Viagra to your door via the Internet

After signing a "waiver of liability," one proceeds to a short list of questions: Do you have trouble getting and maintaining an erection? Yes or no. Do you currently take "any medication classified as a nitrate in any form" (e.g., nitroglycerin)? 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, and in a few days, a bottle of Viagra will land on your doorstep, no physician contact, no questions asked. This is exactly what I did last week.

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 questions on an Internet questionnaire and an $85 charge.

"This is clearly pushing the envelope way past the limits," said 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."

Shocked at how easy it had been to obtain the drug over the Internet, I immediately e-mailed Lamm about his apparent affiliation with the Pillbox Pharmacy. 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."

Still amazed, I called Dr. Ron Nelms, of San Antonio, whose name appeared on the bottle as prescribing physician. 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 Pillbox Pharmacy and asked its genial proprietor, Bill Stallknecht, to explain his operation. It turns out that the pharmacy originally went online to advertise its specialty: custom compounding of pharmaceuticals for hard-to-treat patients. Then Stallknecht began getting queries about Viagra. He decided to create 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, currently a Libertarian candidate for Congress in Texas' 23rd District, I began to think that it possibly wasn't the worst thing to minimize contact with the medical system as we know it, or to simply be allowed to experiment on oneself. Indeed, said Stallknecht, some of the biggest users of the Web site's Viagra service have been physicians.

Why was that?

"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."