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Virtually Practicing Medicine

A recent survey examined direct sildenafil (Viagra) sales to consumers over the Internet (see JW Dec 1 1999, p. 186, accession number 991109004, and N Engl J Med 1999; 341:1389). Now, a new report adds to our understanding of how the Internet is being used to sell prescription drugs.

Investigators searched the Web to identify sites through which consumers could purchase prescription medications. Of 46 sites identified in early 1999, 11 percent revealed their geographic location, and 80 percent required a physician prescription or consultation. (All sites that did not require prescriptions were outside the U.S.) Almost all sites sold sildenafil; many did so exclusively. Other commonly offered drugs included finasteride, valacyclovir, orlistat (before FDA approval), celecoxib, loratadine, and bupropion.

Virtual physician consultations were available through sites that required them; the physician's name and qualifications were not disclosed. Consultations involved a liability waiver and were costly (median, $70) if the medicine requested was prescribed. Consultations were free if medication was not prescribed. Patients received consultation results by e-mail. Median per-pill prices for these Internet purchases (excluding shipping costs) were higher than prices in Philadelphia pharmacies for 2 of the most commonly offered drugs.

Comment: The Internet may be more convenient initially for patients than a face-to-face physician consultation. But this report suggests potential harms, including the consequences of purchasing goods and services of unknown quality based on advice that by necessity is limited and may be inappropriate. Editorialists highlight the position, held by the AMA and the FDA, that virtual consultation does not meet the standards of appropriate medical care. (Note: These articles are available on the Web at: http://www.acponline.org/journals/annals/05oct99/bloom.htm and http://www.acponline.org/journals/annals/05oct99/henney.htm.)

— R Saitz

Published in Journal Watch General Medicine December 3, 1999

Citation(s):

Bloom BS and Iannacone RC. Internet use for prescription pharmaceuticals. Ann Intern Med 1999 Dec 7 131 830-833.

• Original article (Subscription may be required)
• Medline abstract (Free)

Henney JE et al. Internet purchase of prescription drugs: Buyer beware. Ann Intern Med 1999 Dec 7 131 861-862.

• Original article (Subscription may be required)
• Medline abstract (Free)