Call it a sick joke but pharmacies are like Ralph Lauren shops. A few years ago, they were mushrooming in every town and village. They are now closing down as fast due to a lack of pharmacists. Every pharmacy must have a qualified chemist on site.

The Pharmacy Board wants to ensure that everyone who walks into a pharmacy has proper advice. It is backed by chemists who are annoyed that sales assistants wearing white coats are giving potentially dangerous advice to customers everyday.

The equation is simpler for the public: if a pharmacy closes down, there will still be another one down the road. Then again, you could stay home and order your medication on the Internet. Online drugstores are the pharmacy owners? ultimate nightmare. Despite some controversies, they are booming in the United States and Europe.

An e-pharmacy offers the same services as your local chemist: advice, prescription drugs, over-the-counter medicines, beauty products and a host of health-related items. However, you view the descriptions and images of the product instead of feeling it, you have to buy online with a credit or debit card and you have to wait for delivery.

These differences encouraged cynics to discard the e-pharmacy concept at the very beginning. If you have a headache, you demand an immediate cure, but if you have a medical condition and need a regular supply of drugs, you will search for a better deal. Online pharmacies have carved out a niche market by offering lower prices with the added bonus of discretion.

The low-cost strategy has been successful. By buying direct and in bulk from manufacturers and cutting out all middlemen and commissions, online drugstores keep their prices to a minimum. Their operating costs are lower than conventional pharmacies as they don?t have to employ large staff or rent high street premises.

The Royal Pharmaceutical Society (RPS) has licensed only two online pharmacies in Britain: Pharmacy2U, which pioneered the industry in 2000, and Allcures.com. When prescriptions or medicines are bought online, the orders are checked by a qualified pharmacist before being delivered to the customer?s door.

Amazon.com may have acquired 40% of Drugstore.com, one of the big e-pharmacies in the US, but selling drugs over the net is not as simple as selling books and CDs. In the UK, for example, the RPS code of ethics forbids the use of ?third party carriers? for medicines in an attempt to ensure that drugs are not stolen, and that patients are always properly informed about treatment regimes and possible problems. However, express courier services are routinely used for international orders.

Undermining safety

This year, US online pharmacies are expected to cash in $ 25 billion - a fifth of the total prescription market. The Food and Drug Administration monitors the US e-pharmacies but companies operating in Canada and elsewhere are swamping the market.

In February, Pfizer decided to cut off supplies to Canadian online pharmacies. It said the decision was designed to protect the safety of patients and the integrity of the pharmaceutical supply system. Critics argue the move was intended to influence profits since prescription drugs are up to 50 percent less expensive in Canada, which has government price controls.

Last week, the United States and Switzerland joined forces to curb the rise in illegal sales of prescription drugs on the Internet. Both are major players in healthcare, the world?s largest industry, and hence have interests to protect. The pharmaceutical lobby is also very powerful in the US Congress. However, there is a worrying trend behind the development of e-pharmacies.

?We observed information published on e-pharmacy web sites that potentially undermines the safe and appropriate use of medicines,? admitted a team of researchers from Australia?s Monash University.

Their study revealed that cyberpharmacies operated in at least 13 countries though the country of origin could not be identified for 22 web sites. Twenty web sites (19%) appeared to supply prescription-only medicines with no prescription required. Only 12% of e-pharmacies displayed quality accreditation seals.

While a handful of online drugstores are approved by regulatory bodies and operate according to strict codes of ethics, most are rogue websites with the sole aim of making a quick buck.

?No prescription? No doctor? No problem!? boast some websites. Rogue medical sites even write up prescriptions without having assessed the patient and provide anyone with a credit card a supply of hard medication (such as Prozac, Valium or Viagra) and even ship out of date drugs.

Online pharmacies can offer convenience and savings, but people who buy drugs on the Information Highway can easily also be taken for a ride -and endanger their health.

Controlling Internet pharmacies is a complicated task, because they are operating all over the world and they can and do relocate their business when a particular country strengthens its legislation and law enforcement. However, many believe consumer education is the way forward as it would empower patients in choosing the proper e-pharmacies and boot the rogue sites out of business. And it should start with the doctor.

E-pharmacy is to play a part in the British government?s National Heath Service plan. Doctors will be expected to send prescriptions by email to pharmacists, where customers can pick them up or have the medicines sent to their homes. But patients have every right to take prescriptions to the cheapest pharmacy on the net.

Traditional pharmacies do not have such a good reputation either. According to undercover research by the Consumers? Association, four in ten British pharmacies give unsatisfactory medical advice.

?If researchers? symptoms during this test had been real, they could now be taking drugs inappropriate for their symptoms, or suffering with untreated serious infections or even an unplanned pregnancy,? the association said.

At the moment, only a handful of Mauritians order their medication online. The main factor that would encourage more people to forget their local and go global would be quicker delivery of medicines and a leaner postage and packing bill attached to it.

Then again, the e-pharmacy concept is so simple that it could be introduced locally. The government, which is keen to be seen as promoting any initiative involving keyboards, will have to cut down on the red tape.

This appears as sugarcoated to the patients but may be too bitter a pill to swallow for pharmacy owners.

Ryan Coopamah

Outlook correspondent in London

E-mail: [email protected]