Buying Sildenafil Citrate (Viagra®) Online: Are prospective buyers informed of Contraindications?

Vinod Scaria
Intern, Calicut Medical College

Address for Correspondence:Dr Vinod Scaria, Perumcheril,33/4711,Malaparamba,Calicut 673009,Kerala,India.
E-Mail: vinodscaria@yahoo.co.in  

Abstract:

Background: Sildenafil citrate (Viagra®) is one of the most advertised drugs on the Internet. A number of websites offer to sell the drug to potential consumers. Little is known about the consumer information these websites offer potential consumers. This study assesses the extent to which these websites provide information regarding contraindications to this drug.
Material and Methods: The World Wide Web was searched using Copernic Agent 6.01 and the first 100 top scoring URLs were analysed. Only cyber pharmacies that actually sold the drug were analysed.
Main outcome Measures: Assess the information regarding contraindications for taking the drug as provided at the websites
Results: 43 websites were identified and analysed, out of which 32 websites provided information that the drug was contraindicated in people taking Nitrates, while only 7 provided information that it was contraindicated in women and 6 websites provided information that the drug was not to be used in children. Out of the websites that provided information that taking Nitrates was a contraindication, 8 websites provided vital information that 'poppers' contained nitrates.
Conclusions: Though most of the websites provided information on contraindications, the information was often incomplete.

Keywords: Internet, Drug, Commerce, Quality of Health Care,


Introduction:

The booming e-commerce has made available a large number of Prescription and Non-prescription based drugs available Online.Sildenafil Citrate (Viagra®) is one of the most advertised drugs on the Internet[1]. There have not been any studies assessing the information these cyber pharmacies offer prospective buyers, though there have been studies reported on the unethical conduct of Cyberpharmacies [1-3]. This study is aimed at assessing the extent to which information is provided to prospective customers who visit the website before actually buying the drug.

Material and Methods:

In March 2003, we searched the web using Copernic Agent Basic Version 6.01[4], which searched 17 search engines simultaneously. The search was conducted using the term "Viagra" setting the maximum results per search engine as 300. The first one hundred Uniform Resource Locators (URLs) sorted according to the relevance score were visited and the number of websites actually selling Viagra through their websites were analysed. The information was compared with that offered by the company that manufactured the drug [5] and at the FDA website [6].

Aims:To assess the information provided to prospective buyers, regarding the contraindications of the drug by Cyber pharmacies selling Viagra® Online. The pages were analysed for information regarding three contraindications: People taking Nitrates, Women and Children.

Results:

We retrieved information regarding 1180 top ranking URLs.

Of the one hundred URLs, we could visit only 83 websites. The websites provided only links to other cyber pharmacies, without actually selling the drug on their website and they were excluded from the analysis. Dead links were revisited after a week and still inaccessible URLs were excluded from the study .We retrieved a total of 43 websites that actually sold the drug on their websites. The URLs which entirely redirected to another website automatically [doorway URLs] were analysed as if it was the original website and the score was applied to that website. 

Four websites gave no consumer information while one provided information by linking to the FDA website[6] and the Pfizer website [5].

32 websites provided information that the drug was contraindicated in people taking Nitrates, while only 7 provided information that it was contraindicated in women and 6 websites provided information that the drug was not to be used in children. Two websites that did not mention that the drug was contraindicated stated information on trials in women.

Out of the websites that provided information that taking Nitrates was a contraindication, 8 websites provided vital information that 'poppers' contained nitrates.

Discussion:

The main outcome of this study is the finding that though most of the Cyber pharmacies provided consumer information, the information provided was often incomplete. The study rightly substantiates the need to be cautious while buying drugs over the Internet [8],[9].

The poor quality of consumer information is often reflected in the fact that most websites, which sell the drug, have no motive other than create profit. A great proportion of websites that offered links only, meaning they were affiliates of bigger websites. These websites operate as doorway websites attracting traffic to the larger providers, in-turn generating income through the affiliate commissions. The ethical perspectives of Cyberpharmacies have been reviewed in detail and further evidence based strategies to curb the menace have been discussed [9]. We hope this report would attract considerable interest and resources in this direction.


References:
[1] Peterson AM. A survey of selected Internet pharmacies in the United States. J Am Pharm Assoc (Wash) 2001 Mar-Apr;41(2):205-12

[2] Bonakdar RA. Herbal cancer cures on the Web: noncompliance with The Dietary Supplement Health and Education Act. Fam Med 2002 Jul-Aug;34(7):522-7 

[3] Bessell TL, Silagy CA, Anderson JN, Hiller JE, Sansom LN. Quality of global e-pharmacies: can we safeguard consumers? Eur J Clin Pharmacol 2002 Dec;58(9):567-72

[4]Copernic Agent version 6.01 downloaded from URL http://www.copernic.com on March 01 2003

[5]Viagra.Com website URL: http://www.viagra.com/consumer/general/commonQuestions.asp Accessed on April 03 2003

[6] Viagra Information on the Federal Drug Administration [FDA] website: http://www.fda.gov/cder/consumerinfo/druginfo/Viagra.htm [Accessed April 03,2003]

[7] Eysenbach G. Online Prescribing of Sildanefil (Viagra®) on the World Wide Web. Journal of Medical Internet Research 1999;1(2):e10 URL: http://www.jmir.org/1999/2/e10/ 

[8] Medical products and the Internet A guide to finding reliable information World Health Organization Geneva Document WHO/EDM/QSM/99.4 1999 URL: http://www.who.int/medicines/library/qsm/
who-edm-qsm-99-4/medicines-oninternet-guide.html Accessed on April 03 2003

[9] Scaria V. Cyber-pharmacies and emerging concerns on marketing drugs Online. Online J Health Allied Scs. 2003;2:1 URL: www.ojhas.org/issue6/2003-2-1.htm 


List of Abbreviations Used:
URLs: Uniform resource Locators
FDA: Federal Drug Administration, United States.

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