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Researchers test on-line drug services

TORONTO – After watching their e-mail boxes become inundated with spam from companies offering mail-order pharmaceuticals, a group of Toronto-based researchers decided to see whether the products would actually arrive if ordered. The answer was yes, and no.

Out of 27 different products ordered, only nine arrived – a 33% success rate. On the bright side, they were only billed for the ones that were shipped.

Alejandro Jadad, a professor of medicine at the University of Toronto and a founder of the Centre for Global eHealth Innovation at Toronto’s University Health Network, along with research fellow Peter Gernburd, were able to purchase products that claimed to be brand-name erectile dysfunction medications, anti-anxiety drugs and obesity supplements.

The centre is now having the substances tested by a lab to see if what was advertised was actually delivered – the right drug, in the right dose, and the purity of the product.

“These could be fake,” Jadad told CBC News. “These could be real. These could be adulterated. We don’t know,” Jadad said of the products he and Gernburd managed to purchase. “So, it’s ‘User beware’, big time here.”

Jadad warned the on-line drug business is a shady one. An address used to purchase medication one week can be a dead-end the next, leaving buyers with no recourse if the drugs turn out to be bogus or past their expiry date.

“The message really is not, ‘Oh, you’re going to get it.’ The message is you’re going to get things from places that you don’t know, that are not responsible, that disappear, and that are breaking the law. So be very careful.”

Jadad’s study was recently published in the journal “Public Library of Science Medicine”.

For its part, Health Canada pointed to cautions posted on the department’s website, where the public is warned that people put their health at serious risk when they buy drugs online.

“You have no way of knowing where these companies are located, where they get their drugs, what is in their drugs, or how to reach them if there is a problem,” the department says in a fact sheet posted on its website.

“If you order from these sites, you may get counterfeit drugs with no active ingredients, drugs with the wrong ingredients, drugs with dangerous additives, or drugs past their expiry date. Even if these drugs do not harm you directly or immediately, your condition may get worse without effective treatment.”

Jadad was inspired to explore the business of spam-generated drug sales because of the volume of the unwanted e-mail he was getting himself.

A check of the medical literature produced little on the subject. So he and Gernburd set up three e-mail accounts and monitored the number and types of spam messages they received.

In one month – November 2006 – the accounts received 4,153 messages that qualified as spam, 82 percent of the total e-mail traffic. Health-related spam made up 32 percent of the total.

As far as the researchers could tell, most was from abroad – the United States, China and the Democratic Republic of Congo. Only 58 percent of the active links in the spam e-mails were still viable a week later and only a quarter of the links still worked at the end of the month.

Jadad’s wife had secured a special credit card with a low credit limit and Jadad and Gernburd tried to order 27 items using it.

Only nine orders went through. Five were for prescription drugs (erectile dysfunction drugs and anti-anxiety medications) and four were for natural health products (weight management and penile enlargement).

The only charges made against the credit card were for items that were actually delivered, Jadad said. But whether the products are the real thing remains to be seen.

He wouldn’t say if the drugs were expired or more expensive than they would have been in a local pharmacy, saying that analysis will be in a future installment of this work.

While some might worry that this study would actually give people confidence they can buy drugs from spammers, Jadad said it’s important to know what’s going on in this netherworld, because people clearly are accessing prescription drugs this way.

“The fact at the end of the day is ... there are enough people who are willing to look at those messages and consider the products and make an order. And that is what keeps this going,” said Jadad.

“If people didn’t respond, we wouldn’t have spam. And the fact that spam is growing so much is a reflection of the fact that the spammers are making a lot of money out of it.”