Online Pharmacies and Telemedicine

Not a day goes by when our email inboxes do not fillunder controversy as in some cases all it takes to
with advertisements for prescription drugs. Many ofhave that prescription delivered to you by next day
these emails promise to deliver drugs of all classes byair, is to fill out a questionnaire online.A study
overnight courier without a prescription. While thereconducted by Henkle in 2002 to ascertain how easy
are legitimate online pharmacies, and the practice ofit would be to obtain drugs over the Internet found
telemedicine or cyber-medicine is gaining acceptance,that "37 of the 46" pharmacy required a prescription
this change in the way medicine is being practiced isfrom a licensed doctor. The emphasis was on the
rocking the foundations of the medical establishment.prescription and not on the doctor. Henkle (2002) in
Being able to consult a doctor online, and obtainfact notes that some sites offered to recommend a
prescription drugs delivered to your doorstep by UPSdoctor." Henkle (2002) was able to obtain prescription
has broad social and legal implications. The Internetdrugs from nine sites outside the US during the
facilitates making drugs available to those who maystudy, without a prescription.Online pharmacies with a
not be able to afford to pay US prices, aredoctor affiliationThere are a number of online
embarrassed to see a doctor face-to-face, or arepharmacies, with a medical affiliation is that take
suffering from pain, the treatment of which putsgreat pain to differentiate themselves form
most doctors in direct conflict with the 'war on drugs'unlicensed overseas pharmacies. These pharmacies,
but on the other hand there is the question whetherstress that they are "American based companies that
these pharmacies make drugs available to recreationalprovides consumer's easy access to FDA approved
drug users without the oversight of a licensedonline prescriptions over the Internet and are quick to
medical practitioner.The Need for AlternativesMedicalpoint out that "An online consultation can be just as
care in the US has reached a point where it isrelevant as an in-person consultation." It is interesting
expensive and impersonal which has caused theto note that many of these online pharmacies also
consumer to become generally unsatisfied with thepoint out that "While they are committed to making
medical establishment as a whole. Examples includeaccess to online prescriptions easier, they believe that
the huge differences between the cost of drugs inthe Internet can not replace the importance of
the US and Canada, long wait times in US pharmacies,regular doctor visits to fully evaluate your health and
and poor service in general. Perhaps realizing this, USany medical conditions." Many of these online
customs appears to tolerate the millions of Americanspharmacy sites also makes a wealth of drug
that visit Canada every year to buy theirinformation available on its web site that enables the
medications, as for the most part, these 'drug buyers'consumer to educate themselves on drugs that may
are elderly American's that can't afford the high costhave been prescribed. The Internet has for all
of filling their prescriptions in the US.Rather than tointensive purposes is quickly replacing the brick and
travel to Canada or Mexico millions of Americans aremortar base physician as a patient's primary health
now turning to the Internet for both their medicalcare provider.A sales pitch, of course, or is it? Most
needs. Telemedicine (or cyber medicine) providesof the legitimate online pharmacies ensure that they
consumers with the ability to both consult with acomply with state and federal regulation. The doctors
doctor online and order drugs over the Internet atare licensed in all 50 states and their pharmacies are
discounted prices. This has resulted in consumerstoo. These legitimate Internet pharmacies cater to
turning to online pharmacies for their medical needs,those that are looking for a better price; for some it
and in particular pharmacies with a relationships with acomes down to making the choice of eating cat food
physician, which allow the consumer to completelyon crackers in order to afford their medications
bypass the traditional brick and mortar pharmacies,because of the high US drug prices. In other cases
with the added benefit of having their physician actpatients resort to cyber-medicine to avoid the
as an intermediary between the consumer and theembarrassment of having to deal with a physician or
pharmacy. According to Johnson (2005) this is as apharmacy that may be judgmental. Many of these
result of consumers becoming very dissatisfied whenonline pharmacies will arrange a consult with a
it comes to dealing with both brick and mortarlicensed, medical doctor over the phone and will then
pharmacies and medical practitioners. As Johnson,fill the prescription accordingly.According to Henkel
notes, "Consumers are more likely to know the name(2000) "More and more consumers are using the
of their hairdresser than their pharmacist." WhenInternet for health reasons" and references a study
Johnson (2005) rated the various professions withincarried out by a market research firm Cyber Dialogue
the health care system, he found that pharmacistsInc., "that found that "health concerns are the sixth
had the lowest interaction with their patients than didmost common reason people go online" (Henkel
any other group. Today, as a result of this2000).For many people a trip to the pharmacy is an
"consumers are buying 25.5 percent of theirordeal. In some cases the local pharmacy may also
prescriptions online, opposed to 13.5 percent of whichbe located in the closest town which may mean a
are picked up at a brick and mortar pharmacy"long drive if one lives in a rural community. Online
(Johnson 2005).Drugs and SocietyWhat has broughtpharmacies provide a means through which their
so much attention to online pharmacies is that it isprescriptions can be delivered conveniently and
possible to obtain just about any drug without aquickly. Being online also allows the consumer to shop
prescription online. Many of these prescriptions arefor the best prices, an important factor if one is living
for legitimate purposes purchased through an onlineon a pension.The Internet has also created a more
pharmacy because the buyer is too embarrassed toaware user. It is not unusual for a consumer to
visit the doctor or for other reasons including theresearch drugs on the Internet. A consumer may
unavailability of FDA approved drugs to thehave seen a TV or magazine advertisement
consumer. These drugs may include steroids that dueadvertising a new drug. Ultimately, the Internet also
to their misuse and being classed as a classed aprovides the consumer the opportunity to enter into
category three drugs, are seldom prescribed bya doctor patient relationship that may in fact be
physicians. These drugs have a useful purpose tomore legitimate than the doctor who makes a
those suffering from any wasting disease such asphysical appearance. Further information on doctors
AIDS, they also play a role in ant-aging (FDA,that practice telemedicine can be found at: is
2004).The Doctor Patient RelationshipToday a visit tointeresting to note, as discussed previously, that
a doctor is generally brief, much of the triage it isconsumers are becoming dissatisfied with the care
done by a nurse or a nurse practitioner with theand treatment they receive from both brick and
doctor only dropping in for a few minutes, if at all. Inmortar physicians and pharmacies. Zanf (2001),
many cases the patient is seen by a nursereferences a study by Lang and Fullerton that
practitioner. One of the arguments against"Identified four factors related to outpatient
telemedicine or perhaps a better term ispharmacy services: professional communication,
cyber-medicine, is that the doctor does not have aphysical and emotional comfort, demographics, and
physical relationship with the patients and thus is in nolocation and convenience." All of which are
position to make a diagnosis, and thus can not legallycontributing factors as to why more and more
prescribe drugs.Ironically when one compares theconsumers are resorting to cyber-medicine.The Dark
work up that one has to go through to consult withSideThere is also a dark side to the Internet
an online physicians and compares this to apharmacy, as previously discussed, spam email
face-to-face visit with a brick and mortar doctor, onetouting the availability of any prescription drug one
finds that the online physician, in many cases, has acould want, without a prescription, is something
better understanding of the patient's medicaleveryone is familiar with has reached epidemic
condition than does the doctor who meetsproportions.From Ambien, and of course Viagra to
face-to-face with the patient. In most cases beforemore powerful drugs such as Oxycontin, you can
an on-line a doctor prescribes any type of medicationhave it all. Over night shipping is available in most
they insist on a full blood workup they may alsocase, or so these emails proclaim.
require that one has additional tests performed, forIn some instances this pharmacy spam originates
example.The AMA, the federal government, andfrom unscrupulous individuals who have no intention
various states claim, however, that it is illegal for aof delivering the drugs, realizing that very few
doctor to prescribe drugs without a validpeople, if any, will complain about the non delivery of
doctor-patient relationship. While there are no laws atan illegal drug through the mail.In other cases the
present that outlaw online pharmacies, various statesdrugs are sent without a prescription from countries
have enacted legislation, or are in the process ofwhere that particular drug may legally be sold without
enacting legislation to prohibit a doctor froma prescription, or at least the laws are more relaxed.
prescribing drugs to a patient that they have notValium, for example, is sold over-the-counter in
seen face to face. Some states also require that theTaiwan.According to Crawford (2004) "Consumers
doctor that prescribes the drugs be licensed in theirwho purchase drugs online thinking that they are
state. This alone could hamper the development ofthey are getting the same drugs as they would from
cyber-medicine. According to William Hubbard (2004),their local brick-and-mortar pharmacy are being
FDA associate commissioner "The Food and Drugmisled, and as a result are putting their health, and
Administration says it is giving states first crack ateventually their lives at risk" Crawford cites examples
legal action, though it will step in when states do notof Internet pharmacies supplying drugs that were
act" (FDA, 2004).Internet PharmaciesThe reason thatunder strength, contaminated and mislabeled
email boxes around the country fill up with offers to(Crawford 2004).According to Won (2005)
supply drugs of all kinds, at reduced prices, withoutDrug-industry executives think the Internet and
prescriptions, and more is because people buy themmail-order operations will be the biggest source of
as the billions of dollars the drug companies arecounterfeit drugs over the next five years, according
making each year attest to. The Internet hasto a report released today by Ernst & Young.
become the drug store of choice forAccording to James G Dickinson (2005):The federal
many.Categories of Internet PharmaciesInternetgovernment in July shut down an alleged illegal
pharmacies are generally acknowledged to beInternet pharmacy for selling counterfeit drugs and
comprised of the following five categories:Internetissued a warning on other counterfeits found to have
pharmacies can be divided up into five differentbeen sold in Mexican border pharmacies to individual
categories, as follows:Licensed online pharmacies withpatients from the U.S. The Internet pharmacy had
a no medical affiliation.sold more than $7 million in counterfeit Viagra and
Licensed online pharmacies with a medical affiliationother prescription drugs over the past five years,
No record online pharmacies (NRP)according to the San Diego Union-Tribune. The San
International online pharmacies (IOP)Diego-based operation required individuals to complete
Licensed compounding pharmaciesThe licensed onlinea $35 "doctor consultation" survey before receiving
pharmacies with a no medical affiliation are of coursethe prescriptions, but the survey was never shown
Drugstore.com, CVV, and others. They all require ato a health professional to evaluate whether a safety
prescription from a licensed doctor that the patientrisk existed, the paper says (Dickson, 2005).In a
has a doctor patient relationship with. The prescriptionseparate action, the FDA warned Americans about
can be called in by the doctor.The licensed onlinecounterfeit versions of Merck's cholesterol drug
pharmacies with a medical affiliation often depend onZocor and generic Carisoprodol - used for treating
a broker. The broker collects your medicalmusculoskeletal conditions - that had been imported
information, and then assigns your case to one offrom Mexico by individual Americans (FDA,
their networked physicians. Many of these2005).Over the last year patients suffering from pain,
networked physicians are willing to prescribe painand other conditions that they are reluctant to see a
killers as they believe that it is only through the usedoctor face-to-face, have had the option of
of these drugs that some people can live aconsulting a doctor online. The ability to consult with a
harmonious life.A Government Accountability Officedoctor online, and then to receive drugs as a result
(GAO) Committee on aging held in June 2004 foundhas come under much controversy. This has for the
that "Unlicensed international pharmacies do notmost part been as a result of not adequately
require a prescription, and are generally located offscreening patient's records, or ordering from
shore." No prescription pharmacies can be found allunregulated overseas pharmacies.
over the world. Many of these sites have come