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You can lower LDL, the bad cholesterol, with niacin. Niacin can cause flushing which, though uncomfortable, is harmless. more...   |
 Internet Medicine On February 5, 1999, the Wisconsin Medical Examining Board issued a complaint against a Milwaukee physician who prescribed Viagra® via the Internet. Among other things, the board complained that the physician did not conduct face-to-face meetings with patients and, in many cases, didn't even speak with them. Instead, prospective patients spoke with a screening person, who asked what medications they were taking, whether they were allergic to any medications, and what surgeries they had had. The complaint also objected that the doctor could not reasonably ensure that Viagra® was being used for "legitimate medical purposes [rather than for] recreational or experimental or other non-medical uses."1 This is the first instance I am aware of in which a state medical board initiated a disciplinary proceeding against a licensed physician for practicing medicine on the Internet. Advantages of Internet Medicine Why would anyone want to get a prescription for Viagra® over the Internet? The answer is that it's convenient and it may be cheaper than going through your regular physician. But added to that is the very facelessness that the Wisconsin medical board complains about, the sense of privacy and relative anonymity. Of course, the Internet communication may not be adequately secured and, if you actually order the drug from the website, you have to pay with a credit card and give some sort of address. But this may be preferable to discussing your sex life in person with someone, even your physician, and enduring the embarrassment of picking up the prescription at the drugstore, particularly when the pharmacist or clerk, in making sure that they are giving you the correct prescription, announces the name of the medication to you and everyone else standing in line. Risks Yet, the dangers of Internet medicine can not to be ignored: the potential for inaccurate or incomplete information about the patient, particularly information from an actual physical examination; the difficulties of providing adequate warnings to the patient; the lack of follow-up. But how real are these dangers, compared to typical non-Internet prescribing practices, and are there reasonable ways of avoiding them? Are the Risks Real? Internet medicine certainly doesn't look like the traditional patient-physician relationship. There is no face-to-face interaction. There is little or no opportunity for physicians to access and consult patient records. Nor does it resemble the image of the small-town, family doctor who knows all of the medical histories of his/her patients by heart. Yet, how realistically do these traditional models describe the modern patient-physician relationship? Modern physicians increasingly practice and prescribe by telephone, which is similar in many respects to practice via the Internet. Researchers studied a two-physician family practice and found that 31 percent of telephone conversations with patients resulted in prescriptions, more than half of which were not for refills.2 Many of these interactions took place after hours, when physicians did not have access to patient records. Physicians may be disinclined to prescribe medications for someone they've never met or examined but, practically speaking, without immediate access to the chart, the physician may retain little information from a previous encounter with the patient who is on the other end of the line. Furthermore, in an era of managed care, in which patients are cared for increasingly by non-physician health professionals, and rarely if ever see their actual physician and in which patients voluntarily and involuntarily switch physicians frequently as they change residences, jobs and health plans, the likelihood is small that the physician will know or recall enough information about the patient to avoid relying on what the patient tells the physician over the phone. In its facelessness and need to rely on patient-reported information, Internet medicine may not differ all that much from so-called traditional medical practice. Let's recognize the Internet's value in educating and informing, while we maintain the same critical eye we have for our doctors and hospitals and HMOs. The Future Someday, Internet medicine most likely will be routine. Patient information will be accessible to physicians online from electronic medical records. Physiologic data will be transmissible telemetrically. Laboratory results will be obtained via in-home testing. Our task should not be to prevent the growth of Internet medicine but, rather, to make sure that it is delivered ethically and responsibly. As for the Wisconsin medical board's concern over "recreational" and "non-medical uses" of Internet-prescribed Viagra®, how many traditional prescriptions for the drug do you suppose are written for true, frank, erectile dysfunction? Or, to put it another way, whose sexual performance is so perfect that they can't say that they suffer at one time or another from some measure of dysfunction that Viagra® might remedy? The Wisconsin officials would seem hard put to distinguish between prescribing the drug for a non-approved use, which is perfectly legal, and prescribing it for a non-medical purpose. After all, most of us probably regard sex as "recreational" in the first place. January 2000 Maxwell J. Mehlman, J.D. |
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