There has been a major crack down on illegal pharmacies over the past year. But how many convictions have actually been made and is it as big a concern as it was a year ago?

The Clinton Administration brought the issue to the forefront with its initiative in December to invest $10 million to help the FDA "identify, investigate, and prosecute Web sites selling such items as: prescription drugs without a valid prescription, unapproved new drugs, counterfeit drugs, and expired or illegally diverted pharmaceuticals."

John Henkel reported in FDA Consumer Magazine in January that "In July 1999, the FDA announced that it was joining forces with state regulatory agencies and law enforcement groups to combat illegal domestic sales of prescription drugs.

The agency signed agreements with the National Association of Boards of Pharmacy and the Federation of State Medical Boards. These organizations have made a commitment to help enforce federal and state laws against unlawful Internet sellers and prescribers of drugs in the United States."

One activity that the FDA took exception to was the way Viagra prescriptions were being filled by the use of an online questionnaire.

Henkel reported in his article that a 52-year-old Illinois man with episodes of chest pain and a family history of heart disease died of a heart attack last March after buying the impotence drug Viagra from an online drugstore that required only answers to a questionnaire to qualify for a prescription.

Henkel points out "though there is no proof linking the man's death to Viagra, FDA officials say that a traditional doctor-patient relationship, along with a physical examination, may have uncovered any health problems such as heart disease, and could have ensured that proper treatments were prescribed."

This tends to contradict other findings. Research indicates that other men have had heart attacks while on Viagra and these men had been prescribed Viagra through traditional doctor-patient relationships.

In a recent article in Associated Press, Daniel Q. Haney reported the finding of Dr. Sanjay Kaul of Cedars-Sinai Medical Center in Los Angeles who had reviewed Viagra reports sent to the FDA between April 1998 and May 1999.

There were 522 deaths reported. Of that number 200 were heart attacks and 94 were cardiac arrests. There were 79 of the heart attack victims who had been taking nitroglycerin for chest pains.

In Haney's article it was also reported that men with erectile dysfunction also have other medical problems and the chances are they will die of heart attack whether they are taking Viagra or not. In other words studies indicate that impotence is often an indicator of other more serious health problems like cardiovascular disease.

Tom Spring interviewed William A. Stallknecht, R.Ph president of the Internet Pharmacy, the Pill Box, in PC World in June 1999 who said that "there was nothing inherently dangerous about writing a prescription for a patient a doctor has never seen. ...These prescriptions are not illegal. They're bona fide prescriptions with bona fide doctor patient relationships.' Stallknecht said."

At that time Spring had also interviewed Jill Wiggins of the Texas State Board of Medical Examiners, which licenses doctors, who said they had found no reason for disciplinary action against the Pill Box's site, which operated out of San Antonio, Texas.

When contacted recently Stallknecht said he no longer had his online pharmacy. He closed it down when Texas made changes to its policy in December.

In his article Spring had reported Stallknecht as saying that the pharmaceutical drugs he was selling online primarily Viagra, Propecia, Claritin, and Xenical were safe. 'These drugs only require a prescription because "manufacturers are "milking their patents" before they expire and the drugs become available over the counter.'

Claritin for instance can be bought legally over the counter in countries like Canada at a lower cost.

As it is now Americans cannot buy prescription drugs from Canadian pharmacies over the Internet. According to Janet Cooper, B.Sc. (Pharm.) Director, Practice Development of the Canadian Pharmacists Association, there are a few Internet drugstores in Canada but the prescription must come from a licensed prescriber in the province the prescription is being issued.

"The pharmacy must have a written, faxed Rx or take a verbal order directly from the physician.... If a patient has existing refills on a prescription from a pharmacy, they can request a refill on-line." A prescription from an American physician cannot be accepted, unless that physician has a license to practice in Canada as well, she said.

The Canadian Pharmacists Association Website says that "in September 1999, the Provincial Pharmacy Registrars initiated discussions with the U.S. National Association of Boards of Pharmacy (NABP) to possibly adopt or adapt the VIPPS program (Verified Internet Pharmacy Practice Sites) for use in Canada.

Development is underway nationally for either a VIPPS or similar Canadian-made certification program. Development will include external consultation with CPhA and other pharmacy organizations," the site reported.

Whether the VIPPS designation on an International site means that Americans will be able to purchase pharmaceuticals from the foreign site remains to be seen.

As it is now there are organizations in the US who are trying to bring in laws to prevent Americans from buying drugs from foreign companies.

Potential legislation to prevent this from happening has already been presented in the House but did not pass. In July Reuters reported that the House "signaled its concern about high drug prices, voting on two separate amendments to the fiscal 2001 spending bill for the FDA to suspend the agency's enforcement of a 1988 law that bars the re-importation of prescription drugs."

One amendment offered by Rep. Joseph Crowley, D-N.Y., and passed by a vote of 363-12, prevented the FDA from enforcing a law that made it illegal to bring back into the country US made prescription drugs that had been shipped out.

The other amendment, offered by Reps. Tom Coburn, R-Okla., and John Baldacci, D-Maine, which passed 370-12, would prohibit the FDA from acting to interfere with the importation of drugs approved in the US that were made in FDA- approved facilities in the US, Canada or Mexico.

Reuters reported "Supporters of the amendments said that drug companies discriminate against US purchasers by charging them higher prices. "Many American citizens cannot bear what the pharmaceuticals are charging," said Baldacci, who added that Congress should approve the language "to send a message that this is not an acceptable practice."

Congressman Ron Klink (D-PA) and Congressman John Dingell (D-MI) were concerned that the legislation, which makes it easier for U.S. citizens to attain drugs from foreign sources, would increase the likelihood of counterfeit, misbranded, or adulterated drugs entering the United States.

In a press release on Klink's Website they urged the Pharmaceutical Research Manufacturers of America (PHRMA) to address the problem of illegal Internet drug sales. Klink pointed out that "while PHRMA had vociferously opposed the importation legislation they had been disturbingly silent on the issue of on-line drug sales."

It is the high cost of drugs in the US that is driving Americans to find cheaper means of obtaining their medicine.

In June the Public Citizen, New York Statewide Senior Action Council and Citizen Action of New York sponsored a bus trip for seniors so that they could buy prescription drugs at 50% less in Canada.

The seniors went from Albany, Binghamton and Rochester areas to Montreal, Canada, which took them about 30 hours. Once in Canada, they were seen by a doctor who performed an examination and issued them a Canadian prescription.

"Congress needs to intervene to make prescription drugs just as affordable for seniors in New York, and every other state, as they are for Canadian seniors," Mary Clark, southern tier regional director, Citizen Action of New York said in a June press release issued by Public Citizen.