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R E C E N T L Y
Just do it, Bill
By Fred Branfman
The president should tell the truth
(08/06/98)
Clinton's sexual scorched-earth plan
By Jonathan Broder and Harry Jaffe
The White House may be ready to declare a "total war" on Congress over the Lewinsky case
(08/05/98)
New JFK death film
By Scott McLemee
New Zapruder film doesn't solve JFK case
(08/04/98)
Author asks: When did Jones and Clinton meet?
By Lori Leibovich
Mystery at the Excelsior Hotel
(08/03/98)
A new kind of strike
By David Bacon
The first auto strike over GM's global investment strategy
(07/31/98)
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That leaves much of the onus for reporting at the discretion of entrepreneurs like Lamm and his friends in the publishing industry. Did Lamm ever think he had a conflict of interest? "Absolutely not," the doctor finally told me in a terse phone interview. "But now I have to go. I elect not to talk to you. I choose that. I elect not to answer your questions. You can do what you want, but I elect to choose not to answer you."
Lamm's response didn't surprise me; press coverage of the Viagra phenomenon has largely been confined to questions like "Does it work?" and "Will it kill me before I come?" This is because Pfizer, the drug's maker, is a brilliant marketing organization. The company has refined the art of publicizing a "blockbuster drug" in stages, not unlike the way Hollywood releases a summertime action flick. That, of course, is all fair play in the course of pure market capitalism.
But what happens when a physician, a person bound to "first do no harm," becomes a cog in the wheel of commerce? What happens when the good name of, say, NYU Med, is used for purposes that might best be called enlightened shilling?
Back arrow to the Drugstore.com, or, in this case, a small button at the bottom of Lamm's Web site titled "thepillbox.com." Click on it and you land on a page sporting a giant bottle of Viagra and asking the question: What quantity would you desire? What strength?
Take your pick and you automatically move to the next page. "If you do not have a prescription click here." Click. "For $85 you will receive a physician consultation, which will enable you to receive your Viagra."
Click.
"Please sign this waiver of liability."
Click.
Next comes a short list of questions: Do you have trouble getting and maintaining an erection? Yes or no. Do you currently take any nitric oxide medications? Yes or no. What other medications do you take? Fill in the blank.
Then comes the most important question: What is your credit card number? Fill that in and click one last time. In a few days, a bottle of Viagra will land on your doorstep, no physician contact. This is exactly what happened to me last week.
Shocked, I immediately e-mailed Lamm about his affiliation with thepillbox.com. His self-described "webmaster," Scott Harrison, answered. "We have no financial connection with [thepillbox.com], save a link they put up for the book on their site," he told me. "They are the only legitimate Viagra-dealing pharmacy on the Web." So fear not.
But few in the medical community would agree with that assessment. A first-time prescription for a new, non-emergency drug issued with absolutely no direct contact with a qualified physician? Even the loosest interpretation of Title 21, the government code that regulates the prescription process, calls for a relationship between patient and physician and/or a consultation based on the "usual course of his professional practice." In this case, the relationship was a cyber-bit. The "usual course of professional practice?" Five yes-or-no questions on a cheesy Internet questionnaire. This is what I got for $85.
"This is clearly pushing the envelope way past the limits," says Gay Dodson, chief of the Texas State Board of Pharmacy, which has opened an investigation of thepillbox.com. "A pharmacist can't generate a script. It has to be a physician. And that physician has to have a relationship with the patient."
Still unbelieving, I called the doctor whose name appeared on the bottle. I got a nurse, who told me she dealt with "all the Viagra stuff." But what if I had a problem, and I wanted to talk to my doctor? Did she have my file? No. "But anyway," she concluded cheerily, "there's only a few side effects you can get with Viagra."
"What if I have one that isn't on your list?"
"Eh, well, the doctor, eh, he takes care of all the Internet orders in the morning. You'll have to talk to him. What did you say your name was?" I then called the operators of thepillbox.com, the San Antonio pharmacy that Lamm's webmaster had assured me was "the best." I got its genial proprietor, Bill Stallknecht, to explain his operation. It turns out that thepillbox.com initially put up its Web site to advertise its specialty: custom compounding of pharmaceuticals for hard-to-treat patients. It got a few calls from highly specialized physicians.
Then Stallknecht began getting queries about Viagra. He decided to advertise a service to pre-order the drug, in advance of its approval by the FDA. The idea was to "get the orders early," then get the official prescriptions. "Then the form that the customer fills out, you know, yes this or no that, gets downloaded to the lab, then gets sent over to the doctor, who reviews it and then passes it back to us," Stallknecht told me. Sometimes the doctor even says no. "There's a lot of 'em that he kicks right back out. "
Listening to Stallknecht, I realized that Lamm might be right after all. Perhaps the right to minimize contact with the medical system as we know it, or to simply be allowed to find ways to legitimately experiment on ourselves, should be stuck onto that ever-growing list of patient's rights. After all, some of the biggest users of thepillbox.com's Viagra service have been physicians.
Why was that? I asked Stallknecht.
"Ahh, you know," Stallknecht said with a chuckle. "I mean, if you were a doctor, would you want to go fill your own script for Viagra at the next-door pharmacy? Doctors, you know, they can be real shy."
SALON | Aug. 7, 1998
Greg Critser writes frequently about the pharmaceutical industry.
Does the rampant prescribing of Viagra raise any red flags for you? Discuss this ubiquitous wonder drug in the Science and Health area of Table Talk.

T A B L E+T A L K What exactly is on Monica's dress? Discuss the most famous cocktail dress in history in the Headlines area of Table Talk D A I L Y+Q U O T E Another Globe columnist in hot R E C E N T L Y Just do it, Bill By Fred Branfman The president should tell the truth (08/06/98) Clinton's sexual scorched-earth plan By Jonathan Broder and Harry Jaffe The White House may be ready to declare a "total war" on Congress over the Lewinsky case (08/05/98) New JFK death film By Scott McLemee New Zapruder film doesn't solve JFK case (08/04/98) Author asks: When did Jones and Clinton meet? By Lori Leibovich Mystery at the Excelsior Hotel (08/03/98) A new kind of strike By David Bacon The first auto strike over GM's global investment strategy (07/31/98) - - - - - - - - - - - - - - - - Browse the Newsreal Archives - - - - - - - - - - - - - - - -
		CLICK HERE FOR VIAGRA (OR OTHER DRUGS) \| PAGE 1, 2 - - - - - - - - - - That leaves much of the onus for reporting at the discretion of entrepreneurs like Lamm and his friends in the publishing industry. Did Lamm ever think he had a conflict of interest? "Absolutely not," the doctor finally told me in a terse phone interview. "But now I have to go. I elect not to talk to you. I choose that. I elect not to answer your questions. You can do what you want, but I elect to choose not to answer you." Lamm's response didn't surprise me; press coverage of the Viagra phenomenon has largely been confined to questions like "Does it work?" and "Will it kill me before I come?" This is because Pfizer, the drug's maker, is a brilliant marketing organization. The company has refined the art of publicizing a "blockbuster drug" in stages, not unlike the way Hollywood releases a summertime action flick. That, of course, is all fair play in the course of pure market capitalism. But what happens when a physician, a person bound to "first do no harm," becomes a cog in the wheel of commerce? What happens when the good name of, say, NYU Med, is used for purposes that might best be called enlightened shilling? Back arrow to the Drugstore.com, or, in this case, a small button at the bottom of Lamm's Web site titled "thepillbox.com." Click on it and you land on a page sporting a giant bottle of Viagra and asking the question: What quantity would you desire? What strength? Take your pick and you automatically move to the next page. "If you do not have a prescription click here." Click. "For $85 you will receive a physician consultation, which will enable you to receive your Viagra." Click. "Please sign this waiver of liability." Click. Next comes a short list of questions: Do you have trouble getting and maintaining an erection? Yes or no. Do you currently take any nitric oxide medications? Yes or no. What other medications do you take? Fill in the blank. Then comes the most important question: What is your credit card number? Fill that in and click one last time. In a few days, a bottle of Viagra will land on your doorstep, no physician contact. This is exactly what happened to me last week. Shocked, I immediately e-mailed Lamm about his affiliation with thepillbox.com. His self-described "webmaster," Scott Harrison, answered. "We have no financial connection with [thepillbox.com], save a link they put up for the book on their site," he told me. "They are the only legitimate Viagra-dealing pharmacy on the Web." So fear not. But few in the medical community would agree with that assessment. A first-time prescription for a new, non-emergency drug issued with absolutely no direct contact with a qualified physician? Even the loosest interpretation of Title 21, the government code that regulates the prescription process, calls for a relationship between patient and physician and/or a consultation based on the "usual course of his professional practice." In this case, the relationship was a cyber-bit. The "usual course of professional practice?" Five yes-or-no questions on a cheesy Internet questionnaire. This is what I got for $85. "This is clearly pushing the envelope way past the limits," says Gay Dodson, chief of the Texas State Board of Pharmacy, which has opened an investigation of thepillbox.com. "A pharmacist can't generate a script. It has to be a physician. And that physician has to have a relationship with the patient." Still unbelieving, I called the doctor whose name appeared on the bottle. I got a nurse, who told me she dealt with "all the Viagra stuff." But what if I had a problem, and I wanted to talk to my doctor? Did she have my file? No. "But anyway," she concluded cheerily, "there's only a few side effects you can get with Viagra." "What if I have one that isn't on your list?" "Eh, well, the doctor, eh, he takes care of all the Internet orders in the morning. You'll have to talk to him. What did you say your name was?" I then called the operators of thepillbox.com, the San Antonio pharmacy that Lamm's webmaster had assured me was "the best." I got its genial proprietor, Bill Stallknecht, to explain his operation. It turns out that thepillbox.com initially put up its Web site to advertise its specialty: custom compounding of pharmaceuticals for hard-to-treat patients. It got a few calls from highly specialized physicians. Then Stallknecht began getting queries about Viagra. He decided to advertise a service to pre-order the drug, in advance of its approval by the FDA. The idea was to "get the orders early," then get the official prescriptions. "Then the form that the customer fills out, you know, yes this or no that, gets downloaded to the lab, then gets sent over to the doctor, who reviews it and then passes it back to us," Stallknecht told me. Sometimes the doctor even says no. "There's a lot of 'em that he kicks right back out. " Listening to Stallknecht, I realized that Lamm might be right after all. Perhaps the right to minimize contact with the medical system as we know it, or to simply be allowed to find ways to legitimately experiment on ourselves, should be stuck onto that ever-growing list of patient's rights. After all, some of the biggest users of thepillbox.com's Viagra service have been physicians. Why was that? I asked Stallknecht. "Ahh, you know," Stallknecht said with a chuckle. "I mean, if you were a doctor, would you want to go fill your own script for Viagra at the next-door pharmacy? Doctors, you know, they can be real shy." SALON \| Aug. 7, 1998 Greg Critser writes frequently about the pharmaceutical industry. Does the rampant prescribing of Viagra raise any red flags for you? Discuss this ubiquitous wonder drug in the Science and Health area of Table Talk.