With summer — and tick season — fast approaching, there’s a new weapon available to reduce your chances of catching Lyme disease: a vaccine called LYMErix, approved by the Food and Drug Administration late last year.

Now, the bad news. The vaccine isn’t approved for kids under 15 or people over 70. It protects about 80 percent of the people who get it, and that’s if you get three shots, which, according to current FDA licensing, must be taken over 12 months. If you get only two shots, a month apart, there’s only a 50 percent chance you’ll be protected. And no one knows how long the protection will last.

Moreover, even if the vaccine were 100 percent effective, you’d still have to take the usual precautions — wearing long sleeves and pants and using tick repellents and removing attached ticks — if you live, work or play in woodsy or marshy areas. That’s because ticks that carry Lyme can also infect you with babesiosis and erlichiosis, other tick-borne infections for which there are no vaccines.

But there’s a promising new wrinkle in all this. Last fall, the vaccine manufacturer, SmithKline Beecham, reported that it’s possible to compress the timetable for the three immunizations into six months or even two and still get the same degree of protection as with the year-long schedule.

The company is not pushing this timetable — yet — because it’s still in the process of seeking FDA approval for it. But since there’s justification for accelerating the shots, it’s worth talking to your doctor about it if you’re at high risk.

Lyme disease is a nasty, though rarely fatal, illness that is both often-missed and overreported. It strikes about 12,000 to 16,000 Americans a year, mostly in the Northeast, but also in the upper Midwest, Pacific Northwest and elsewhere.

It starts with a bite from the deer tick, Ixodes scapularis. If you get the ticks off your skin within 36 to 48 hours, you’re probably safe because it takes this long for the disease to be transmitted, says David Weld, executive director of the American Lyme Disease Foundation in Somers, N.Y.

The bite causes a rash that often looks like a “bull’s eye” and flu-like symptoms — fever, chills, headache and fatigue — as well as occasional facial weakness and heart disturbances. Some people may have chronic arthritis or neurologic problems even months or years later.

In fact, scientists from Boston reported this month at an international conference that they have found a neurotoxin made by the Lyme bacterium.

The toxin “may explain memory problems and why nerves get stimulated so that they fire off and you get pain, numbness or tingling,” says Dr. Sam Donta, the lead researcher and a Lyme disease specialist at Boston Medical Center and the Boston VA Medical Center.

‘The evidence is accumulating,” he says, “that this is a subtle, chronic infection, but we have a long way to go.”

If you catch Lyme disease quickly — while you still have the rash — antibiotics often work. But not always. New evidence also presented at the conference showed that even after receiving antibiotics, some dogs with Lyme disease still harbored the bacteria that causes it, Borrelia burdorferi.

Complicating the decision about whether to get vaccinated this year (other vaccines are in the pipeline for future seasons) is the fact that scientists are unsure as to whether this tick season will be worse than usual. Some say it will be, but much of this is guesswork is based on the complicated life cycle of ticks.

Adult ticks mate in the fall on the bodies of large mammals, chiefly deer.

No disease is transmitted at this point, but after feeding on deer blood, pregnant female ticks drop off and bury themselves in leaves. Each female lays about 3,000 eggs, which then hatch — as larvae — the following summer.

The larvae are harmless at first. But they feed on mice or other rodents, and if those animals carry the Lyme bacteria, the larvae become infected, too. After feeding on mice, the larvae huddle in the ground for the winter, then emerge the following spring as nymphs that can potentially infect humans.

But a number of things can affect how many ticks there are in any given area in any year. A mild winter and a wet spring, for instance, can boost the tick population — and may this year.

So can a bumper crop of acorns two years before the ticks appear, says Rick Ostfeld, an ecologist at the Institute of Ecosystem Studies, a private nonprofit research organization in Millbrook, N.Y.

“There are two pathways by which acorns have an effect,” he says. Deer love acorns, so when there’s a bumper crop of acorns, it lures deer deep into oak forests. Mice love acorns, too.

So lots of acorns means lots of mice survive the winter, which means that “two summers after a good acorn fall you have lots of infected nymphs,” he says. Since there were bumper acorn crops in 1997 and in 1998, Ostfeld predicts “a pretty bad summer for Lyme disease in 1999 and worse in 2000.”

Dr. Ned Hayes, an epidemiologist at the Centers for Disease Control and Prevention who specializes in bacterial diseases transmitted from animals to humans, is less convinced about this year’s forecast: “I wouldn’t make any predictions.”

But he and other Lyme specialists, among them, Dr. Bela Matyas, medical director of epidemiology at the Massachusetts Department of Public Health, say that if you’re at risk for Lyme disease, you should talk to your doctor soon about getting the vaccine.

The vaccine works by stimulating the immune system to make antibodies to a protein called OspA, which is found on the surface of the bacteria in the tick’s gut. The vaccine does not attack the tick itself. But when the tick sips a person’s blood, it sucks in the antibodies, which then kill the bacteria.

This process is not foolproof, however. If bacteria enter the body despite vaccination, they quickly stick a different protein called OspC on the surface. The vaccine doesn’t work against this protein, which means that if the first line of defense fails, you may still get infected.

Next month, the Advisory Committee on Immunization Practices, a group of experts that advises the CDC on vaccine issues, is expected to recommend that anyone at high risk of Lyme disease because of frequent or prolonged exposure to tick-infested habitats should consider being vaccinated.

For people with less frequent or less prolonged exposure, it’s unclear how much added benefit a vaccine provides over standard anti-tick precautions.

People with minimal exposure to tick-infested areas need not get the vaccine.

People who have uncomplicated arthritis from a prior Lyme disease infection and are at high risk should consider getting the vaccine, the committee is expected to say. But those who have Lyme disease that has not responded to treatment should not, because the vaccine could make things worse. In healthy people, however, initial data indicate that there are no serious side effects.

The bottom line is to discuss vaccination with your doctor and remember that it takes a while for the vaccine to kick in, it doesn’t work for everyone, and even when it does, it doesn’t protect against other tick-borne illnesses. This means you still have to take precautions to avoid ticks — forever.

• Look for the deer tick on your skin or clothing after walking in fields or woods. The tick – a dark speck the size of a poppy seed – is most likely to bite in the nymph stage.
• If you can’t avoid areas where ticks thrive – woods, marshy areas, high grass and bush – wear long-sleeved shirts, long pants tucked into socks, and closed-toe shoes. Light colors make it easier to spot ticks on your clothes.
• Use insect repellants. Permethrin kills ticks on contact, but it can be irritating, so spray it on your clothes, not your skin. You can use DEET (diethyltoluamide) on your skin and clothes. State guidelines vary, but in Massachusetts and some other states, health officials say you should not use DEET on infants, and don’t use products with more than 15 percent DEET on children. Adults should use products with no more than 30 to 35 percent DEET. High concentrations of DEET may cause severe allergic reactions and seizures.
• When you get home from a tick-infested area, shower or bathe and remove any ticks with tweezers within 24-48 hours.
• If pets have been in tick-infested areas, check them, too, as well as areas where they sit or lie.
• If you become infected – you should notice a rash and flu-like symptoms – call your doctor; antibiotics are often effective if given early, but not always.

For more information, contact:

• The Lyme Disease Foundation, 1-800-886-LYME (or 1-800-886-5963) or on the Web, www.lyme.org.
• American Lyme Disease Foundation, 914-277-6970 or on the Web, www.aldf.com.

Lyme disease in Massachusetts

The original column in the Boston Globe contained a photo and a chart. The Photo Caption read:

• With summer — and tick season — fast approaching, there’s a new weapon available to reduce your chances of catching Lyme disease: a vaccine called LYMErix, approved by the Food and Drug Administration late last year. Now, the bad news. The vaccine isn’t approved for kids under 15 or people over 70. It protects about 80 percent of the people who get it, and that’s if you get three shots, which, according to current FDA licensing, must be taken over 12 months. If you get only two shots, a month apart, there’s only a 50 percent chance you’ll be protected. And no one knows how long the protection will last.

The chart data is available at the Boston Globe on Microfilm.

What Allison Taylor hates most about rosacea, the skin problem that turns faces red and makes people look like they’ve had a few too many, is the chronic embarrassment.

“I wear a lot of makeup because I’m so self-conscious,” says Taylor, 35, who manages a medical practice in Boston. “I always look sunburned. People ask me if I don’t feel well.”

For others, like a 44-year old Cape Cod psychologist who asked that her name not be used, it’s the complications of rosacea, like eye irritation, that are unattractive and make wearing contact lenses impossible. “It’s not like I won’t go out of my house,” she says. But it’s a “major pain in the neck.”

Rosacea is an unglamorous problem. It won’t kill you. It won’t even really make you sick. But emotionally, it can make life miserable for the 13 million Americans who have it. Some hate to go to work; others, like Taylor, dread parties because some foods and alcohol make you “get redder and redder.”

Rosacea is a chronic condition that first strikes in one’s 30s and 40s, though many people suffer for years before they’re properly diagnosed. Famous faces with rosacea have included Rembrandt, W.C. Fields, and Princess Diana. President Clinton also suffers from the ailment.

Initially, rosacea is just excessive flushing and blushing caused by dilation of blood vessels on the cheeks, nose, chin or forehead, says Dr. Arthur Sober, associate chief of dermatology at Massachusetts General Hospital.

Nobody is sure why this happens, but it may be an abnormal response to temperature changes. In fact, researchers have shown it’s the heat in hot coffee or tea, not the caffeine, that triggers flushes. Other triggers include stress – notably anger and embarrassment – sun, wind, hot showers, coughing, spices, chocolate, tomatoes, and even exercise.

When a healthy person exercises hard, he may get red, “but this usually calms down in about 15 minutes,” says Dr. Mark V. Dahl, chairman of dermatology at the University of Minnesota Medical School. When someone with rosacea exercises, his face may stay red for an hour or two.

Chronic flushing leads to the appearance of broken blood vessels, or telangiectasia. “If you have a constantly increased blood flow to the skin, it creates new blood vessels. They may look broken but they’re not,” says Dr. Steven J. Ugent, a dermatologist at Boston Medical Center. But these vessels are treatable with lasers – “perhaps the most gratifying cosmetic procedure one can perform because it works so well and there’s so little risk,” says Dr. Robert Stern, a Beth Israel Deaconess Medical Center dermatologist.

In many people, though, rosacea doesn’t end with flushing and blushing but progresses to inflammation, in which the face breaks out with papules (little red bumps) and pustules (pus-filled pimples) that may look like acne.

Some think this may be caused by skin mites called Demodex folliculorum, though it’s unclear which comes first, the mites or the rosacea. The mites may trigger inflammation, but they may also flock to sites of rosacea and take up residence.

Others blame Helicobacter pylori, the bacteria that causes stomach ulcers. One recent study of more than 200 people, however, found that the prevalence of H. pylori is no higher in people with rosacea than in those without it, says Dr. Kenneth Arndt, chief of dermatology at Beth Israel Deaconess. And treatment of H. pylori doesn’t seem to get rid of rosacea.

What does work for inflammatory rosacea is the antibiotic metronidazole (Flagyl), applied as a cream or gel, with or without tetracycline, another antibiotic taken in pill form.

“Antibiotics work tremendously well,” says Dahl of Minnesota, though researchers still aren’t sure whether it’s because the drugs – often taken for months or longer, at low doses – actually kill microbes or simply quell inflammation.

In some cases, rosacea progresses to a third phase, called rhinophyma – or W.C. Fields nose – in which the nose becomes bulbous as oil glands become enlarged and the layer of skin called the dermis becomes thicker.

“This is women’s greatest fear,” says Dr. Joseph Bikowski, clinical associate professor of dermatology at the University of Pittsburgh. In reality, women “rarely, if ever” get rhinophyma, he adds, though men often do.

If the nose gets so big it interferes with vision, surgery is necessary to resculpt tissues. In cases where rhinophyma is caught early, a drug called Accutane may work, though it can’t be taken by women who are pregnant or who might become pregnant because it causes birth defects.

In some people, like the Cape Cod psychologist, rosacea can attack the eyes. She’s been taking low dose antibiotics for years, which helps, though she still can’t wear eye makeup.

But for most people with rosacea, it’s the embarrassment, not the medical problems, that hurts most, especially the assumption that rosy faces are a sign of alcoholism.

“People assume that people with rosacea are drinkers, when that is not the case,” says Ugent of Boston Medical Center. “You can have rosacea and never touch alcohol.”

“People tend to trivialize it because it’s a skin disease,” adds Dahl of Minnesota. But “for some people, it’s life-destroying.”

Triggers of rosacea

A number of foods, drinks, skin care products and other factors can cause flare-ups of rosacea, including these:

Foods:

• Certain cheeses, chocolate, soy sauce, vinegar, citrus fruits, spicy and thermally hot foods.
• Beverages: Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne. Any thermally hot drink.
• Emotional factors:
• Stress, anxiety, embarassment, anger.
• Skin Care Products and Medications:
• Cosmetics and hair sprays, especially those containing alcohol, acetone, witch hazel or fragrances.
• Topical steroid creams.
• Any product that causes redness or stinging.
• Vasodilators (used to lower blood pressure).

Thermal factors: 

• Saunas, hot baths, excessively warm environments.

Weather:

• Sun, strong wind, cold, humidity.

Exercise:

• Any workout that raises body temperature and increases blood flow to the face, such as aerobic exercise.

Medical conditions and behavioral factors:

• Menopause, chronic cough, caffeine withdrawal, smoking.

For more information, contact the National Rosacea Society on the web at www.rosacea.org/ or by telephone, 1-888-NO-BLUSH.

Here’s the so-called problem: The kids in the Colorado Springs schools just aren’t drinking enough Coke, or so says John Bushey, an area superintendent for 13 schools who signs his correspondence, “The Coke Dude.”

It seems the Colorado district had been hard up for money for extras like band competitions and debates. So in 1997, it signed a 10-year contract by which it would get $8-$11 million from Coca-Cola in return for giving the soft drink giant exclusive rights to peddle Coke, juices, teas, other sugary drinks and fancy water in school vending machines.

Coke has similar “partnerships” with schools around the country, including the Burlington, Mass. system and dozens of individual schools in the Boston area, says Bob Lanz, Coke’s vice president for public affairs for New York and New England.

With sugar consumption by teenagers already in the stratosphere, this scheme is not exactly popular with nutritionists. Surprisingly, it doesn’t seem all that popular with kids in Colorado Springs, either, because they haven’t held up their end of this sugar-coated deal.

Sales of Coke products have been so sluggish that Bushey wrote to school officials in September: “We all need to work together to get next year’s volume up to 70,000 cases.”

He wasn’t kidding, as he made plain in an interview. In fact, his solution is to let kids buy drinks “throughout the day except for the half hour before and after lunch” and to place machines “where they are accessible all day.”

Let’s say, for argument’s sake, that bombarding kids with soda pop and other sugary drinks makes economic sense for cash-starved schools. But nutritional sense? Forget it.

Sugar consumption, especially among teens, is “off the charts,” says Michael F. Jacobson, executive director of the Center for Science in the Public Interest, a health advocacy group in Washington, D.C. The group lays much of the blame on the soft drinks, or “liquid candy,” that teens are guzzling.

(Sugar-free drinks aren’t much better, he adds. Artificial sweeteners “are used almost exclusively in worthless foods. If you’re consuming much of them, you ought to worry about your overall diet. They aren’t making good foods better, they’re making bad foods less bad.”

Twenty years ago, his group says, teens drank almost twice as much milk as soda. Now they drink twice as much soda as milk. Girls get only 60 percent of the calcium they need to build bones to prevent osteoporosis in later life. Some data suggest drinking soda instead of milk may also contribute to breaking bones while they’re still teenagers.

The US Department of Agriculture is worried, too, noting that Americans consume twice as much sugar as desirable. Indeed, many of us now get 16 percent of our calories from sugar, including table sugar and products like corn syrup that are added to processed foods.

It’s not that sugar is a toxin, as some health faddists argue. In and of itself, it’s not bad for you. It isn’t even a major risk for diabetes.

But too much sugar can make for health problems, including obesity, heart disease and tooth decay, said a panel of 21 nutritionists in December. They called for a National Academy of Sciences study of the health consequences of sugar consumption.

Metabolically, sugar is a refined carbohydrate, like white bread or potatoes. And, like them, it can trigger a rapid rise in blood glucose, which sets off an outpouring of insulin, the hormone that escorts sugar molecules into cells.

Over time, too much of this cycle can raise blood levels of fatty substances called triglycerides and lower levels of HDL (good cholesterol), increasing the risk of heart disease. There’s also some evidence that this carbohydrate-insulin cycle can exhaust the insulin-producing cells in the pancreas, says Dr. Walter Willett, chairman of nutrition at the Harvard School of Public Health.

But the main problem with sugar, aside from the calories it packs, is that “it squeezes out the good things” like fruits, vegetables and milk from the diet, says Dr. George Blackburn, medical director of the Center for the Study of Nutrition and Medicine at Beth Israel Deaconess Medical Center. Sugar is just “empty calories,” agrees Willett, adding that an eight-ounce serving of Coke contains about eight teaspoons of sugar.

“If people thought of spooning down eight teaspoons of sugar, they’d be grossed out,” he says. “But drinking makes it virtually invisible, which means you can take in a lot more calories than you realize.”

And too many calories, regardless of where you get them, leads to weight gain, unless you exercise off what you take in.

Sugar is also seductive. “It’s not only in things that are sweet, which we know have sugar, but it’s also in processed foods that don’t taste particularly sweet,” says Larry Lindner, executive editor of the Tufts University Health & Nutrition Letter. That includes ketchup, canned beans, barbeque sauce, spaghetti sauce, even cereals that don’t appear to be sweet.

But to focus solely on sugar – and not on refined carbohydrates in general – is to miss the point, nutritionists say, because in some ways, pure sugar may be less of a problem.

“People have been given the idea they can load up on potatoes and bagels but not sugar,” says Willett. In fact, table sugar (sucrose) is made up of both fructose and glucose. Because fructose does not trigger an insulin response like glucose, in some ways, ironically, you may be better off eating pure sugar than starch, in terms of metabolic effects on the body, he says.

“No matter how you take carbohydrates in, enzymes in the pancreas turn it all to sugar,” adds Blackburn. “What the body sees is sugar. It never sees a starch.”

What, then, is a body to do?

Remember the basics – calories do count, and sugar, especially in liquid candy form, can be an insidious wrecker of healthy diets. Weight control, no matter what the fad diet books say, still boils down to a matter of “calories in, calories out,” says Karen Chalmers, director of nutrition services at the Joslin Diabetes Center in Boston.

The bottom line is that you should eat a diet that’s roughly half carbohydrate, including sugar. Within that category, you should try to eat less of the refined stuff, which has had much of the fiber and many of the nutrients removed, and more of the whole grain products like brown rice or whole oats.

And soft drinks? Forget it. If you’re thirsty, drink water. (Juices are okay in small quantities, but they have lots of calories.) If you’re hungry, eat real food.

1: Substitutes can be risky

If you spend time on line, chances are you’ve stumbled upon e-scares about artificial sweeteners, especially aspartame, or NutraSweet, which is alleged to cause methanol toxicity, headaches, brain cancer, lupus, and multiple sclerosis.

In truth, methanol toxicity (which can cause blindness) from aspartame is not a serious concern, says Timothy Maher, director of pharmaceutical sciences at the Massachusetts College of Pharmacy. In fact, there’s more methanol in a can of tomato juice than a soda sweetened with aspartame, which was approved by the US Food and Drug Administration for use in some food products in the early 1970s and for soft drinks in 1983.

“There is some evidence that aspartame may be linked to migraine headaches,” he says, but there’s no credible evidence of any link between aspartame and brain tumors, MS, or lupus, although that’s largely because these haven’t been studied.

There is a danger that anti-aspartame crusaders often don’t talk about, however, the fact that some people can’t metabolize one of the two amino acids (phenylalanine) in aspartame.

Those are people born with a condition called PKU (phenylketonuria). Since children with PKU cannot metabolize phenylalanine, they must eat a special diet to avoid proteins that contain the amino acid, or they run the risk of becoming mentally retarded and dying young. If these children consumed aspartame, “it would really do them in,” adds Maher.

Thanks to genetic screening at birth, however, most people with PKU know it. But this test doesn’t pick up people – a few percent of the population – who inherit just one defective gene for PKU, not two. This means you could be at risk for an adverse reaction from aspartame and not know it.

In addition, some data suggests that schizophrenics who react adversely to antipsychotic drugs such as Haldol also may not be able to metabolize aspartame normally. If they consume it, their reaction to the medications, including involuntary muscle movements, may get worse, says Maher.

In other words, if you’re worried about aspartame, don’t touch it. There are other sweeteners on the market, including Acesulfame K and saccharine, though they’re controversial, too, according to the Center for Science in the Public Interest.

On the other hand, the health advocacy group says, the newest sweetener, Sucralose, approved by the FDA in July, does appear safe.

Even so, the take-home message, as Maher puts it, is “I’d use sugar.” In moderation, of course.

By the spoonful

There is plenty of sugar in many common processed foods. A single teaspoon of sugar weighs about five grams.

Sugar in grams

SOURCE: Tufts University Health and Nutrition Letter.

It sounds promising: You boot up your computer, go to one of the new prescription drug Web sites, type in your name, health insurer, credit card number and address, and ask your doctor to call or fax in your prescription.

Presto! Within a day or so, your medication arrives on your doorstep by mail, UPS or Fedex. No driving to the drugstore. No parking. No standing in line while harried druggists fill your order.

A month ago, the first major Internet pharmacy, Soma.com, went on line with a prescription service, which has already filled thousands of orders through a distribution center in Ohio. By the end of the first quarter, PlanetRx.com and Drugstore.com, with distribution centers in Tennessee and Texas respectively, promise to be up and running, too.

The American Association of Retired Persons (AARP), a longtime mail order prescription giant, recently added on-line ordering for its members, at www.rpspharmacy.com. So has Merck-Medco, which provides prescription drug benefits to health plans and employer groups, though it handles only refills, not new prescriptions, on line (www.merck-medco.com).

With prescription drug sales a booming $88-billion-a-year business, virtual pharmacies were probably inevitable. But it’s too soon to tell how well they’ll work and how different they’ll be from mail order services.

The hope is that Internet pharmacies will make drug shopping even easier than by mail order, says Andy Stergachis, director of pharmacy services at Drugstore.com. You’ll be able to order nonprescription items like vitamins and shampoo along with your antibiotics, for instance, and you can ask your virtual pharmacist questions as well. You will also get e-mail reminders when prescriptions need to be refilled, he says.

True, you have to send personal information into cyberspace, but there are at least some assurances of confidentiality. At PlanetRx.com, privacy will be assured with “the highest level” of encryption, says Stephanie Schear,a founder and vice president of business development.

And if all goes according to plan, on-line pharmacies will fill prescriptions as ethically as your local drug store.

At Soma.com, your doctor must call or fax in the prescription. The pharmacists are required to call the doctor to verify that he or she is legit and the prescription is correct. They’re also supposed to make sure your new drugs won’t conflict with what you’re already taking.

In theory, the virtual pharmacies will also be duly licensed in the states from which they distribute drugs and will be licensed or registered in every state where they have customers as well.

In reality, though, cyber pharmacies, which are expected to be fiercely competitive, are springing up in a regulatory limbo. Is there anyone minding the virtual store?

“There’s not, in my opinion,” says Dr. James Winn, executive vice president of the Federation of State Medical Boards.

The Federal Trade Commission is concerned mostly with deceptive practices, not violations of standards of care, he notes. The Food and Drug Administration’s job is to oversee drug quality, not the practice of medicine by doctors and pharmacists, who, like pharmacies, are licensed state by state.

And therein lies the rub.

In some states, including Massachusetts, the state has no jurisdiction over out-of-state pharmacies, including the mail order firms that have been around a while, because it has no law requiring they be registered, says Chuck Young, director of the state’s Board of Registration in Pharmacy. If there were such a law, the state could initiate legal action if a Massachusetts resident were harmed by prescription drugs shipped from out of state.

“This whole issue is just exploding right now,” says Young. “We’re doing the best we can. But electronic changes are occurring at a faster rate than regulatory boards can keep up, given the resources they’re provided. I would want to be convinced these drugs are being packaged in conformity with federal and state law.”

Another problem is that it may be difficult for consumers to distinguish between on-line pharmacies that are legitimate and those that aren’t, says Carmen Catizone, executive director of the National Association of Boards of Pharmacy.

Some Web sites have already been criticized for having doctors write prescriptions, most notably for the potency pill Viagra, for patients they have never even seen, a medical practice widely viewed as unethical.

“We’re trying to come up with some system for consumers to differentiate between legitimate on-line pharmacies and the not-so-legitimate,” Catizone adds. “In the meantime, consumers should not order any medications over the Internet from sites that don’t assure you that your doctor has been contacted.” (You can also check with your doctor.)

It also may be risky to get some prescription drugs on the Web and others at your local drugstore. “So if you’re switching to an on-line pharmacy, that pharmacy needs to know what else” you’re taking because of potential drug interactions, says Susan Winckler, director of policy and legislation for the American Pharmaceutical Association.

To guard against this danger, new customers at Drugstore.com must fill out a form indicating what other medications they’re taking and what allergies and medical conditions they have. All prescriptions are checked against this information.

Another issue is how Internet pharmacies will deal with controlled substances, says Dr. Helga Rippen, director of the Health Information Technology Institute at Mitretek Systems, Inc., a nonprofit technology think tank in McLean, Va.

Drugstore.com won’t fill prescriptions for narcotics such as Percodan and Demerol, though this type of prescription can be filled at neighborhood drugstores, says pharmacist Stergachis. Drugstore.com will fill prescriptions for some painkillers and sleeping pills, however, after checking with your doctor.

In general, Stergachis says, the on-line service plans to call the patient’s physician “if there is any reason to suspect any type of a problem or if clarification is needed,” just as pharmacists are supposed to do already in local drugstores. (With the on-line service, just as in the current system, there’s no automatic way to tell if this consultation does occur.)

Despite such concerns, ordering prescription drugs on line may not turn out to be all that revolutionary. After all, says Schear, PlanetRx’s founder, “We’re not changing anything about the existing system. You go to a doctor. You say you want your prescription filled from PlanetRx. They fax or call us just as they do today.”

“We plan to verify prescriptions,” she adds, precisely how she won’t say, for competitive reasons, until the site is launched.

Stergachis agrees that in many ways, on-line pharmacy services will be “similar to mail order services,” which account for about 13 percent of the prescription drug business.

In fact, if there’s a downside to all this, that may be it.

Even with the net, there will “still have to be contact between the pharmacist and the physician,” says Ed Spearbeck, senior vice president of corporate and pharmacy affairs for the AARP. “That is time-consuming. I’m not sure people are prepared to understand that fully.”

Using an on-line pharmacy

 – Check to see whether the on-line service is willing to contact your doctor to verify prescriptions, especially for controlled substances such as painkillers and sleeping pills.

• If you have any doubts about whether your personal medical information will be kept confidential, don’t use that site.
• Call the board that licenses pharmacies in your state and ask if they have received any complaints about the site you want to use; also ask whether your state has a law giving it jurisdiction over out-of-state pharmacies.
• If there’s anything that doesn’t look right when you get the medication, don’t take it. If your current medication is green and you get red pills, for instance, don’t take them.
• If the package looks like it’s been opened or tampered with, don’t take the medication.
• If you order some medications on line and others from your regular pharmacy, tell both pharmacists what other medications, vitamins, herbal supplements and the like you are taking, to minimize the danger of adverse interactions.