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The researchers contacted the victim of one infection, who shared Web traffic log data from the compromised machine. The log data from the compromised machine also recorded visitors’ Internet addresses; that discovery revealed the number of unique visitors and the country of origin of each customer.

The UCSD team found that after visitors selected a particular drug from the pharmacy’s home page, they were sent to a product page, where they were prompted to select the particular dosage and quantity. After that, users were sent to a shopping cart page, which included many new
images representing product recommendations. By comparing the number of cart visits with distinct Internet addresses, they were able to estimate the fraction of visitors who selected an item from the shopping cart images, and were able to infer the product each customer selected.

The researchers found significant differences between the drug selection habits of Americans and customers from Canada and Western Europe. The analysis divided the EvaPharmacy pills into two broad categories: lifestyle drugs such as erectile dysfunction and human growth hormone pills, and non-lifestyle drugs, including those used to treat disorders including anxiety, sinus infections, high blood pressure, hair loss, cancer, and infertility.

The researchers discovered that U.S. customers selected non-lifestyle items 33 percent of the time. In contrast, Canadian and Western-European customers almost always bought drugs in the lifestyle category—only 8 percent of the items placed in their shopping carts were non-lifestyle items.

“We surmise that this discrepancy may arise due to differences in health-care regimes; drugs easily justified to a physician may be fully covered under state health plans in Canada and Western Europe, leaving an external market only for lifestyle products,” the researchers
write. “Conversely, a subset of uninsured or underinsured customers in the U.S. may view spam-advertised, no-prescription-required pharmacies as a competitive market for meeting their medical needs. To further underscore this point, we observe that 85 percent of all non-lifestyle drugs are selected by U.S. visitors.”

Unlike many other nations, the United States has not enacted price controls on prescription medications. According to a study last year by the AARP, prescription drug prices in the United States rose more than 8 percent in 2009; some drug prices have increased between 40 and
92 percent in the past five years.

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