NOTE: A physician-scientist reader that has provided some fantastic emails in the past has sent in the below post about prescription drugs sold over the web illegally. I believe it is in response to our post about Xandrox15 Plus. Again, the following (below the line) was not written by myself or any of the other BaldingBlog editors, but it provides some very useful information and is important to read for all U.S. residents.

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Balding Blog Patients: Buyer Beware

Contributors to the Balding Blog often ask about the benefits and risks of various drugs sold over the internet. Some of these drugs are (a) approved (such as finasteride) and available without a prescription, and (b) reformulations of approved drugs (e.g. minoxidil) that normally do not require a prescription but have high concentrations that are not approved by any regulatory agency or have undergone any clinical testing to determine risk/benefit ratio. Readers should know that providing prescription (“non-over-the-counter”) drugs over the internet by a physician without a proper medical evaluation is illegal in the US. The reasons for this follows, with information that has been nicely summarized and adapted from Annals of Internal Medicine, 7 December 1999 | Volume 131 Issue 11 | Pages 861-862):

1. Sale of drugs on the Internet without a prescription is illegal. At present (2008), the FDA and state licensing boards are underresourced, and are able to pursue the most egregious complaints related to misconduct and public safety (and typically only following a consumer complaint). As a result, the presence of this activity should not imply its legality. Both the FDA and state medical boards have intervened to close many sites where this practice is common (including suspension of the physician’s medical license).
2. The main reason why this activity is illegal is that it bypasses the normal risk-management system inherent in a physician-patient relationship. The concept of a “prescription” drug is to ensure an evaluation by a physician to determine whether use of the drug places the patient at increased risk for adverse effects, to determine and educate the patient about the risk/benefit ratio, and to evaluate for potential dangerous drug interactions. Congress requires that the FDA classify certain medications as prescription drugs for a reason: a practitioner’s supervision is essential to safe use of these drugs.
3. Beyond the illegal practice of prescribing certain drugs on the internet without a medical evaluation, internet prescribing of new formulations that involve high concentrations of approved drugs without a medical evaluation is also illegal. In addition to the inability to evaluate the aforementioned factors, this practice also increases the possibility of contaminated drugs during manufacturing.
4. Many “baldness drug sites” do nothing other than require the consumer to click a button and supply address and credit card info to obtain certain prescription drugs (e.g., finasteride). However, internet prescribers who supply prescription drugs solely on the basis of a questionnaire also are acting in an inappropriate manner and do not meet the standard for the appropriate care of a patient. The American Medical Association formally adopted the position in the early 1990’s that any health care practitioner who offers a prescription to a patient solely on the basis of an on-line questionnaire without having ever examined the patient has not met the appropriate medical standard of care. The FDA agrees with this position, and more than a dozen states have already taken action against practitioners who prescribe drugs in this manner.
5. However, the most egregious situations are where physicians supply prescription drugs (such as finasteride) over the internet without either a questionnaire or direct evaluation of the patient.
6. In general, patients should not buy drugs from Web sites that offer to prescribe a drug for the first time without a physical examination, sell prescription drugs without a prescription, sell drugs that are not approved by the FDA, sell approved (over-the-counter) drugs in formulations that have not been approved, do not offer the opportunity to ask questions of a registered pharmacist, require that you link to another Web site to purchase the drug, or do not provide a U.S. telephone number and address to contact with questions.
7. The “Balding Blog” website can play an important role in educating patients about dangerous practices on the Internet related to obtaining drugs for baldness under these circumstances.