title: Quality of global e-pharmacies: can we safeguard consumers?
abstract: OBJECTIVE
  E-pharmacies are web sites selling prescription-only medicines and other products including non-prescription and complementary medicines to consumers via the internet. This study aims to evaluate the quality of global e-pharmacies, discuss whether e-pharmacies support the safe and appropriate use of medicines, and consider how we can protect consumers in the future.
  
  
  METHODS
  A survey of public information published on global e-pharmacy web sites was conducted between July and September 2001. We used a meta-search engine, Copernic, and the search terms of 'online' or 'internet', and 'pharmacy', 'pharmacies' and 'medicines' to identify a sampling frame of global e-pharmacies. We surveyed all web sites in the sampling frame except those under construction or only offering electronic refills, members-only and non-English web sites. Survey data included country of origin, range of medicines sold, prescription requirements, availability of online medical consultations and pharmacists' advice, quality accreditation seals, policies and advertisements.
  
  
  RESULTS
  E-pharmacies operated in at least 13 countries; however, the country of origin could not be identified for 22 web sites. Twenty web sites (19%) appeared to supply prescription-only medicines with no prescription required. Only 12% of e-pharmacies displayed quality accreditation seals. We observed information published on e-pharmacy web sites that potentially undermines the safe and appropriate use of medicines.
  
  
  CONCLUSIONS
  Safeguarding consumers and ensuring the quality of web sites that sell medicines across state and national boundaries is both complex and difficult. Strategies to improve the quality of e-pharmacies include independent third-party regulation of providers, evaluation and enforcement of sanctions in cases of dissemination of fraudulent or harmful information and practices, self-regulation and consumer education. The development of internet regulatory technologies themselves and the resolution of jurisdictional issues offer future solutions but international co-operation is vital.
authors.affiliation: Institute of Health Services Research, Monash University, Locked Bag 29, Clayton VIC 3168, Australia. tracey.bessell@med.monash.edu.au
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Bessell
authors.forename: Chris A
authors.initials: CA
authors.lastname: Silagy
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Anderson
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
authors.forename: Lloyd N
authors.initials: LN
authors.lastname: Sansom
mesh_terms: D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004335:Drug and Narcotic Control / Q000706:statistics & numerical data; D005607:Fraud / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005791:Patient Care / Q000706:statistics & numerical data; D010593:Pharmaceutical Services / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000639:trends; D028743:Professional Misconduct / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012306:Risk