Anna Merla*, Section of Hygiene, Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia (Italy), BRESCIA, Italy Grazia Orizio, Section of Hygiene, Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia (Italy), Brescia, Italy Peter J Schulz*, Institute of Communication and Health – University of Lugano (Switzerland), Lugano, Switzerland Umberto Gelatti*, Section of Hygiene, Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia (Italy), Brescia, Italy Track: Research Presentation Topic: Public (e-)health, population health technologies, surveillance Presentation Type: Oral presentation Submission Type: Single Presentation Building: LKSC Conference Center Stanford Room: Lower Auditorium 120 Date: 2011-09-18 01:00 PM – 02:30 PM Last modified: 2011-08-12

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Background
Drug-Selling Websites (DSWs) are companies that sell pharmaceutical preparations, including prescription-only drugs, on the Internet. Very little is still known about this phenomenon, due to its hidden nature when occurring outside national legislation. The aim of the study was to perform an up-to-date and comprehensive review of scientific literature focusing on the broader picture of DSWs by scanning several scientific and institutional databases, with no publication time limits.
Methods
We searched as of January 2011 four electronic databases (PubMed, ISI web of knowledge, Science Direct and PsycInfo), the grey literature on the Internet using the Google search engine and its tool Google Scholar, and we investigated the official websites of 7 institutional agencies (World Health Organization, the US and European Centers for Diseases Control and Drug Regulation Authority. We focused specifically on DSWs offering prescription-only drugs. We decided to analyze further and report only articles with original data, in order to review all the available data regarding DSWs and their usage. We report data on the three main areas on which the literature focuses: the characteristics of the websites, the quality of pharmaceutical products purchased online, and the number of consumers and their characteristics. Regarding the first group (articles dealing with DSW characteristics) we reported, if available, the number of DSWs analyzed, year of data collection, willingness to dispense pharmaceuticals with or without a prescription, availability of a physician’s assistance or online medical consultation, disclosure of contact details, geographic location, delivery conditions, types of medicines available, availability of drug information, prices of online drugs and overall costs, sales-promotion strategies, presence of quality certifications, duration of websites, privacy and disclaimer statements, and date of last website update.
Results
We selected 198 relevant articles: 76 articles with original data, 117 articles without original data (editorials, regulation articles or the like) and 5 reviews. Our findings show first of all that a great part of papers available on DSWs are reflection articles, such as commentaries and editorials, which do not include original data. When they do contain original data, the latter are highly fragmentay as they aim to answer highly varying search demands, using different method. The articles with original data concerned samples of DSWs in 47 cases, online drug purchases in 13, consumer characteristics in 15, and case reports on adverse effects of online drugs in 12.
Conclusions
The evidence shows that DSWs are an important phenomenon which is continuing to spread, despite partial regulation, due to intrinsic difficulties linked to the impalpable and evanescent nature of the web and its global dimension. From a broader point of view, the example of DSWs is emblematic regarding internet and public health: where public health – in terms of regulation and education – does not take control of phenomena, someone else does, with interests often very little to do with people’s health. A considerable effort must therefore be made to keep up with technological advances and the resulting social changes, by means of an international approach, in order to exploit the Internet’s huge potential, while minimizing the risks it can generate.