Grazia Orizio*, Section of Hygiene Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia , Brescia, Italy Sara Rubinelli, Institute of Communication and Health – University of Lugano, Lugano, Switzerland Peter Schulz, Institute of Communication and Health – University of Lugano, Lugano, Switzerland Serena Domenighini, Section of Hygiene Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia, Brescia, Italy Maura Bressanelli, Section of Hygiene Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia, Brescia, Italy Luigi Caimi, “Quality and Technology Assessment, Governance and Communication Strategies in Health Systems” Study and Research Centre – University of Brescia, Brescia, Italy Umberto Gelatti*, 1Section of Hygiene Epidemiology and Public Health, Department of Experimental and Applied Medicine – University of Brescia, Brescia, Italy Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: MaRS Centre, 101 College Street, Toronto, Canada Room: CR2 Date: 2009-09-17 03:30 PM – 05:00 PM Last modified: 2009-08-13

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Introduction: Online Pharmacies (OPs) are recognized as a threat to public health by FDA and WHO, as they pose a risk to consumers. Indeed, it is difficult to determine whether drugs purchased online might be counterfeit, unapproved or illegal. Moreover, OPs often provide drugs without a prescription.
Despite the efforts by health authorities to regulate the selling of drugs over the internet, the global dimension of the web makes it difficult to control the phenomenon of drug selling.

Objectives: Drawing from the field of argumentation theory and persuasion research, this paper investigates the strategies of communication that OPs adopt to market their drugs.

Method: The sample frame of OPs analyzed comprises 175 OPs selected using the Google search engine and coded using an ad hoc Codebook according to the Content Analysis method.

Results: Regarding prescription requirements, 39 (22.3%) OPs asked for a medical prescription (prescription OPs, POPs) and the remaining 136 Ops (77.7%) did not ask for a medical prescription (non-prescription OPs, nPOPs). 87.2% of POPs declared their physical location, compared with 23.5% of nPOPs (p= .000).
Regarding sales promotion strategies almost all pharmacies provided privacy reassurances, about safe use of personal data, and delivery in a plain package. Concerning prices, 96 (54.9%) stressed the lower prices in comparison with “bricks and mortar” pharmacies, 84 (48.0%) offered the chance to become a member of the web pharmacy in order to gain a bonus, 78 OPs (44.6%) used sales arguments encouraging customers to buy more to pay less, 72 (41.1%) offered free delivery. Among the reassurances regarding the quality of service we found the opportunity to check the orders in 77 OPs (44.0%), and testimonials by people who had already bought online in 61 cases (34.9%). Statements about drug quality existed in 124 OPs (70.9%) and reassurance that buying on the web is legal in 58 OPs (33.0%). The selling arguments regarding not having to undergo a doctor’s examination and avoiding costs, queues and embarrassment were present in 84 of nPOPs (61.8%).
In about one third of OPs no side effects were declared for the most sold drugs. Regarding quality markers, they were found in 23 (13.1%) out of the 175 OPs. They were significantly more present in POPs than in nPOPs (p=0.000).

Conclusion: The core issue is that online drugs are advertised in an argumentative fashion: while navigating on these websites consumers are more or less implicitly invited to buy a certain drug through a set of unequivocal arguments that justify the purchase itself. These ‘selling arguments’ play on aspects which are far removed from the intrinsic characteristics of the drugs in terms of benefits and side-effects. This strategy of persuasion results in a critical gap between the information that consumers should receive to make informed health decision and the actual pieces of information that they get.
Considering that there is no international legislation regulating the existence of virtual pharmacies, it is reasonable to think that consumer education can, in fact, be in the long run the winning plan to limit the size of online trade of pharmaceutical products.