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Buyers flock to lax online pharmacies

Net stores that don't require prescriptions draw the most visitors

Bought any discount drugs on an Internet site without a prescription from your doctor? Join the crowd.

Of an estimated 17.4 million visits to all online drugstores in the fourth quarter of 2004, 63 percent, or 10.9 million, were visits to sites that either require no prescription or offer a doctor's ''remote consultation" before a prescription is written, according to an analysis of browsing patterns by comScore Networks Inc., a Reston, Va., firm that tracks consumer patterns on the Web.

That is 36 percent higher than visits to those types of Internet pharmacies in the previous quarter, the firm said. The growth is most likely a result of heavy on-line advertising and e-mail spam, said Carolina Petrini, vice president at comScore.

Rules governing online or telephone consulting by physicians vary state-to-state. The practice of prescribing without a physical examination does not violate federal law as long as sites do not dispense narcotics and other controlled substances, such as Vicodin, Valium, and OxyContin.

The American Medical Association and the Food and Drug Administration have said doctors who issue prescriptions without personally examining a patient are engaging in substandard care. The FDA has strongly recommended that consumers not order drugs from such sites, because consumers have few ways of knowing how much care is taken during online examinations, and because the sites often list no address or telephone number to avoid law enforcement.

''You have no idea where these guys are or how to get back to them," said Thomas McGinnis, the FDA's director of pharmacy affairs.

But those warnings do not seem to bother millions of Americans who are shopping for medications from their homes.

''There's a certain level of risk these visitors are willing to take in exchange for a discount," said Petrini of comScore. Petrini added that analysts at her firm suspect that some sites claiming to offer e-mail consultations with a doctor actually do nothing of the kind.

''We don't know whether that doctor really exists behind the scenes," she said. ''I'm sure in some cases it doesn't."

Overall, the firm's survey found a fast-growing marketplace of at least 3,000 different Internet pharmacy sites. ''It's a volatile market where pharmacies come in and go off the radar screen," Petrini said.

Of the 15 most popular sites, the top six require that patients get their own prescriptions and mail or fax them to the site.

The most-visited sites are based in Canada, canadapharmacy.com and legalmedsonline.com, according to the survey. Legalmedsonline is not actually a pharmacy site, but a site that links consumers to other Web pharmacies for a $37.95 fee, according to a woman who answered the customer service line but declined to give her full name.

Ranked third, fourth, fifth, and sixth, in the comScore survey are drugstore.com, Walmart.com, Walgreens.com, and Express-Scripts.com, all based in the United States, the survey said.

After that are listed a handful of Internet sites with little or no information identifying their location, and some offering remote consultations with doctors.

The seventh-ranked site, with 627,000 visits in the fourth quarter last year, Pillstore.com, is typical of how the sites work. Patients must fill out an online questionnaire and ''communicates with the physician using our secure online communications system."

The Pillstore.com website prominently displays low prices for sex-enhancing drugs like Levitra and Viagra, and Ultram, a pain reliever. It also lists weight loss drugs and appetite suppressants, sleep aids, baldness treatments, birth control pills, and allergy drugs. The online questionnaire requires a patient to provide age, sex, height, and weight. It asks a number of questions, including what other drugs the patient may be taking. It is not clear from the site how a doctor would know if a patient were telling the truth in any of the responses, or how a patient would know a legitimate doctor is reviewing the forms. There is no telephone number listed on the site, and an e-mailed inquiry about the company from the Globe did not receive a response.

''Price is driving it," said Ronald Buzzeo, chief regulatory officer at Dendrite International Inc., a consulting firm whose services include Internet surveillance and investigations for clients in the US pharmaceutical industry. ''Some consumers are not differentiating between what may be reputable or could not be reputable."

Gabriel Levitt, vice president for PharmacyChecker.com, a free website that offers links and safety analysis for Internet pharmacies based in Canada and elsewhere, said there has been a proliferation in the last year of ''remote consultation" sites.

''Generally these pharmacies are not as safe as pharmacies that require your original prescription," said Levitt. ''Some are based in the United States, some are not. Even the FDA can't keep tabs on how many are foreign and how many are domestic. It's not an easy number to come by when you're dealing with the World Wide Web."

Christopher Rowland can be reached at crowland@globe.com.

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