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Cedar Rapids, Ia. ? The physician sitting at the defendant's table looked like he could be a kindly colleague of TV's Marcus Welby, M.D.
He had neatly trimmed gray hair, a conservative sport coat and silver-framed bifocals. He identified himself as Edward Schwab, a 71-year-old osteopath from Shreveport, La.
He was in federal court late last month to admit that he also was a drug dealer, one of numerous doctors who helped run one of the biggest Internet pill-distribution rings ever busted.
A magistrate judge double-checked his calm admission. "Do you understand what they're claiming you did wrong?" the judge asked.
"Yes, your honor," Schwab said.
In court papers, the doctor acknowledged illegally approving more than 19,000 electronic prescription requests from people wanting to buy narcotics or stimulants over the Internet.
Before he pleaded guilty to counts of conspiracy and money-laundering, the judge warned him that he could face up to 15 years in prison when he is sentenced at a future hearing. In return for his guilty plea, prosecutors agreed to ask for only about three years, but the sentencing judge could order the full term, and there will be no parole.
Six other physicians also have pleaded guilty in court here. Prosecutors say they expect to charge up to 50 doctors, which could make this the broadest such prosecution in U.S. history. None of the doctors charged so far is an Iowan, but authorities won't say if any Iowans are among the remaining suspects.
The scheme began to unravel in 2003, when regulators noticed that a small Dubuque pharmacy suddenly was mailing out huge quantities of addictive drugs to addresses throughout the country.
Investigators raided the pharmacy, then tracked many of the drug orders to a Web site called BuyMeds.com. The site's owners allegedly paid physicians to write prescriptions based on electronic questionnaires that customers filled out from their home computers. Schwab admitted authorizing a total of more than 1 million doses of drugs requested via such Web sites. He admitted approving up to 200 orders per day, and receiving $8 for each one.
Three Iowa pharmacists surrendered their state licenses, but so far, only physicians have faced criminal charges in the investigation. The government's broad net represents an increasingly aggressive approach against doctors involved in Internet drug schemes, a national expert said. "This is one of the biggest, if not the biggest, case of this kind that we've seen," said Dale Austin, senior vice president of the Federation of State Medical Boards.
Stephanie Rose, an assistant U.S. attorney prosecuting the cases, said doctors can provide a veneer of legitimacy to unscrupulous Internet drug sites. "The hope of the Department of Justice is to stop the flow of legal drugs to the illegal market," she said in an interview. "Doctors are a big part of the legal market. We want to make sure they're not drawn into the illegal market."
Authorities say it is illegal for a doctor to prescribe drugs without examining patients or having a legitimate medical relationship with them. It also is illegal for consumers to buy such medicine without a valid prescription, but consumers rarely are prosecuted for making purchases from the growing array of Web sites offering Vicodin, Valium, Ritalin and other addictive drugs.
BuyMeds.com, which was owned by a company in the Virgin Islands, no longer sells drugs, but many other sites remain in business. I nternet message boards are filled with boastful reports from the sites' customers. Here's one posted in 2003 by "Tyler," who related his experience buying the narcotic painkiller hydrocodone on BuyMeds.com. He ordered 60 pills on a Sunday night, and received them by Federal Express Wednesday morning, he said. "These will come in useful if ever I should run out of the Tylenol 3's my doctor prescribes. I have to say that out of the SIX internet pharmacies I have tried, they have ALL come through."
"Tyler" wrote that he spent $168 for the drugs. If he had brought a legitimate prescription for the same pills into an Iowa pharmacy, he could have bought them for about $35.
Urbandale pharmacist John Forbes said the fact that Internet customers will pay so much for the drugs implies they have addiction problems. "It runs up a big red flag to me," he said. Forbes applauded authorities for aggressively prosecuting the current case. "I think they're doing this to set an example. They want to put a stop to this."
Rose, the prosecutor, acknowledged that the government lacks resources to prosecute every customer who purchases pills illegally. "I don't think we're ever going to stop the addicts from wanting to buy them," she said. "All we can do is try to shut down the supply."
The leader of Iowa's largest doctors' group said he had no qualms about possible imprisonment for physicians in such cases. "This isn't about legitimate business. This is about drug-dealing," said Dr. Stephen Richards of Algona, president of the Iowa Medical Society.