President Bill Clinton may be the last man in the US to need Viagra, but last week he raised eyebrows by saying that, if he ever considered doing a commercial, he would join Bob Dole in promoting the drug which freed millions from the curse of impotence.
Clinton's casual comment belies the battle lines he has drawn against the peddling of medicines - most markedly, Viagra - in cyberspace.
Drastic legislation drawn up by Clinton unleashed a nationwide sweep by government agents to clamp down on prescriptions and sales of so-called 'lifestyle' drugs on the internet. A sudden wave of investigations and 'search and seizure' raids rounded up providers of Viagra and other drugs. The vendors were charged with breaking laws which do not yet exist.
The popular drugs involved are prescribed to hundreds of thousands of patients who now face being stripped of treatment. The main four are Celebrex for arthritis, Clarityn for asthma and allergies, Xenica for obesity, and Viagra for 'erectile dysfunction'.
None are 'controlled substances', nor addictive or dangerous, but - says Clinton's proposal now before Congress - prescription of such medicine from doctors to patients who never meet should be outlawed.
Clinton's legislation aims to impose a $500,000 fine on any online business or pharmacy selling these drugs without a 'valid prescription'. About $10 million has already been spent training hundreds of specially trained Food and Drug Administration agents and sending investigators to raid prescription sites.
Of 350 providers and pharmacies hit, about 150 have come under criminal investigation. Affidavits for the raids are sealed, so that those raided do not know on what legal grounds - no law having yet been passed - they are being investigated.
Clinton's crusade and the counter-campaign recall rows over Prohibition in the Thirties and the abortion debate in their fury. Fuelling the emotion of this battle, the lobby fighting on Capitol Hill to oppose the Bill is led by Roy Lucas, famous in America for his victory in the epic Roe versus Wade case which established the legal right to abortion.
Lucas says Clinton's 'witch-hunt' legislation is 'oppressive and needing to be watered down tremendously'.
The government insists that the drugs - especially Xenica and Viagra - are abused by people who do not need them medically for slimming or sexual recreation. It says patients fall victim to 'cowboy' websites.
Officials cite the proliferation of Viagra in clubland, and claims the drug is being sold to buyers and administered to patients who simply fill in online questionnaires.
The senior policy chief at the administration, William Hubbard, testified to Congress during hearings last month that 'illegal dispensing of prescription drugs poses a serious threat to the health and safety of American citizens'.
Meanwhile, besieged prescribers and online doctors have formed OPPA - the Online Prescription Providers' Association - whose director Anton Pusztai retorts: 'Where are the victims? We read and read about the victims of obesity, arthritis, impotence and allergies, but where are the victims of these drugs?'
Pusztai says, as with Prohibition and abortion, the closing down of legitimate sites that provide consultations with doctors will only 'give the rogues and the cowboys the break they need'.
The providers want a list of drugs that do not contain 'controlled substances' on the internet, with guarantees of proper medical consultation online or by telephone. 'You are always going to get people who abuse the system, in any form of healthcare,' says Pusztai. 'It's the same with alcohol. But that doesn't mean that we prohibit access to drugs for most of the people we deal with and the millions who genuinely suffer from obesity and impotence.'
Pusztai says that his members would never, for instance, sell the dieting medicine Phentamine, which contains a controlled substance, only the fat-blocker Xenical. 'They say, "what would happen if an anorexic got hold of some Xenical?". Well, the answer is nothing, because an anorexic has no fat to block. They might as well have taken a sugar cube.'
The irony, says Pusztai, is that 'the sites that offer consumer protections are the visible ones and therefore the ones they're going for, while the rogue sites are going to be difficult for them to get to'. Oppa members are sites with registered real addresses, whereas rogue sites have cyber-addresses only.
Ironically, most online prescribers, who offer consultations with US or foreign doctors and reject some applications, had set up OPPA just as the government clampdown began, to campaign for regulation of the online medical business and cut out the cowboys.
Clinton's legislation aims to throttle the frontier-less nature of the internet, deploying laws that forbid pharmacies to deal beyond the borders of the state in which they operate. 'What the FDA is doing, however,' says Pusztai, 'is to use this in order to control the practice of medicine, which it has no right to do'.
The government's position is that a prescription is 'illegal' if the patient and doctor have not met face to face. One woman whose firm is under investigation counters: 'If you go to a doctor in New York City, you fill out forms that are less rigorous than ours, and you can lie. You don't need to go to a doctor to know if you're impotent, and if you do he won't do a physical examination to find out'.
If the legislation passes Congress it will have global ramifications - including for Britain. It bans dealing with providers in the US 'or abroad'. The $500,000 fine is just enough to enable the US to apply for extradition.
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