1999.06.13 Ostrich Behavior by Medical Professionals
Medical professionals continue to ignore the risks -- and the benefits -- of online medicine. With news this last week that a young teenaged boy was able to buy Viagra online, perhaps those of us in the medical profession will heed our call to protect the public health.
Of particular interest is a pair of comments I received back from the editors of JAMA and the New England Journal of Medicine. In order to bring attention to the need for online standards and regulations for the practice of medicine, I wrote letters to the editor for both journals. Both replied back to me that the reviewers felt the topic wasn't of sufficient importance to be published! Here is the letter I sent on May 1, 1999 to the New England Journal of Medicine:
Letters to the Editor
New England Journal of Medicine
10 Shattuck St.
Boston, MA 02115
Thomas F. Heston, MD, FAAFP
Mountain Health Care
740 McKinley Avenue
Kellogg, ID 83837
To the editor:
Is it still correct to define primary care as a "hands-on" specialty? With the online pharmacies and medical clinics, Iím not so sure.
Historically, young males made up the bulk of internet users. This has been assumed to be the reason that pornography has flourished online. Thus, it is not surprising that when a medicine designed to enhance sexual performance became FDA approved, the climate was right for the emergence of online prescribing. For example, earlier this year I received an email solicitation urging me to join an affiliate program promoting sildenafil (Viagra). This affiliate program was similar to the one Amazon.Com used to build its internet empire. All I had to do, according to the advertisement, was place a banner on my website. I would then earn a commission anytime someone clicked on the banner and made a purchase. I was not sent this email because I am a doctor, but rather because I am a webmaster. Virtually anyone with a website can join in the Viagra bonanza!
Physicians need to insist upon standards and regulations for online medical clinics. Those of us who have dedicated our lives to helping others improve their health must address this very real danger. With this in mind, I propose the following three point plan as a starting point for our examination.
1. Online medical clinics that establish doctor-patient relationships can dispense medical information, but not medical advice. The health care providerís credentials shall be made easily accessible online, free of charge. These providers must clearly state their precise degree and field of expertise (e.g. medicine, psychology, or education).
2. Online prescribing should be forbidden both legally and ethically. A health care provider needs to examine the patient before prescribing, and be available to manage any side-effects.
3. A world-wide licensing program should be established to allow internet users to identify reputable sources of medical information, and allow physicians from any country to establish an online medical clinic.
The internet can be a tremendously useful tool to bring doctors closer to their patients, but primary care rests upon a personal, intimate, hands-on relationship. As physicians, we need to take a leadership role in establishing online standards and regulations.
Thomas F. Heston, MD, FAAFP
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