MEDICAL MATTERS Muiris HoustonOne of the hazards of having an email address at the end of this column is that it attracts all sorts of unsolicited messages.
Many of these refer to the online availability of drugs. Here is one from today: "Doc, want cheap Viagra? Most charge $15 to $19 each. We just charge $4. Special wholesale price! Delivered to all countries! No embarrassing doctor's visits!"
While I can readily empathise with someone wishing to avoid an embarrassing consultation, the reality is that unless a drug is designated as "over the counter" (OTC), regulatory authorities have specifically decided that its potential side-effects warrant a doctor-patient interaction.
'Medscape', an online educational facility for doctors, recently addressed this topic.
Dr J Pomerantz, an assistant professor of psychiatry at Harvard Medical School in Boston, describes internet prescriptions as "a risky business for physicians and patients alike".
A study of internet pharmacies conducted by the US General Accounting Office identified 190 Web-based pharmacies selling prescription drugs directly to consumers.
Some 111 sites required a prescription from a physician; 54 were willing to provide drugs after the consumer filled out an online questionnaire; and 25 sold prescription drugs on demand.
"The growing number of physicians who engage in internet prescribing has raised concerns within the profession," Dr Pomerantz says.
He points to guidelines from the American Medical Association (AMA) outlining the ground rules for prescribing to patients via the internet. "These guidelines state that physicians should obtain medical history information and perform a physical examination before prescribing medications online," he notes, adding that the AMA recommends doctors have a full discussion with patients about other treatment options and the risks and benefits of each.
In addition, the doctor must clearly state his name, practice address and any financial interest he may have in the products he is prescribing online.
The Federal Drugs Administration (FDA) is also very clear about the potential dangers inherent in remote prescribing: "Getting a prescription drug by filling out a questionnaire without seeing a doctor poses serious health risks.
"A questionnaire does not provide sufficient information for a healthcare professional to determine if that drug is for you or safe for you, if another treatment is more appropriate, or if you have an underlying medical condition where using that drug may be harmful."
Emphasising the importance of caveat emptor, Dr Pomerantz concludes: "consumers must be encouraged to forgo the temptation to bypass their own physicians, especially when dealing with the treatment of depression and/or anxiety.
"Looking to the internet for an anonymous prescription is for knaves and fools, old terms that still apply in the time of cyberspace."
On a more progressive note, a recent international cardiology conference in Dublin heard an interesting paper from Dr Kay Berra of Stanford University on risk reduction via the internet.
Dr Berra answered the question: "how will the internet change cardiovascular health?"
She said despite some concerns on the part of doctors that internet usage was not yet safe (from the point of view of confidentiality), they could not ignore research evidence that 80 per cent of those with access to the Web used it to find health information.
Dr Berra suggested it offered the opportunity for doctors to more easily communicate with their patients and to monitor their progress.
An example of this was a study of 1,000 patients attending a hospital's out-patients department who required a better management of their cholesterol levels.
Those assigned to an electronic intervention via the internet achieved 90 per cent of treatment goals whereas those offered more traditional paper-based advice managed to reach only 47 per cent of the targets set for them.
"The internet is a successful method of achieving risk reduction goals in cardiac disease," Dr Berra concluded.
But back to the subject of the over-the-counter availability of Viagra and a joke.
A lady walked into a chemist and spoke to the pharmacist. She asked, "Do you have Viagra?" "Yes," he answered. She asked, "Does it work?" "Yes," he answered. "Can you get it over the counter?" she asked. "I can if I take two," said the pharmacist - reportedly without a hint of embarrassment!
Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.