C6 | SATURDAY, NOVEMBER 25, 2023
HEALTH
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HEIDI GODMAN | Harvard Health Publishing
ype the words “best online pharmacy” into a search engine, and you’ll find
countless options promising prescription drugs delivered right to your door
at discount prices. Just be careful if you plan to place an order. Many online
pharmacies are unscrupulous purveyors of potentially harmful products. It
takes some know-how to identify legitimate pharmacies selling approved
medications.
Online pharmacy dangers
The vast majority of online pharmacies
are rife with risks, according to the FDA
and the National Association of Boards
of Pharmacy (NABP), an independent
nonprofit group.
The NABP has found that at least
40,000 online pharmacies aren’t com-
plying with patient safety standards or
laws; about 95% of websites offering
prescription-only drugs operate illegally;
and 89% of illegal online pharmacies
don’t require prescriptions for prescrip-
tion-only drugs. Yes, it really is that bad.
What does that
mean for consumers?
You don’t know who you’re dealing
with. “It could be a pharmacy in another
country that doesn’t have the same level
of quality control that we do, or it could be
a fake pharmacy with a legitimate-look-
ing storefront,” says Joanne Doyle Petron-
golo, a pharmacist at Harvard-affiliated
Massachusetts General Hospital.
You don’t know what you’re getting.
“You can’t tell if the pill you get has been
stored properly, if it’s expired, if it’s the
correct strength, or even if it’s the right
medication. Also, you don’t know what
else is in the product,” Doyle Petrongolo
says. The NABP found that some pills
contain dangerous substances along with
the medicine.
You’re risking more than your health.
The NABP reports that some online
pharmacies are out to steal your per-
sonal information (putting you at risk of
identity theft) or install malware on your
computer.
Don’t be scared off
Despite the risks, there are plenty of
licensed, legitimate online pharmacies.
Using them has many benefits. The main
one is cheaper prices for certain drugs.
“You can sometimes save hundreds of
dollars, so it’s worth considering,” Doyle
Petrongolo says.
Other reasons to use online pharmacies
include the convenience of having medica-
tions delivered directly to your home, and
privacy if you’re too embarrassed to pick
up certain drugs at the corner drugstore.
Ordering safely
To order prescriptions with the con-
fidence that you’re getting legitimate
products, learn the signs of safe online
pharmacies. These companies:
 Are licensed with a state board of
pharmacy.
 Have a physical address and phone
number, preferably in the United States.
 Require a doctor’s prescription.
 Have a licensed pharmacist available
to answer your questions.
 Have prices that aren’t too good to
be true.
 Clearly state that they don’t sell
your personal information.
How can you tell all that by looking a
website? Doyle Petrongolo recommends
using the NABP’s Buy Safely tool (safe.
pharmacy/buy-safely), which allows
you to type in an online pharmacy web-
site (the website address, not the name of
the pharmacy) to see if it’s been verified
by the NABP.
You can also look for a symbol on the
pharmacy website indicating that it’s
NABP-accredited. The symbol resembles
a vertical infinity sign (like the number
8) inside a red circle, and has the words
“NABP Accredited Digital Pharmacy.”
Examples of online pharmacies with
this symbol are Amazon’s pharmacy
service (pharmacy.amazon.com) and
HealthWarehouse.com (healthware-
house.com).
And before you order anything online,
remember that you can sometimes find
prices that are just as good — or better
— at a local pharmacy.
“You don’t have to look for deals on
medications that have been around for
a long time, like hydrochlorothiazide or
atenolol to treat blood pressure, or sim-
vastatin to treat high cholesterol,” Doyle
Petrongolo says. “You think they’ll be
more affordable somewhere else, but
they’re actually often cheaper — just a
few dollars — at a local drugstore or big-
box store.”
Live healthy and safe: Point
your phone camera at this
code, then tap the link for
SafeLiving101.com.
Warning signs
of bogus online
pharmacies
Avoid online pharmacies that:
 Don’t require a doctor’s
prescription.
 Aren’t certified by the
National Association of
Boards of Pharmacy.
 Don’t have a licensed
pharmacist on staff to
answer your questions.
 Offer discounts that seem
too good to be true.
 Don’t protect your personal
and financial information.
Safe online
pharmacies
It is essential to stay informed
about safe ways to buy medica-
tion. Buying prescription medicine
online or through social media
may seem to cost less, but it can
put you, or your loved ones, at
risk. Make sure a website is repu-
table to safely order prescription
drugs and medicine online.
40,000
Websites identified by the NABP
that fail to comply with NABP
patient safety and pharmacy
practice standards, or applicable
laws.
Nearly 95 percent of
websites offering
95% prescription-only
drugs online operate
illegally.
of illegal online
pharmacies reviewed
89% by NABP did not
require a valid
prescription for the
sale of prescription-only medicine.
of Americans know of
an event where
38% someone — either
themselves or another
— got substandard or
falsified prescription medication
from an online pharmacy, according
to ASOP.
NAPA VALLEY REGISTER
THE MEDICINE
CABINET
Why your
fingers hurt
in colder
weather
DR. ROBERT H. SHMERLING
Harvard Health Publishing
Q:
I am getting more sen-
sitive to colder weather.
I am worried about the
times my fingers get cold enough
to hurt and throb. What are some
of the possible causes?
A: A likely possibility is Ray-
naud’s phenomenon. People with
this condition have blood vessels
that respond in an exaggerated
way to cold. This occurs in their
fingers and toes and sometimes
other parts of the body.
Instead of the blood vessels
constricting normally in reac-
tion to the cold, they “overreact”
and constrict more severely. This
causes discomfort.
A key feature of Raynaud’s
phenomenon is reversible color
changes in the fingers. Initially,
the fingers may appear white,
but within minutes will turn blue
and then red before returning to
normal.
Raynaud’s phenomenon may
accompany other conditions
such as lupus and scleroderma.
However, these conditions are
relatively rare while Raynaud’s
phenomenon without another
condition (such as lupus) is com-
mon.
Other potential explanations
include:
Poor circulation: Athero-
sclerosis can affect blood vessels
anywhere in the body, but it’s rare
that it primarily affects the hands
A congenital circulation
problem: Some people are born
with small or missing arteries in
the hands, so their fingers may
get less than normal blood flow.
Thyroid disease: An under-
active thyroid (hypothyroidism)
may cause cold intolerance,
though this is usually body-
wide, not just in the fingers.
Drugs: Prescription, over-
the-counter and recreational
drugs may provoke Raynaud’s
phenomenon. Examples include
beta-blockers (such as metopro-
lol/Lopressor), pseudoephedrine
(as in Sudafed) and cocaine. Caf-
feine and nicotine may also con-
strict small arteries in the fingers.
Diseases that cause slug-
gish blood flow: These can
include polycythemia vera, cold
agglutinin disease or cryoglobu-
linemia. Among all people com-
plaining of cold hands, however,
these are rarely to blame.
See your doctor for an evalu-
ation. It may be worthwhile to
have your thyroid checked, your
medications reviewed and to
have some basic blood tests (to
look for some of the conditions
mentioned earlier in this article).
In the meantime, keep warm.
Wear a hat, coat, scarf and gloves
before going out in the cold.
Hand warmers are another ef-
fective remedy for cold fingers.
However, if you have Raynaud’s
phenomenon and these actions
don’t help, medications (such as
nifedipine/Procardia) to open up
the arteries of the fingers may be
helpful.
Dr. Robert H. Shmerling is a senior
faculty editor at Harvard Health
Publishing and corresponding
member of the Faculty of
Medicine, Harvard Medical School.
For additional consumer health
information, please visit
www.health.harvard.edu.
DREAMSTIME
People with Raynaud’s phenomenon
have blood vessels that respond in
an exaggerated way to cold.
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