Italian study shines a light on online pharmacy practices

Online pharmacies routinely adopt marketing strategies that emphasise the convenience of buying medicines online while playing down the nature and risks of the products they sell, according to Italian researchers.

The team from the University of Brescia also found that almost 80 per cent of 175 online pharmacies surveyed did not ask for a prescription even for prescription-only medicines. Among these, 60 per cent asked for the patient to input a simple questionnaire in order to secure the products, while 40 per cent did not ask for any type of medical information.

The researchers also identified the four most frequently offered drugs as sildenafil for erectile dysfunction, the antidepressant fluoxetine, opioid painkiller tramadol and antidepressant amitryptiline.

The study also revealed some interesting differences between online pharmacies which required a prescription from those that did not.

For instance, almost 90 per cent of the pharmacies requiring a prescription identified their location, but this fell to just 24 per cent among those which did not require one, according to the researches, who have published their findings in the journal Pharmacoepidemiology and Drug Safety (DOI: 10.1002/pds).

Online pharmacies which did not ask for prescriptions were three times more likely to offer to supply products in plain wrapping, and were more likely to use selling arguments based on drug quality and low pricing and offer discounts on bundles including additional medicines.

Conversely, those requiring a prescription tended to emphasise short delivery times, free shipping and online order checking.

Prior research has shown that dispatch of goods only occurs in about half of orders placed with online pharmacies.

The analysis revealed that both online pharmacy groups stressed lower prices compared to 'bricks and mortar' pharmacies, and offered incentives for patients to buy more medicines to secure a lower unit price.

There was little difference between the two in reporting the side effects of drugs - worryingly in about third of online pharmacies there was no mention at all of the potential side effects associated with the four most popular drugs sold.

The authors note that the online pharmacies use emotion-based tactics similar to other online retail outlets, such as Amazon, which are inappropriate in the context of medicines.

"Emotions can distract from critical thinking [and] our research shows that online pharmacies' argumentation plays on the knowledge of this," they write.

Another interesting result was the longevity of the websites. Fully 75 per cent of sites identified by the team in an early sweep in 2007 were still operational two years later, pointing to a lack of effect by enforcement and regulatory agencies in driving illegal operators out of business.

On the positive side though, there was something of an endorsement of the use of various accreditation logos, such as the US National Association of Board of Pharmacy's VIPPS scheme.

The pharmacies insisting on a prescription "were almost exclusively the only ones displaying the code-of-conduct quality markers," they note.