Online consultations and prescribing are now commonplace on the world wide web. Tonight I just notice that there has popped up another website on Yahoo! offering online prescriptions and consultations for Viagra, bringing the total to 19. Yahoo! has even given Viagra its own category! Recently I received a spam in my email box asking me to join an affiliate program fo Viagra. All I had to do was to place a banner or link on my site, and I would get paid every time someone I referred bought some Viagra. Of course, the spam was not addressed to "Doctor Heston" but rather to "Dear Friend."

As a primary care physician, I am concerned about this evolution of online consultations and prescribing. My teachers always stressed the importance of a physical exam when making a medical decision, even if the exam simply consisted of observing the patient walk, smile, laugh, or cry. Often, the only thing a doctor can offer a patient is friendship, and being by the bedside offering friendship, caring, and compassion.

Nonetheless, the internet can offer improved communication between the physician and patient. Without the high overhead of an office, it's likely that the costs could even be much less than an office visit. With real-time chat, audio, and video conferencing, a virtual visit to the doctor has already become reality. The internet may also facilitate communication by taking away some of the embarassment people may feel when discussing sexual issues (I've noticed very little inhibition in the usenet groups!).

As netizens, we need to figure out what is safe and reasonable, then establish standards and regulations for practicing medicine online. Wouldn't it be great to tear down some of the political borders, and be able to have a consultation with a physician on the other side of the globe? Regulations don't need to be restrictive. Rather, they can act to bring about a more global approach to medical care.