Kai Wright

Monday, Apr 17, 2000 4:00 PM UTC

Online pharmacies evading regulation

U.S. officials struggle to control prescription drug-dispensing Web sites.

By Kai Wright

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It should be a simple open-and-shut case. The Web site Hair2Go.com is in clear violation of state and federal laws governing the sale of prescription drugs. The opening lines of its home page unabashedly state as much: “Hair2Go provides safe mail order access to prescription medications from overseas pharmacies without a prescription.” Among the drugs available are the impotency drug Viagra, the weight-loss drug Xenical and the hair regrowth drug Propecia.

In March, the Food and Drug Administration sent the site’s operators a stern letter that explained the laws regulating the sale of pharmaceuticals and ordered the site operator to contact the FDA to resolve the matter. But that was it — no lawsuit, no agents descending on the offices of the site operator, no formal charges brought of any kind — and the site is still up today. Why? Because Hair2Go is based in Auckland, New Zealand.

In the last year, pharmacies and health product providers in general have caught dot-com fever. According to a study cited by the Justice Department in its recent report on confronting online crime, Internet pharmacies sold more than $1.9 billion worth of prescription and over-the-counter drugs, vitamins and a host of other health-care products in 1999. As the Justice Department report stresses, much of the new industry is legal. Drugstore.com, founded by former Microsoft executive Peter Neupert in February 1999, is one example of an apparently booming, and legal, dot.com pharmacy. Neupert says his Web site has served almost 700,000 customers since starting, and predicts the online drug market will grow from what was all but nothing in 1998 to $15 billion a year by 2004.

But the problem is that no one has any idea how much illegal activity is out there. The National Association of Boards of Pharmacy estimates at least 200 U.S.-based Web sites offer prescription drugs without a prescription. The FDA says the worldwide number could range anywhere from 200 to 1,000. Meanwhile, the NABP has certified exactly five sites as in compliance with state regulations for dispensing prescription drugs. In all fairness, the NABP offers that certification only to those who apply for it. Nevertheless, rogue sites far outnumber legitimate ones. And as government and industry officials begin to ask how they will regulate those sites, nobody seems to have a compelling solution.

No matter what regulators do to control domestic sites, they can do little more than send threatening letters to those overseas. And the more pressure regulators put on operators of domestic sites, the more they will move overseas and out of reach. Already, in 1999 the amount of pharmaceuticals seized by U.S. Customs increased by over 400 percent.

The rogue sites specialize in what officials call “lifestyle” drugs: treatments for things such as male impotence, balding, dieting and skin care. Typing the word Viagra into a search engine will bring up screen after screen of links offering the drug. Inside, most of the sites will require only an “online consultation” as a prerequisite for ordering.

KwikMed.com, for example, offers a “fast, discreet and 100% private” way to start weight-loss treatment with Xenical, a prescription drug. The site requires customers submit to a $65 consultation billed only if you are approved for the drug. After asking the customer’s mailing address, drug order, shipping preference and credit card information, the consultation gets around to the “Customer Medical Declaration.” The customer is then asked to declare a number of medical facts: height, weight, history of a list of illnesses, if he or she has taken Xenical previously, allergies, what other medications he or she is now taking and whether she has a history of breast cancer. Finally, the customer is asked if “there are any reasons why you believe you may not be able to take Xenical?”

This process, the FDA and state regulators say, hardly replaces a prescription. The first concern is whether or not the person fielding these consultations is actually a licensed doctor. In one widely publicized incident last year, a magazine editor entered in the actual information for her neutered cat and was approved for the purchase of Viagra. There’s also the question of whether or not the drug ultimately shipped is authentic and safe, as many of the sites contain no information about where the drugs come from.

And, even if the site is honest, the “online consultation” process does nothing to ensure the customer tells the truth. The focus on diet drugs is particularly worrisome from that perspective. “My worst nightmare is an anorexic girl getting hold of these drugs,” says Kansas Assistant Attorney General Fran Brunner, who is working on six suits her state brought against online pharmacies last year. “The consequences are astronomical.” A person with an eating disorder would merely need to fabricate the weight he or she “declares” and could have a fatal supply of diet pills.

Because the Internet offers site operators both anonymity and the ability to change their location and identity quickly, regulators depend largely on consumer complaints to spot and prosecute violators. But for illegal online pharmacies, those complaints aren’t flowing in. NABP executive director Carmen Catizone says the complaints his group does hear come mostly from traditional pharmacists whose customers talk about getting a particular drug without the prescription online, or at a cheaper rate from an online pharmacy based overseas.

“The strange thing about these cases is we don’t have consumers complaining,” Brunner adds. “Consumers believe they should be able to get these drugs without a prescription. And they believe they are safe.”

The lack of complaints also means there is little data on how much actual harm is being done. No one can say how many adverse reactions due to rogue Web sites there were last year. Given the probable profile of customers drawn to the idea of getting cheaper pharmaceuticals without the hassle of a prescription — someone already disposed to circumvent the health-care bureaucracy — victims are less likely to report problems to the government. “I’ve only known of a few cases,” says FDA spokesman Tom McGinnis.

The overall health risks associated with the sorts of lifestyle drugs illegal online pharmacies target remains in question as well. The FDA has long been criticized as lax in monitoring a drug’s safety once it has been approved and is on the market. In the case of lifestyle drugs, any data that is available is shrouded by the fact that people taking them often have high risks for other medical problems.

With Viagra, for instance, researchers have been unable to definitively determine whether the seemingly high number of heart attacks among men using it stem from the drug itself or from preexisting heart problems. Still, one study in the Journal of the American Medical Association showed 564 people died while taking Viagra from the time of its approval in early 1998 to July 1999 — a death rate almost 10 times that of former treatments for erectile dysfunction.

And so the regulatory machine is cranking up to deal with the latest dot-com conundrum. State attorneys general are banding together to sue as many rogue sites as they can round up. Illinois and Missouri have sued operators of six sites, and Michigan has sent out notices of a pending suit to operators of 17 sites.

The states are trying to work together, but the effort is by no means systematic or comprehensive. “Several states get on a conference call and we share information,” Brunner explains. “We are trying to teach each other, [but] does anyone have a list of 400 sites that we’ve divided up? No.”

Meanwhile the federal government is also taking its own steps to tighten the online drug market. Rep. Ron Klink, D-Penn., has introduced a bill in Congress that would make online pharmacies disclose more information about themselves on their Web sites. The FDA is requesting $10 million from Congress to fund new staff and other resources that would be dedicated to dealing with the new industry.

But no matter what course regulators chart, one has the feeling that the effort is once again doomed by the Internet con man’s ace in the hole: Ultimately, Web site operators merely have to move overseas. Indeed, the U.S. Customs Service seized almost 10,000 packages with illicit prescription drugs last year — almost four times as many as agents seized in 1998.

“I think it’s directly tied to the Internet sites,” FDA spokesman McGinnis says of the spike. He notes that officials held their first real public discussion of regulation last year (at a House committee hearing on the matter in July) and that all of the states launched their legal efforts last summer. Last year also saw the big-name legitimate sites such as drugstore.com and cvs.com take off. All of these things, he said, conspired to begin driving rogue operators overseas.

That leaves the feds, the states, the industry and the public in the hands of regulators in whatever country the operators set up shop. Here the states throw their hands up in deference to the feds; the feds throw their hands up in deference to diplomacy.

So in January, the FDA launched its cyber-letter campaign, in which the agency sends a threatening letter to rogue operators overseas. The letter carefully explains that, barring special considerations, pharmaceuticals cannot legally enter the U.S. and that the company cannot, therefore, sell its product here. The equivalent regulatory agency in the particular country also receives a copy of the letter, as do U.S. Customs officials, who then keep an eye out for packages from the company cited. McGinnis says the FDA has sent 15 such letters so far, and three companies have responded apologizing and promising to desist.

Still, the effort seems toothless. LifeStylePharmacy.com got a letter on Feb. 2. But this week, it still advertised itself on its home page as “a safe and secure Internet-based mail-order service offering Viagra.” It informs customers that they do not have to present a prescription, but offers them the option of a $20 consultation and promises overnight delivery of Viagra only in the U.S. “Importation of prescription medication is legal in most countries (including the U.S.),” the defiant page reads. “Click here for the Order Form.”

Tuesday, Mar 27, 2012 3:44 PM UTC

The “Trayvon Martin had it coming” narrative

Black men are treated as menaces every day. At 17, Trayvon may have done what most of us know we can't: Confront it

By Kai Wright, Colorlines.com

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This undated photo provided by the Martin family shows Trayvon Martin snowboarding. (Credit: AP Photo/Martin Family)

This article originally appeared on Colorlines.com.

Trayvon Martin had it coming, or so we will soon be led to believe. The surely unattractive details of his short life as a black man in America will tumble forward—his troubles in school, the weed baggie that got him suspended, the altercation in which police and George Zimmerman claim he was the aggressor. He was a maladjusted, Negro man-child, so ferocious he could kill an armed man with his bare hands. He had to die.

On Monday, local law enforcement offered a preview of this old, familiar narrative when someone leaked Zimmerman’s account of the night to the Orlando Sentinel. According to the Sentinel, Zimmerman had given up his hunt of Martin and was returning to his SUV when the 17-year-old caught him by surprise. Do you have a problem, Martin is said to have asked, before answering for himself, “Well, you do now.” He reportedly began pummelling Zimmerman, leading the armed man to shoot and kill.

Sadly, it’s necessary to point out that there isn’t an imaginable scenario in which an armed man can shoot an unarmed child to death and it be okay. But set that obvious fact to the side. Trayvon Martin did in fact have it coming. He was born black and male in the United States and was thus marked for death. The cruelness of our economy and of our criminal justice system isn’t reserved for men or for black people. But there is a particularly gendered and particularly racist way in which black men are set upon in this country, most acutely those who don’t have the resources to push back. And it has a very long, still relevant history.

For the entirety of American history—from the first African captured and enslaved to the moment Geraldo Rivera opened his mouth to pimp Martin’s death for ratings—black men have been relentlessly caricatured as menaces to society. We were dangerous, so chattel slavery was necessary, and a nation’s wealth was born. We are still dangerous, so a police state is necessary in black neighborhoods all over this country, and the wealth of a prison-industrial complex flourishes. This is what Trayvon Martin’s murder is about. It’s not about his high school suspension. It’s not about his hoodie. It’s not even about Florida’s Kill at Will law, at least not at root. It’s about the enduring, dark fantasies to which America still clings, in order to justify a society in which more black men are locked up or on parole today than were enslaved in 1850—to pick just one of many indicators of the scale at which black men are battered. But we’re menaces; we’ve got it coming.

As black men, we’ve all got our strategies for dealing with the resulting morass of fear and loathing that we must navigate every day. Few of those tricks are healthy, unfortunately. Some work themselves to an early death in a vain effort to disprove the fantasy of their sloth and ignorance—see under, John Henry, Harold Washington, my father. Some fight and fight and fight until they can’t take it, then get the hell out—see under, DuBois, Baldwin, Ture. Most of us just duck and dodge the emotional bullets, try not to let the inevitable wounds fester into self-hate and do our best to keep it moving.

The strategies aren’t always heroic, either. Some black men go mad in pursuit of the self-reliance and individual will that’s supposed to save them, and end up like a bleary eyed, permanently angry Clarence Thomas. A troubling many just give up and become the Baby Boy that too many black mothers, sisters and lovers spend their lives propping up and excusing. Some say screw it and go all Bigger Thomas, doing their best to pantomime the monster that haunts America’s twisted fantasies. I’m more of a Langston Hughes than Richard Wright guy myself, but after hearing the cops’ leaked bile on Monday I found myself re-reading “Native Son,” and relating.

Trayvon Martin was just 17, and maybe he hadn’t yet put together his own strategy for dealing with life as the object of America’s nightmares. So when he found himself being stalked down a dark street, having just been suspended for a crime that his middle class white peers laugh about, perhaps he improvised. He doubled back on white supremacy and tried to catch it off guard with a mixture of Nat Turner and N.W.A. You got a problem? Well, now you do. That got him killed. But you know what Trayvon? I feel you. At least you came at the problem head on.

If Zimmerman and the cops are to be believed, Martin did what so many of us know we can’t. Like when someone asks if it’s safe in your neighborhood, and you want to reply, sure, expect for the white women we keep as sex slaves. Or when the school counselor says your kid has an anger problem and special needs. Or when the cop tells you to quit loitering on your own damn block. You got a problem? Well, now you do.

That was Trayvon Martin’s approach. Hey, he was just a kid. He hadn’t learned the subtle art of disarming the racism that can come flying at you when you’re walking home from the store. The fact that the racism in this instance came flying from a Latino man isn’t relevant. Martin’s killer could’ve been black and it wouldn’t change the circumstances. All of us live in a country in which black men are defined as pariahs. All of us consume that message in ways both overt and implicit and, on some level, far too many of us use it to excuse the brutality we can see all around us.

Like I said, Trayvon Martin was marked for death already, statistically at least. As a black infant, he was more than twice as likely to die as his white peers. In his teens, he was at least one and a half times as likely to meet an early death as his white peers. Homicide is the leading cause of death for black men his age, and comes at a rate many times every other racial or ethnic group. If he had reached his 20s, he had a 1 in 8 chance of going to prison, because that empty bag of marijuana he had at school would have meant something very different for him than it does for the middle class white kids who use drugs at higher rates. He’d have gone on to live in a country in which nearly 4 in 10 black children live in poverty, in which 1 in 4 black households lack food security.

The fact is the U.S. often seems like it’s built to kill black people. This is not to say racism is equally lethal today as it was even a single generation ago. But it is to say that the same set of deeply ingrained ideas about what black people have coming to us justified the brutality of yesterday and today alike. And one particular manifestation of those ideas routinely leads to the early death of men like Amadou Diallo and Sean Bell and Oscar Grant and Trayvon Martin.

Of course, this violent manifestation of white supremacy is not visited upon black male bodies alone. Indeed, as Tea Party candidates like Nevada’s Sharron Angle reminded us in the past election cycle, we must very much begin to see Latinos in the same way—lurking, dangerous, illegal. Fear and loathe them. If you encounter them on a dark street be ready to go to arms. And so Latino men have a lengthening gruesome roll call, too.

Surely all these people have done something to bring the murder, the poverty, the brutality down upon themselves! That’s America’s unique twist on systemic oppression. We cage people, then call them animals. We starve people, then jibe them for being malnourished. We write laws that allow people to gun down unarmed children and then make the child the aggressor. And so now Trayvon Martin will be all manner of sinner—a pothead, a dropout, a ne’er-do-well with a temper problem who had it coming. But what he will indisputably be is dead, like too many before him and surely many after him. He had it coming, as a black man in America.

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Kai Wright is editorial director of Colorlines.com (@colorlines), fellow of The Nation Institute, and author of three books on race, sexuality and African American history. He leads a multiracial team of writers and reporters in Colorlines.com's daily news, analysis and award-winning investigative reporting. Follow Kai on Twitter at @kai_wright.