INTERNET PRESCRIPTION SALES RAISE QUESTIONS FOR DOCTORS, DRUGGISTS

WASHINGTON -- Dr. Leandro Pasos, 68, was struggling to make a living when,
about a year ago, an unusual advertisement in a Seattle newspaper caught
his eye. Doctors with active licenses, the ad said, could earn up to
$10,000 a month doing "fully automated online medical reviews."

The ad was placed by Performance Drugs Inc., a fledging company that had
set up shop on the Internet to market Viagra, the diamond-shaped blue pill
that offers millions of men the hope of better sex through chemistry. The
company had lined up pharmacies in Miami and Las Vegas to ship the pills to
patients. But it needed doctors to write the prescriptions.

As an orthopedic surgeon, Pasos specialized in ailments of the bones and
joints, not impotence. Still, he signed up with Performance Drugs. For a
salary of $5,000 a month, he agreed to review questionnaires submitted
electronically by prospective Viagra patients, authorizing prescriptions as
he saw fit. As he later explained to investigators, "I needed a job."

Thus did Pasos join the ranks of a growing breed of physicians:
cyberdoctors. His patients were strangers to him; his examinations took
place in the facelessness of cyberspace. That got Pasos into trouble with
the Washington Medical Quality Assurance Commission, which in May cited him
for unprofessional conduct for prescribing drugs to people he had not
physically examined, and fined him $500.

Although Pasos declined to be interviewed and his lawyer said no patients
had been harmed, the officials who put an end to his online prescribing
career like to think his case will serve as a warning. Yet their efforts
have barely been noticed in the flourishing electronic drug market, a new
brand of commerce that is raising questions of medical ethics and law.

In cyberspace, pharmacies are shipping pills across state lines without the
requisite licenses. Doctors are writing prescriptions for people they have
never met, a practice the American Medical Association says is unethical,
but not illegal. And nobody -- not Congress, not the American Medical
Association, not various federal and state agencies -- knows quite how to
stop it.

"It is strictly the Wild West of drug dealing via the Internet," said Rep.
Ron Klink, D-Pa., who is pressing Congress to hold hearings on the problem.
Buyers, he warned, should beware: "We don't know where these drugs are
manufactured. We don't know if the people taking them have conditions that
should preclude them. We know nothing and neither does the public. No one
is watching it."

The idea behind prescriptions is that certain drugs are dangerous enough to
warrant authorization from a doctor. Typically, once the Food and Drug
Administration approves a drug for sale, it is prescribed by doctors, who
are licensed by state medical boards, and dispensed by pharmacies licensed
by state pharmaceutical boards. But on the Internet, said William Hubbard,
associate commissioner for policy at the FDA, "you might as well just put
drugs on the shelf down at the drugstore and say, `Take your pick.' "

Online prescribing is closely tied to another recent phenomenon: the
emergence of three new "lifestyle drugs," medicines meant to enhance
quality of life, as opposed to curing disease. In addition to Viagra, they
are Propecia, the first pill to treat baldness, and Xenical, a new diet
pill. Yet other drugs are readily available with a cyberdoctor's
consultation. Among them are Celebrex, for arthritis; Valtrex, for herpes;
Claritin, for allergies, and Zyban, an anti-smoking pill.

At the same time, there is a burgeoning black market on the Internet,
driven primarily by foreign companies selling everything from infertility
pills to antidepressants without even the pretense of a doctor's orders.
But beyond having Customs inspectors stop those foreign shipments at the
border, there is little the authorities can do. So they are focusing on
companies like Performance Drugs, though whether they can rein them in is a
matter of opinion.

"I don't think the politicians are going to be able to do anything to us,"
said Bill Reeves, who runs Viapro.com, a Phoenix-based Web site that sells
Viagra. He reiterated a quote he once heard: "It's kind of like trying to
nail Jell-O to a wall."

Just about anyone with a credit card can buy medicine from sites such as
Viapro.com. For a fee that typically ranges from $35 to $85, patients
receive an online medical consultation, which consists of filling out a
health history questionnaire. If the doctor approves, the pills arrive in
the mail, shipped either by a pharmacy or the doctor.

No one knows how much business these sites do. But Reeves and others say
they have no shortage of customers, drawn by low prices, convenience and,
in the case of Viagra, the promise of anonymity.

Nor, apparently, is there any shortage of doctors. "I probably have 5,000
names of doctors who want to participate," said Bill Stallknecht, co-owner
of ThePillbox.com, based in San Antonio.