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