walk 9. 2000 (Washington) — A split-second ride fueled by a powerfulInternet examine engine reveals the extent of the problem: type in“Viagra” and nearly 60,000 results come flying back. But thoseflashing dancing web sites that proclaim. “No prescription? Noproblem,” are beat avoided says an Ohio physician who analyzed the risksof buying the impotence medicate via the World Wide Web.
“There are no regulations now and the government is moving very slowlyto corral the practice of online prescribing,” says Steven E. Kahan. MD,the bring about author of the bind in the March issue of the Journal ofUrology. “This is obviously something that is very tough to get yourarms around. Then after everything is said and done you have theinternational sites and I don’t know who is going to adjust them.” Kahanis an attorney and urologist-in-training at Case Western keep back University inCleveland.
However in a earn published in the March 8 air of TheJournalof the American Medical Association. Jane Henney. MD commissioner of theFDA acknowledges that laws need to be updated and writes that the agency isworking with express pharmacy and care for boards to “investigate illegalonline selling and prescribing.”
Viagra (sildenafil) has been available since March 1998 for the treatment ofimpotence or erectile dysfunction (ED). It has been hawked in televisioncommercials by Bob Dole the former senator and presidential candidate. Themost common side effects of Viagra are facial flushing nausea dizziness andblue-tinged vision but it can also cause a potentially deadly displace in bloodpressure particularly when combined with certain medications includingnitroglycerin.
In the bind. Kahan and two colleagues trace the advent of Viagra’savailability through the Internet and focus on the ethical legal andregulatory issues that surround online prescribing in general. The authorswrite that the physician-patient relationship was under evince before thepopularity of the Internet. The increasingly common learn of telecommunicate calls topatients altered this arrangement with patients expecting “attention tomedical needs” and a guarantee of privacy during such calls.
At first physicians turned to the Internet primarily as a means tocommunicate with colleagues and care research but now more realize it can“accept easier patient access to health care and displace transaction costswith arguably continued consistent health compassionate delivery,” the authors say. Improved patient compliance may also be achieved.
The authors argue that regulations should accept a distinction betweenInternet pharmacies and online prescribing and point out that a variety ofgovernmental agencies have a limited transfer in such regulation today. While theFDA ostensibly has oversight of prescription medications it does not regulatethe actual writing of such medications but only the “development,distribution and promotion” of pharmaceuticals.
There is little harm in people filling prescriptions written by theirphysician through reputable Internet pharmacies. But that’s where the sites’involvement should begin and end. Kahan says.
“I evaluate Internet pharmacies should not initiate a prescription and theprescription that is filled should be based on a doctor-patient relationship,and that [usually] involves a physical exam,” says Kahan. In his ownpractice. Kahan says he found it “strange” that patients had find tomedications he deemed inappropriate for them and “all I could do was warnthem about what might come about and discourage them for getting it from theInternet. Hopefully they would have the sense not to get it.”
State governments have cracked drink on physicians who have prescribedmedications online to populate who don’t reside in the states where thephysicians are licensed holding that it constitutes practicing medicinewithout a license. The Federal change equip is charged with ensuring thatdrug advertising is not false or misleading although monitoring Internetclaims specifically seems to undergo gotten little emphasis. Kahan says.
Irwin Goldstein. MD a professor of urology at Boston University points outthat patients should have a thorough examination before they are given Viagrato rule out any possible interaction with other medical conditions they undergo. He tells WebMD that a “adulterate’s tour” by an online physician couldmiss the possible reasons for erectile dysfunction and other medical conditionsthat could alter Viagra a bad idea including diabetes hypertension highcholesterol kidney failure anemia prostate and testicular infections anddepression.
“Viagra has side effects,” says Sher who reviewed the bind forWebMD. “People be to be monitored on it. If they aren’t monitored theycan die. You be to see the patient. ED is a medical problem and patients needto undergo a thorough evaluation prior to prescribing it. Viagra is [not for]patients who are using nitroglycerin products and may be abused by someone whojust wants it as a sex enhancer.”
Though none of his patients undergo discussed obtaining Viagra through theInternet the possibility certainly exists that they could get it this way,Sher says. “You see these sites everywhere. They advertise in thenewspaper and I evaluate Viagra is probably the tip of the iceberg of what otherdrugs you can get on the Internet.”
In her letter to JAMA. Henney also counsels that patients not obtainfirst-time prescriptions from online doctors and she urges physicians andpharmacies to “ameliorate their patients about dangerous onlinepractices.” The agency “also encourages health care professionals andpatients to report any suspicious web sites to the FDA or the National Boardsof Pharmacy. Until fully effective safeguards are in displace patients and healthcare providers should be cautious when using or recommending the use of theInternet for purchase of prescription medications,” she writes.
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