information on contraindications, they were often
incomplete.
Bessel et al [7] surveyed I nternet websites selling
medicines online, and found that a variety of
malpractices like selling prescription-only medicines
without one were rampant.
Legal/Regulatory Issues
E-commerce is virtually a regulation free
envir onment.
Legal issues have been raised by Harrington [8] ,
Stanberry[9] and Weis emann [ 1 0] . The legal issues
from a pharmacist’s perspective are that he/she may
be charged for unlicensed practice and may have
problems in taking legal action for reimbursement.
From the consumer perspective, he/she is likely to
have problems with quality assurance and consumer
reprisal, due to the fact that liability issues are
closely related to licensing and legal reach, which
often is not possible in cross-border practice. Such
legal issues have been recently addressed. [11 ]
There are also legal issues arising from the
differences in law within countries or regions. For
example, in Europe, companies are prevented from
advertising drugs to customers [ 12] , and are
permitted in the United States.
From a regulatory standpoint, several issues have
been raised. It is also interesting to note that several
approaches are underway to address these issues-
like regulation[ 13] and trust-marking. [14]
Ethical I ssues
Ethical conduct ensuring privacy and confidentiality
of the patient is one of the cornerstones of medical
pr actice. Selling drugs over the I nter net obviously
necessitates the collection and use of confidential
medical information. I n an anarchic world over the
I nternet, nobody can be sure of what happens to this
information. [ 15] Moreover, the security of electronic
transactions is difficult to assess. Electronic
environments inevitably carry significant non-zero
probabilities of large information losses once a
security br each has occur r ed. [ 1 6] Cas es of Cyber-
pharmacies not keeping privacy and confidentiality
promises have also been r epor ted. [17] Other issues
like Trust have also been raised. Studies reveal that
trust in drug information from traditional media
sources such as television and newspapers transfers
to the domain of the I nternet[ 18], leading to
utilization of the I nternet for information search after
exposure to prescription drug advertising.
Quality concerns
Concerns over the quality of drugs sold over the
I nternet have been raised. [19] It is often difficult to
objectively analyse the quality of online services. In
a study analysing the websites selling medicines over
the I nternet[7] , some websites appeared to s upply
prescription-only medicines with no prescription.
T hey concluded that only a minority of e-pharmacies
displayed quality accr editation seals . They also
observed information published on e-pharmacy web
sites that potentially undermines the safe and
appropriate use of medicines .
Moreover , concerns on the professional s tandar d
have also been raised. [8]
T here have also been cas es [17] where cyber
pharmacies indulged in malpractice, claiming
infrastructure that they never had.
Figure 1
Screenshot from a website that sells a
herbal product claiming "Medically
Proven Results", but does not furnish
any agreeable evidence to prove their
claims.