It's not what the doctor ordered

PUBLISHED : Tuesday, 13 March, 2012, 12:00am
UPDATED : Tuesday, 13 March, 2012, 12:00am


Shopping online is one of Anita Lim's favourite pastimes. Her regular purchases include pharmaceuticals, such as appetite suppressants, painkillers and tablets that claim to do everything from boost energy to improve memory. Lim buys them without a doctor's prescription and doesn't see anything wrong with it.

'They aren't 'hard-core' medicines, so I don't think it's necessary to get my doctor's advice before buying them,' says the 36-year-old graphic designer. 'Plus, if I can access them easily online, why bother with a prescription?'

Lim, who spends HK$300 a month on various medications, isn't the only one clicking her way to what she believes is better health. The global online pharmaceuticals trade is a multibillion-dollar industry - and is still growing.

It isn't just the convenience of online shopping that attracts customers. In many cases, drugs bought online are cheaper - particularly generic brands - plus, there's no need for a prescription. There are also drugs available online that are not on sale in Hong Kong.

Dr Winnie Mui, a general practitioner at Dr Lauren Bramley and Partners in Central, says: 'Many shoppers also don't consult their doctors before buying because they want to save time, especially if they have only a minor ailment. There are also no doctor's fees or insurance coverage when purchasing medicine online.'

Self-medication is nothing new. But the proliferation of online pharmacies means that more people are taking medical treatment into their own hands, through self-diagnosis and then searching online for drugs that might help.

But Mui points out that with self-medication comes the danger of overdosing, allergic reactions, interference with other drugs, and side effects from the drug itself.

She adds that under the influence of certain medications, some people might experience drowsiness, amnesia, hallucinations or erratic behaviour. Not experiencing side effects immediately does not mean the drugs are safe, either. Sometimes the consequences don't show up until years later if patients take the drugs for long enough.

Dr William Wong Chi-wai, clinical associate professor with the department of family medicine and primary care at the University of Hong Kong's Li Ka Shing Faculty of Medicine, says that self-medication when appropriate is encouraged. But many don't turn to their doctors when they should. 'If you don't seek medical help for a particular condition, there is a real danger of that condition developing into an irreversible disease,' he says.

There is also the issue of the quality of drugs sold online, since it's difficult to guarantee their authenticity and safety. Allergy warnings, list of active ingredients and expiry dates can be altered or even omitted. Some online pharmacies might even be outlets for unregistered or illegal drugs.

'As the pharmaceuticals market is lucrative, dubious online pharmacies abound,' says Mui. 'Online drug dealers need not be licensed. With low overheads and cheap labour from developing countries, anyone with chemical or pharmaceutical knowledge, the inclination, and the start-up capital can open an online drugstore. The profit margin is potentially staggering, and making money tends to override safety.'

In the case of drugstores that do not comply with local health regulations, the internet is like a no-man's land, so there is no jurisdiction over orders and deliveries, and certainly no accountability if anything goes wrong. That said, Mui adds that there are numerous legitimate online pharmacies that are a blessing for people who are homebound, busy or far from a conventional pharmacy.

Dr James Oliver, a general practitioner at Island Health Family Practice, says that another issue with ordering medication online is that, unlike your doctor, the company has no interest in your well-being, and there is no on-going relationship.

He urges buyers to keep this in mind when purchasing drugs from an online pharmacy and to do some research before placing an order, because online purchases may get you sent to court. 'One of my patients ordered codeine, which in Hong Kong is a tightly controlled substance,' says Oliver. 'His parcel was intercepted by customs, and he received a summons to appear in court to explain his actions.'

It's important to let your doctor know if you're intending to purchase drugs online, even if it's just simple vitamins or something you can buy over the counter. There can be a danger of drug interference.

Choose the larger, more reputable pharmaceutical companies, and check that your medication is registered with the Health Department's Drug Office (, says Mui. Oliver also advises to be aware of the effects and side effects of the medication, and the appropriate dosage.

Drugs that you should never purchase online without first seeking your doctor's advice include injectable ones such as insulin, cancer medicines, sedatives and amphetamines. Also check on anything that might be considered exotic, including herbal drugs. Intravenous blood products are dangerous because you risk contracting blood-borne infections such as hepatitis and HIV.

Even topical medicines aren't always safe, says Mui. That's because the ingredients can be absorbed into the skin. Oliver adds that some topical creams, such as the stronger steroids, can cause serious problems if not monitored.