JUST
WHEN YOU'RE getting comfortable looking up answers to
health questions online, the Web is throwing out new
challenges that might make you consider how far you want
to go in using it as a medical resource.
Are you ready to confer with your doctor
electronically? Fill prescriptions via the Internet?
Have prescriptions written by a doctor who has never met
you? No matter how good the Internet gets, "nothing can
replace the physical exam for an accurate diagnosis as
the basis for prescribing medicine or doing any other
type of medical treatment," said Dr. Stuart Lewis,
assistant professor of clinical medicine at New York
University School of Medicine.
Yet the lure of faster and cheaper ways to access
health care is overcoming some qualms about the
recurring Internet issues of privacy, confidentiality
and verifiability: If you can access your medical
records online, who else can? Is the person at the other
end really a doctor? Is a pharmacy merely an Internet
version of a known brick-and-mortar one, or is it an
unlicensed drug factory in another country? It can be
hard to focus on all those concerns if your first
priority is a prescription that is so easy to get, all
you have to do is "enter a little bit of information,
which may or may not be true, in a few boxes," said Joan
Price, a health and fitness expert, and author of "The
Complete Idiot's Guide to Online Medical Resources"
(Alpha Books, 2000, $18.95).
It's hard to quarrel with forgoing the long lines at
the local pharmacy, but what about having a pharmacist
you recognize, who will be there tomorrow if you have a
question? "It's very dangerous for someone to circumvent
the prescription process, which is there for the
protection of the consumer," Price said.
In particular, lifestyle drugs like Viagra have
become popular via the Web, she said, because it gives
some people a way to avoid discussion or face the
prospect of being turned down by a doctor who actually
knows their medical history.
Risks include getting a drug you shouldn't take, or
getting a drug that isn't what it's supposed to be.
"Some sites are fly-by-night," said Price, "and a lot of
the medications are coming from places overseas that do
not have the same restrictions and regulations that we
do." What you need to do is distinguish between the type
of online pharmacy that plays by the rules and one that
does not. Harvey Jacobs, an Internet attorney with
Jacobs & Associates in Washington, said the National
Association of Boards of Pharmacy (www.nabp.net) has a
program called VIPPS (Verified Internet Pharmacy
Practice Site). Any online pharmacy that carries its
seal has passed a rigorous review based on 17 criteria.
They include the opportunity to consult with a
pharmacist and assurance of compliance with licensing
and inspection requirements of both the pharmacy's state
of origin and each state to which it dispenses drugs.
Similarly, there's a move afoot to verify the
identity of doctors online.
Intel Corp. is working with the American Medical
Association (AMA) to issue digital IDs to physicians.
"We think that health is one of those online areas
where it's really critical that you understand in a real
world sense who the parties are on both ends of an
online transaction," said Mariah Scott, general manager
of Intel's Internet Authentication Services. The next
step, she said, is to have IDs for consumers for use in
creating and accessing personal medical records online
confidentially.
It's not likely that you'll be able to avoid such
issues of telemedicine for long.
"Health care plans are being connected to their
patients, and physicians are being connected to each
other, their patients, and to health plans. It's all in
the works," said Doug Hastings, president-elect of the
American Health Lawyers Associates in Washington.
The health care field is a highly regulated one, with
the federal government and each of the 50 states having
a hand in multiple rules for physicians, hospitals,
HMOs, pharmacies. But, said Hastings, a lot of
regulatory agencies say they can't really keep up.
For example, each state licenses its own physicians
and pharmacies, said Linda C. Fentiman, director of the
health law and policy program at Pace University Law
School in White Plains. So what happens if you're online
in New York, ordering from a pharmacy or getting advice
from a doctor licensed in California? Under current
rules, a doctor has to be licensed in New York to
practice medicine in New York, and a pharmacist has to
be licensed here to dispense drugs in the state.
Problems may include using a doctor who is, in effect,
practicing without a license and resolving the question
of jurisdiction if you ever needed to bring that doctor
to court.
Fentiman said she hopes legislation down the road may
change some of this, including providing for some form
of national licensure for doctors who perform any type
of telemedicine.
What complicates the matter is that these questions
are not just about patient care, she said, but are "an
economic and turf issue. Each state has a strong medical
society and a lot of lobbying clout." But in the
short-term there is at least one approach that still
works to fend off the unreliable, invalid or risky. The
AMA, which recently started a peer-reviewed Web site
connected with medical specialty societies
(www.medem.com), "is very supportive of the electronic
networks," said its president, Dr. Thomas O. Reardon.
But when it comes to using those networks wisely, he
said, "you should still see your physician and go over
all that information and all your symptoms."
