''

The Chronicle's Viagra-Stimula order was shipped by U.S. mail from
Pencol-Medisave Pharmacy, which listed a Denver address.

A man who answered a telephone request for an interview at the pharmacy
identified himself as Marshall Tobin. He initially refused to answer any
questions, and he ended the conversation shortly after a reporter declined
to grant him anonymity.

`The Wrong Thing To Do'

``I know I'm not in any jeopardy,'' Tobin said, claiming that he did not
know all the details about the Web supply operation when the Chronicle
reporter's order was filled.

But he then added that he has since stopped filling such orders. ``It was
the wrong thing to do,'' he said.

Viagra still appears to be safe and effective when used as intended,
according to the FDA. The most serious known side effects have been listed
on the drug label since it was approved.

One known risk is the strain that sexual activity could have on newly
potent men in poor health. The drug can trigger potentially fatal drops in
blood pressure in heart patients taking nitrate drugs -- an increasingly
common problem in emergency rooms.

It's also potentially dangerous to combine Viagra with the inhaled
recreational nitrates known as ``poppers.'' But part of the demand for the
drug, doctors say, is in recreational use by men who are not impotent but
seek to enhance their sexual prowess, even though the drug evidently does
nothing for men who have no problems achieving erections. The pill also is
being tested by the manufacturer as a sexual aid for women.

Health authorities said the Viagra traffic on the Internet opens the
possibility that the drug will fall into the hands of children or people
refused prescriptions by their doctors, presumably for fear of side effects.

`Bad Medicine'

``We are very concerned about this,'' said Dr. James Winn, executive vice
president of the Federation of State Medical Boards, a Texas-based
organization that advises state physician-licensing agencies across the
country. ``This is bad medicine.'' Winn's organization issued a memorandum
last week warning state medical boards about the Performance Drugs Web site.

The operation is ``technically not illegal,'' the memo stated, but ``does
raise flags about the quality of medicine being practiced by physicians who
have agreed to write prescriptions for the individuals placing orders.''

Ubiquitous gossip about what the medication might do for normally
functioning men -- or perhaps even women -- has prompted phenomenal demand
for the pills, even at $9 or more a pop.

In some Bay Area neighborhoods, the pills can be had on the street with
little more difficulty than copping a bag of marijuana.

``It's true,'' said one San Francisco police investigator, confirming that
Viagra is being passed around in some bars for $20 or $30 a pill.

Merely A Misdemeanor

But local authorities noted that it's merely a misdemeanor to possess
prescription medications without a prescription. A felony could be charged
if large quantities are involved, but successful prosecution would require
showing intent to sell the drug -- and that's not easy to do.

Nor can the Food and Drug Administration step in. The agency has no
authority over how pharmacies and physicians use an approved drug.

Dr. Stuart Nightingale, associate FDA commissioner for health affairs, said
some Web sites may be treading on dangerous legal ground, however, citing
at least two past instances of a provider being shut down by state and
local authorities.

The FDA has joined in a global effort through the World Health Organization
to reach effective cross-border agreements to monitor pharmaceutical
marketing in the online era.

Officials in several countries hope to reach agreements for a cooperative
program that would force pill mills out of business wherever they might
arise.

The world health group has even adopted a resolution against unlicensed
cross-border sales of prescription drugs, although the Pharmaceutical
Research and Manufacturers of America, a Washington trade group, said WHO
lacks authority to deal effectively with the problem.

HOW THE CHRONICLE ORDERED VIAGRA ON THE INTERNET

1. June 15: Customer makes quick internet search for ``Viagra'' and finds
Performance Drugs Inc. one of several sites that fills orders for drugs
online.

2. Customer completes a short order form and agrees to pay:

- -- $99.50 for 10 Viagra tablets

- -- $20 for 10 doses of ``Stimula'' for women

- -- $50 ``physician review '' change

3. Form is transmitted instantly to Seattle to the company's telemarketing
partner

4. Form is transmitted to Denver, where physicans and Performance Drug Inc.
co-founder Dr. Ben Johnson decides soley on the information found on the
form whether to prescribe the drug.

5. The presciption order is sent to Pencol-Medisave Pharmacy in Denver,
where the order is filled.

6. Prescription arrives in San Francisco by regular mail.

1998 San Francisco Chronicle Page A1

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