Byline: Merrill Matthews Jr, SPECIAL TO INSIGHT

On a daily basis I get "spam" e-mails from well, I am not sure exactly who they're from promising "wholesale prescription medicines" and informing me that "our licensed doctors will write your prescriptions for free."

The drugs generally are lifestyle drugs for "weight loss, muscle and general pain relief, allergies, men and women's health, impotence, heartburn, migraines and more!" All I need to do is provide the company with a credit card and answer a few short questions so the "doctor" can make a thorough (wink, wink) evaluation of my medical condition and write a prescription. The online pharmacy promptly will fill that prescription and have it to me overnight.

I ask myself, "overnight from where?" So I peruse the Website to see if I can find a return address. Hmmm! No return address, no phone number, no contact information. I can, of course, send the company an e-mail, but I have no idea who runs the company or where it is located. There is no accountability whatsoever.

There are responsible online pharmacies, often run by the national "brick-and-mortar" chain drugstores, which comply fully with state and federal laws and are accredited by the National Association of Boards of Pharmacy. But there are others many of which operate outside this country that are unregulated and may pose real threats to their customers' health. Weakening federal and state regulations that attempt to control these entities and protect the public will lead to an even greater explosion of the questionable online pharmacies than we have seen in the last few years.

Access to less-expensive prescription drugs has become the Holy Grail of Washington as politicians consider expanding prescription-drug coverage to seniors, imposing various types of price controls or helping Americans buy their prescriptions from other countries primarily Canada where government price controls mean lower prices on many popular drugs. Some U.S. consumers cross the Canadian and Mexican borders to buy their drugs. IMS Health, a company that tracks prescription-drug sales, estimates that Americans spend $650 million in cross-border purchases.

But a growing number of Americans are willing to buy their drugs online. As a result, the number of online pharmacies has exploded both here and abroad. There are an estimated 80 online-pharmacy Websites in Canada that sell prescription drugs, many of which are shipped to U.S. customers. While it is impossible to tell how many drugs are purchased from Canadian Websites, U.S. Food and Drug Administration (FDA) Commissioner Mark McClellan estimates it to be about 1 percent to 2 percent of pharmaceutical sales and growing.

Now some doctors, pharmacies, politicians and insurers are encouraging and even helping patients to get their brand-name prescriptions from Canada. Those concerned about online-pharmacy sales especially sales from other countries cite patient safety as the primary issue. GlaxoSmithKline, one of the largest pharmaceutical companies, has decided to stop selling its products to Canadian-based online-drug vendors that are reimporting.

It is important to understand that it is against the law to import (or reimport) drugs into this country. For practical and political reasons the FDA and the U.S. Bureau of Customs and Border Protection (U.S. Customs) allow U.S. citizens traveling internationally to bring back or to purchase online small amounts of prescription drugs for personal use. That doesn't mean the practice is legal; the law just is not rigidly enforced.

Twice Congress has passed legislation that would allow Americans to buy their drugs from Canada, but the legislation came with a caveat: The secretary of health and human services had to determine that U.S. consumers would be safe. The secretaries have been unable to come to that conclusion, and they aren't alone. Ten former FDA commissioners, the U.S. Customs Service and the Drug Enforcement Administration (DEA) have raised serious concerns about the safety of drugs coming from other countries, even those drugs alleged to have been made originally by U.S. manufacturers.

Thus, U.S. politicians who encourage seniors even help them arrange for buses to travel to Canada to buy their prescription drugs from other countries are helping those Americans break the law. Bizarrely, some U.S. politicians are threatening to punish any drug company that chooses not to sell to Canadian online pharmacies that break U.S. law.

Proponents of buying drugs across international borders claim that drugs purchased from Canada are just as safe as those bought in the United States. But are they? See if you can reconcile the following two stories. An April 21 Wall Street Journal story begins, "Canada is boosting security at its seaports following stinging criticism that they are rife with crime and could be used to smuggle weapons of mass destruction into North America." According to the story, this action is the result of a Canadian Senate committee which said that "crime groups including Asian Triads, the Russian mafia and the Hell's Angels motorcycle gang are active at Canada's ports, using them to smuggle illegal drugs, weapons and refugees into North America."

Now for the lead paragraph from a May 8 Washington Post story: "The Canadian government has officially said that it will be responsible for the safety and quality of the large and growing flow of prescription drugs across the borders to American consumers, a clarification long sought by U.S. officials."

Whew! I feel much safer knowing that a country that can't control its own borders is going to help us control ours, don't you?

Health experts think that roughly 5 percent to 8 percent of the world prescription-drug market is counterfeit, although the vast majority of counterfeit sales are outside U.S. borders. But that could change if we weaken the laws or restrict the FDA and Customs Service from seeking out and stopping counterfeit-drug vendors.

When the DEA and Customs Service surveyed 200 travelers who made a trip from San Diego to Tijuana, Mexico, and back, the organizations estimated that 25 percent of the pharmaceuticals were counterfeit or contaminated. In 2001, the Customs Service, working with authorities in Thailand, shut down several online pharmacies and arrested 28 people in Thailand and Albany, N.Y., according to an article last year in the San Diego Union-Tribune.

While counterfeit prescription drugs can be a source of huge profits for organized crime, there is another potential danger terrorism. A recent report by Global Options Inc., which deals with security and terrorism issues, points out that terrorists increasingly are delving into the prescription-drug market, both as a way to make money and commit terrorist acts.

According to the study, "Interpol, the largest international police organization in the world, has uncovered a connection between terrorists and pharmaceuticals. Based on evidence gathered by police in North America and Western Europe, Interpol believes the profits from counterfeit [prescription] drug trafficking are, in part, financing international terrorism."

Americans wanting to find less-expensive sources for prescription drugs seem to trust that drugs bought online from vendors purporting to reside in Canada that is, if you can even find out where they reside will be as safe as the ones they buy at their local pharmacies. That trust is reinforced when U.S. politicians try to weaken laws forbidding reimportation or even encourage the practice.

The fact is that the U.S. prescription-drug distribution system through local pharmacies has been so effective in ensuring that Americans get high-quality, untainted drugs for so many years that many people may be oblivious to the problems that have plagued other countries. Just think about the irony: Seniors who travel to Mexico in droves may try to avoid the water or the food, yet they may feel no reservations about buying prescription drugs in that country.

Americans are becoming increasingly annoyed indeed, irate over the barrage of unwanted spam. Most people I know think the spammers are shameless invaders of privacy. The Wall Street Journal reports that 33 states have enacted laws trying to limit unwanted spam. There are computer hackers who have made it their mission to "do unto spammers as they have done unto us," by flooding their e-mail accounts with messages to give them a little taste of their own medicine. However, these "counterattacks" aren't easy because most spammers go to great lengths to make sure that even computer whizzes can't track them down.