The Internet is rapidly transforming the systems of acquisition and sale of goods. In the case of the pharmaceutical channel, the electronic commerce of medicines through the Internet raises a series of ethical, legal and economic questions of great importance not only for the pharmacy office itself, but also for the drug distribution chain. This paper analyzes the current situation of electronic commerce of medicines in Europe and the United States.

According to the European Commission, electronic commerce is understood as the way to carry out any usual commercial operation using exclusively electronic means. The National Institute of Statistics (INE) defines it as “any form of transaction or exchange of commercial information based on the transmission of data on communication networks of the Internet type”. The World Trade Organization (WTO), in section 1.3 of its work program on electronic commerce, adopted by its General Council on September 25, 1998, defines it as “the production, distribution, marketing, sale or delivery of goods and services by electronic means ».

Experts believe that in the future 75% of medicines will be sold through the Internet

The electronic commerce of medicines was already done for years between laboratories and pharmaceutical distribution companies through EDI (electronic data interchange) protocols, but this system was very rigid and had many restrictions of use, being necessary to establish pre-agreements Among the companies. It required detailed standardization of computer and management systems, as well as the use of expensive special networks. In addition, it was strictly bilateral and closed, which prevented uses such as “electronic auctions” today so used among companies.

The emergence of the Internet has suppressed all these rigidities and has enabled the appearance of electronic commerce with final consumers, as there are two types of electronic commerce: B2B ( business to business, or electronic commerce between companies), and B2C ( business to consumers, or electronic commerce with the final consumer). It is from the latter that we will deal with here.

The electronic commerce of B2C medicines exists worldwide, legally or illegally. Given the health risks that this trade is causing, and given the repercussions it has for the agents of national health systems, many governments try to control it – with little success so far – so the idea is gaining ground to authorize it by regulating it. The major problem is that since this is a worldwide phenomenon, national laws are not very effective, requiring measures of the same character, very difficult to adopt and enforce.

The situation in the United States

At the head of this trade is the United States, mainly due to the absence of a national health system that, in general, protects its population, along with the price that Americans must pay for medicines, much higher than the paid by citizens of other countries. This causes many citizens of the United States to be forced to pay large amounts for the doctor’s consultation and the purchase of the prescribed medications, and to go online to virtual consultations and pharmacies online as a means of saving healthcare costs. The prices that are obtained in the network are approximately 30% lower than in the pharmacies.

The online market for medicines increases progressively and is often accompanied by online medical consultations. Experts believe that in the future 75% of the medicines will be sold through the Internet. This has caused health companies to have invested large amounts to adapt to the network.

The drug distributors, led by the Merck-Medco company, have acquired a large part of the market due to the knowledge of the environment and the availability of distribution logistics beforehand.

Despite this, the Food and Drug Administration (FDA), aware of the serious health and fraud problems that are being created, has started a fight, at the federal and state level, against the fraudulent sale of medicines through the so-called rogue sites on the Internet, supported by three very powerful organizations in the North American pharmaceutical sector, such as: the National Association of Boards of Pharmacy (NABP), which represents the interests of the pharmaceutical industry; the Federation of State Medical Boards and the National Association of Attorney General .

The best clients of virtual pharmacies are those to whom the purchase involves some kind of psychological, moral or physical discomfort

Measurements

Among the measures put in place by the FDA against the illegal trade of medicines on the Internet are the following:

Campaigns warning the population about the risks of acquiring certain medications via the Internet without having a doctor.

Clues to distrust fraudulent websites. For example, you should be wary of those that offer over-the-counter medications, when required, or drugs not approved by the FDA; of those who do not record any certification of the VIPPS or do not offer information from specialists who pass consultation; of those who tell undocumented stories of fabulous cures; of those who use high-sounding language, obscure terminology, who disguise the lack of scientific knowledge, or of those who accuse the government or the medical profession of pretending to suspend the sale of certain medications; of those who are not registered in Yahoo, Altavista or Lycos search engines as virtual pharmacies or online pharmacies; of those who do not have a telephone or postal address, and of those who offer medicines that have not been approved in the country from which they are sold (listed on www.nabp.net).

Information to consumers

The FDA has also opened an information page to users at www.fda.gov/oc/buyonline, as well as an email address for consumers to report virtual pharmacies that create illegal (webcomplaint@ora.fda. gov).

The VIPPS ( verified Internet pharmacy practice sites ) of the National Association of Boards of Pharmacy (www.nabp.net) is a non-profit organization that provides a certificate to online pharmacies, after verifying that they meet the 17 requirements required 1. These include the control and verification of the identity of the patient and the doctor who signs the prescription, as well as the confidentiality and education of the patient about the use of the drug and its side effects. Likewise, a personal visit to the website and your pharmacy is made to verify the conditions. The VIPPS seal was voluntary, but it is currently mandatory for any virtual, national or foreign pharmacy that wants to sell its products in the United States, Puerto Rico and New Zealand.

At the end of 1999, the United States Congress approved an initiative to protect consumers from fraudulent drug sales online. The initiative aims to fulfill four basic premises:

The establishment of new federal requirements for companies on the Internet, which ensure compliance with federal and state laws.

The creation and approval of fines for illegal sale of pharmaceutical products.

The provision to federal agencies of authority to conduct relevant investigations and to prosecute criminals.

The launch of a citizen information campaign that warns of the dangers of buying drugs without a prescription online.

The General Council of COF of Spain estimates that the network offers about 22,000 different medications

Commercial ethics

The Internet Healthcare Coalition has presented an ethical code for drug sales companies that contains eight basic principles, among which are the quality of information, data privacy, consent to commercial transactions and the professionalism of the equipment that They work in these companies .For its part, the American Accreditation Healthcare Commission intends to form an advisory committee that develops regulations to regulate and control the accreditation of the different web sites dedicated to health issues. This committee would be formed by representatives of organizations that have already developed some type of ethical code and quality controls of the different electronic addresses, such as Internet Healthcare Coalition, Hi Ethics or American Medical Association.

WHO, in its document Medical products and the Internet. A guide to finding reliable information (1999), recommends the consultation of Internet Healthcare Coalition (www.ihc.net) and Health on the Foundation (www.hon.ch) to know if a web page related to health or medications It is reliable.

The FDA also encourages denouncing fraudulent or unscrupulous companies, to which, as a first step, the US agency sends emails ( cyberletters ) 2 warning them that they cannot continue selling certain products in the United States, at the risk of take legal action against them. Recently, the FDA published that it has sent electronic warning letters to 45 web suppliers of medicines over the Internet. At the end of last year the FDA announced that it had taken legal action against several companies, installed in Florida, for selling a suspected anticancer called Laetrile (vitamin B 17or tonsillin), derived from apricot kernels. The FDA is particularly concerned with the so-called party drugs, which sell vitamin supplements and designer drugs online and have already caused a good number of deaths among American teenagers. The most dangerous products are GBL (gammabutyrolactone), GBH (gammahydroxybutyric acid) and BD (butanediol), which are related to 122 serious health side effects.

Together with the cybercards, the FDA sends to the operators on the web the law that governs the drug trade in the United States: the Federal Law on Food, Drugs and Cosmetic Products. If you are looking to do your own pharmacy business and want to buy bulk medicines, you can get in touch with the best pharmaceutical exporters.