Two inexorable forces of the 1990s - the growth of the Internet and rapid rise of prescription drug use - appear to be on a collision course.
Citing lax oversight and serious health risks, the Clinton administration is taking dramatic and controversial steps to regulate online sales of drugs.
Until now, the administration has kept a relatively hands-off policy toward Internet regulation, with the exception of pornography. But the recent surge in the number of Web sites selling prescription drugs - now more than 400 - has prompted the White House to seek congressional approval for federal regulation.
The move takes place against a backdrop of increased use of prescription drugs - and increased costs. As Americans search for cheaper and more convenient ways to obtain medication, the Internet has turned into a virtual online drugstore.
Some of the Web sites require consumers to fill out nothing more than a questionnaire to obtain a prescription, which is then sent by mail.
"Almost anybody" can set up a pharmaceutical Web site, says Henry Aaron of the Brookings Institution here. And almost anybody can purchase the drugs - even people who haven't consulted a physician.
"You log on, a physician comes online, or information is collected about you," he says. "If you are judged eligible, it comes in the mail. You could be a minor asking for a product that is just meant for adults, you could be doing something without parental consent."
Currently, states are responsible for regulating local pharmacies, while the Food and Drug Administration (FDA) approves the medications themselves. But in the interstate world of e-commerce, states have not been able to keep up with online pharmacies that sell nationally - or even foreign ones that sell to consumers in the US.
Indeed, one of the greatest dangers, according to the FDA, is the availability of overseas drugs that have not yet been approved here. The agency is investigating hundreds of online prescription cases related to fraud and abuse.
A recent study by the University of Pennsylvania found it was disturbingly easy to buy prescription drugs online without ever visiting a physician or pharmacist. The study found, for instance, 86 Web sites that sold Viagra, the anti-impotence drug, without requiring a doctor's visit or prescription.
The administration's plans for regulation, which need to be approved by Congress, would require online pharmacies to get FDA certification. A company could be fined $500,000 each time a drug was sold without a valid prescription.
The administration is also requesting $10 million in its 2001 budget to hire investigators and upgrade computer equipment to better police the industry.
At present, a pharmacy trade group encourages Web sites to meet certain standards. Online pharmaceutical companies are bound to resist federal regulation on top of state regulation. But the FDA says the effort by the trade group falls short because it is voluntary, and that it is inadequate to control fly-by-night online dispensers.
Several states have moved against Web operators. Just this month, Michigan ordered 10 online pharmacies to stop selling or face legal action. And Illinois filed suit against four operators in October. But cross-border sales makes monitoring more difficult.
(c) Copyright 1999. The Christian Science Publishing Society