Dear Dr. Barchas:

What do you tell your clients who request that you submit a prescription to an online pharmacy? My vet refuses to provide a prescription that will match the price of the online pharmacy — 50 percent savings for a six-pack of Interceptor [a product that combats several parasites]. That is significant for me, and I feel that I have done my homework in selecting a pharmacy that is not just low cost, but also meets quality standards [of accreditation bodies] such as Vet-VIPPS and PCAB.

Her rationale is that you cannot trust the quality or handling procedures of online pharmacies. Your comments, please.

Gary

San Diego

Online pharmacies are like dentists, spouses, and veterinarians — some are better than others. To understand why, you’ll need to know some history of the animosity between veterinarians and online pharmacies, which is quite dramatic.

Veterinarians once fulfilled the role that auto mechanics fill today. They treated horses and livestock that were used for power and transportation. The development of the automobile led to a professional existential crisis, so vets shifted to treating companion animals and food animals.

As they treated more pet dogs and cats, and pets were more accepted as family members, vets became more like pediatricians, over time, becoming highly trusted professionals. When I was in vet school, I often saw polls showing how much the public trusted vets — more than firefighters, nurses, university professors, teachers, and, for that matter, pediatricians.

Eventually, the trustworthiness of veterinarians was exploited by — surprise! — big pharma. Merial and Bayer, the makers of Frontline and Advantage, respectively, have been most successful at this. They told vets that their fantastically effective products would be available only through vets. The naive vets pushed the products on their clients. Because the clients trusted their vets, they bought the products faithfully, and they came to trust the products.

But that trust lessened, because vets shifted to being drug and flea product pimps. Vets could sell only so much Advantage and Frontline, so big pharma started to move the products through other channels. Internet pharmacies were among the first non-veterinary channels.

There was a slight catch. Merial and Bayer had promised to sell their products only through veterinarians, so a robust “gray market” developed, and many vets believe that Merial and Bayer encouraged or at least turned a blind eye to it.

Here’s how that market works: The big companies sell large quantities of products to some veterinarians, who in turn resell the products to distributors who supply the Internet pharmacies (and pet stores, big box stores, and other suppliers). Because the flea products are technically pesticides and not drugs, this is generally legal (although it is frowned upon in the veterinary community). The process is very shady — several vets supplying the gray market were recently in the news for having been swindled by an especially dirty distributor.

Also, the first big online pharmacy (PetMed Express, or 1800-Petmeds) went out of its way to antagonize vets. Its ads characterized vets as money-grubbing evil people. People who worked for the comapny harassed vets who were reluctant to work with them. Quickly, a lot of veterinarians came to hate PetMed Express and, by extension, all online pharmacies.

What does all this mean? Although rumors of counterfeit or ineffective products circulate, your pet probably won’t be harmed by Advantage or Frontline bought online. (In fact, Bayer now sells Advantage directly to non-veterinary distributors.)

Heartworm preventatives and other medications are a different story. They are drugs — not pesticides — that are more tightly regulated. Most online pharmacies, citing trade secrets, won’t say how they obtain these products. But many vets worry that it’s the same method as the flea products. I regulary receive solicitations from shady distributors who want me to buy and then resell medications to them. I have never taken the bait. It’s dangerous and unethical, and I worry that it’s also illegal. I, too, question the handling and sources of drugs available through some Internet pharmacies. Some appear to be housed in self-storage units without air-conditioning in places such as Phoenix or Guangzhou, China, and prolonged exposure to heat can damage the goods. That said, some pharmacies (for example, those certified by accredidation bodies such as Vet-VIPPS and PCAB) have high standards, obtain their supplies through legal and ethical channels, and handle products in a trustworthy way.

Gary, it sounds like you’ve done sufficient homework for me to endorse your Internet pharmacy decision. And you’ll be interested to know that in California, it is illegal for a veterinarian to refuse to issue a written prescription when one is requested. Your vet cannot be compelled to work with a specific pharmacy, but each vet must issue a prescription that you can fill on your own wherever you desire.

Vets are fretting about the potential for lost income from online pharmacies (as well as new players such as Walmart), but I believe the principle of “crisis equals danger plus opportunity” applies here. As pharmacy income dwindles, vets will have to return to doing what we do best: acting as professional advisers and advocates for pets’ health. We might yet regain our legendary trustworthiness.