Na Internet Pharmacies And Telemedicine

Not na direção de day goes by when our email inboxes do not fill with advertisements for prescription drugs.

Many of these emails promise to deliver drugs of all classes by overnight courier without na direção de prescription. While there are legitimate em rede pharmacies, and the practice of telemedicine or cyber-medicine is gaining acceptance, this change in the way medicine is being practiced is rocking the foundations of the medical establishment.

Being able to consult por doctor na Internet, and obtain prescription drugs delivered to your doorstep by UPS has broad social and permitido implications. The Rede facilitates making drugs available to those who may not be able to afford to pay US prices, are embarrassed to see no sentido de doctor face-to-face, or are suffering from pain, the treatment of which puts most doctors in direct conflict with the 'war conectado drugs' but acessível the other hand there is the question whether these pharmacies make drugs available to recreational drug users without the oversight of no sentido de licensed medical practitioner.

The Need for Alternatives
Medical care in the US has reached essa point where it is expensive and impersonal which has caused the consumer to become generally unsatisfied with the medical establishment as com destino a whole. Examples include the huge differences between the cost of drugs in the US and Canada, long wait times in US pharmacies, and poor service in general.

Perhaps realizing this, US customs appears to tolerate the millions of Americans that visit Canada every year to buy their medications, as for the most part, these 'drug buyers' are elderly American's that can't afford the high cost of filling their prescriptions in the US.

Rather than to travel to Canada or Mexico millions of Americans are now turning to the Internet for both their medical needs. Telemedicine (or cibernética medicine) provides consumers with the ability to both consult with essa doctor na Internet and order drugs over the Rede mundial de computadores at discounted prices.

This has resulted in consumers turning to disponível pharmacies for their medical needs, and in pessoal pharmacies with autor relationships with a physician, which allow the consumer to completely bypass the traditional brick and mortar pharmacies, with the added benefit of having their physician act as an intermediary between the consumer and the pharmacy.

According to Johnson (2005) this is as com destino a result of consumers becoming very dissatisfied when it comes to dealing with both brick and mortar pharmacies and medical practitioners. As Johnson, notes, "Consumers are more likely to know the name of their hairdresser than their pharmacist." When Johnson (2005) rated the various professions within the health care system, he found that pharmacists had the lowest interaction with their patients than did any other group.

Today, as em direção a result of this "consumers are buying 25.5 percent of their prescriptions acessível, opposed to 13.5 percent of which are picked up at em direção a brick and mortar pharmacy" (Johnson 2005).
Drugs and Society
What has brought so much attention to acessível pharmacies is that it is possible to obtain just about any drug without com destino a prescription acessível. Many of these prescriptions are for legitimate purposes purchased through an em conexão pharmacy because the buyer is too embarrassed to visit the doctor or for other reasons including the unavailability of FDA approved drugs to the consumer.

These drugs may include steroids that due to their misuse and being classed as caso classed no sentido de category three drugs, are seldom prescribed by physicians. These drugs have se useful purpose to those suffering from any wasting disease such as AIDS, they also play e role in ant-aging (FDA, 2004).

The Doctor Patient Relationship
Today em direção a visit to por doctor is generally brief, much of the triage it is done by autor nurse or no sentido de nurse practitioner with the doctor only dropping in for essa few minutes, if at all. In many cases the patient is seen by a nurse practitioner. One of the arguments against telemedicine or perhaps para better term is cibernética-medicine, is that the doctor does not have por physical relationship with the patients and thus is in no position to make lá diagnosis, and thus can not legally prescribe drugs.

Ironically when one compares the work up that one has to go through to consult with an na Internet physicians and compares this to para face-to-face visit with por brick and mortar doctor, one finds that the em rede physician, in many cases, has a better understanding of the patient's medical condition than does the doctor who meets face-to-face with the patient.

In most cases before an em conexão com destino a doctor prescribes any type of medication they insist conectado para full blood workup they may also require that one has additional tests performed, for example.
The AMA, the federal government, and various states claim, however, that it is illegal for na direção de doctor to prescribe drugs without com destino a valid doctor-patient relationship. While there are no laws at present that outlaw disponível pharmacies, various states have enacted legislation, or are in the process of enacting legislation to prohibit na direção de doctor from prescribing drugs to para patient that they have not seen face to face.

Some states also require that the doctor that prescribes the drugs be licensed in their state. This alone could hamper the development of relativo a computadores-medicine. According to William Hubbard (2004), FDA associate commissioner "The Food and Drug Administration says it is giving states first crack at lícito action, though it will step in when states do not act" (FDA, 2004).

World wide web Pharmacies
The reason that email boxes around the country fill up with offers to supply drugs of all kinds, at reduced prices, without prescriptions, and more is because people buy them as the billions of dollars the drug companies are making each year attest to.
The Rede has become the drug store of choice for many.
Categories of Net Pharmacies

Internet pharmacies are generally acknowledged to be comprised of the following five categories:
Net pharmacies can be divided up into five different categories, as follows:
Licensed online pharmacies with lá dentro de medical affiliation.
Licensed na Internet pharmacies with em direção a medical affiliation
No record em rede pharmacies (NRP)
International on pharmacies (IOP)

Licensed compounding pharmacies
The licensed online pharmacies with em direção a em o medical affiliation are of course Drugstore.com, CVV, and others. They all require a prescription from e licensed doctor that the patient has lá doctor patient relationship with. The prescription can be called in by the doctor.

The licensed online pharmacies with ao preço de medical affiliation often depend em rede se broker. The broker collects your medical information, and then assigns your case to one of their networked physicians. Many of these networked physicians are willing to prescribe pain killers as they believe that it is only through the use of these drugs that some people can live em harmonious life.


A Government Accountability Office (GAO) Committee em linha aging held in June 2004 found that "Unlicensed international pharmacies do not require a prescription, and are generally located off shore." Junto de prescription pharmacies can be found all over the world. Many of these sites have come under controversy as in some cases all it takes to have that prescription delivered to you by next day air, is to fill out na direção de questionnaire online.

A study conducted by Henkle in 2002 to ascertain how easy it would be to obtain drugs over the Rede found that "37 of the 46" pharmacy required essa prescription from se licensed doctor. The emphasis was online the prescription and not on the doctor. Henkle (2002) in fact notes that some sites offered to recommend e doctor." Henkle (2002) was able to obtain prescription drugs from nine sites outside the US during the study, without com destino a prescription.

Em linha pharmacies with lá doctor affiliation
There are se number of em linha pharmacies, with por medical affiliation is that take great pain to differentiate themselves form unlicensed overseas pharmacies. These pharmacies, stress that they are "American based companies that provides consumer's easy access to FDA approved em linha prescriptions over the Internet and are quick to point out that "An em conexão consultation can be just as relevant as an in-person consultation." It is interesting to note that many of these on pharmacies also point out that "While they are committed to making access to conectado prescriptions easier, they believe that the Rede mundial de computadores can not replace the importance of regular doctor visits to fully evaluate your health and any medical conditions." Many of these online pharmacy sites also makes em direção a wealth of drug information available em rede its rede mundial de computadores página da Internet that enables the consumer to educate themselves em linha drugs that may have been prescribed.

The Internet has for all intensive purposes is quickly replacing the brick and mortar gênese physician as no sentido de patient's primary health care provider.
A sales pitch, of course, or is it? Most of the legitimate conectado pharmacies ensure that they comply with state and federal regulation. The doctors are licensed in all 50 states and their pharmacies are too. These legitimate Rede de computadores interligados pharmacies cater to those that are looking for autor better price; for some it comes down to making the choice of eating cat food disponível crackers in order to afford their medications because of the high US drug prices.

In other cases patients resort to cibernética-medicine to avoid the embarrassment of having to deal with essa physician or pharmacy that may be judgmental. Many of these on pharmacies will arrange caso consult with para licensed, medical doctor over the phone and will then fill the prescription accordingly.

According to Henkel (2000) "More and more consumers are using the Rede mundial de computadores for health reasons" and references e study carried out by em market research firm Cyber Dialogue Inc., "that found that "health concerns are the sixth most common reason people go on" (Henkel 2000).

For many people com destino a trip to the pharmacy is an ordeal. In some cases the sítio pharmacy may also be located in the closest town which may mean lá long drive if one lives in lá rústico community. Em rede pharmacies provide autor means through which their prescriptions can be delivered conveniently and quickly. Being on also allows the consumer to shop for the best prices, an important factor if one is living conectado caso pension.

The World wide web has also created e more aware user. It is not unusual for no sentido de consumer to research drugs conectado the Internet. A consumer may have seen a telerreceptor or magazine advertisement advertising ao preço de new drug. Ultimately, the Net also provides the consumer the opportunity to enter into com destino a doctor patient relationship that may in fact be more legitimate than the doctor who makes com destino a physical appearance. Further information em rede doctors that practice telemedicine can be found at: sítio da Internet

It is interesting to note, as discussed previously, that consumers are becoming dissatisfied with the care and treatment they receive from both brick and mortar physicians and pharmacies. Zanf (2001), references em study by Lang and Fullerton that "Identified four factors related to outpatient pharmacy services: professional communication, physical and emotional comfort, demographics, and location and convenience. If you loved this write-up and you would like to acquire extra information about buy Thailand steroids kindly go to our webpage. " All of which are contributing factors as to why more and more consumers are resorting to cibernética-medicine.

The Dark Side
There is also a dark side to the Rede pharmacy, as previously discussed, mensagem eletrônica indesejada email touting the availability of any prescription drug one could want, without na direção de prescription, is something everyone is familiar with has reached epidemic proportions.
From Ambien, and of course Viagra to more powerful drugs such as Oxycontin, you can have it all. Over night shipping is available in most case, or so these emails proclaim.

In some instances this pharmacy mensagem eletrônica indesejada originates from unscrupulous individuals who have no interior de intention of delivering the drugs, realizing that very few people, if any, will complain about the non delivery of an illegal drug through the mail.
In other cases the drugs are sent without ao preço de prescription from countries where that pessoal drug may legally be sold without lá prescription, or at least the laws are more relaxed. Valium, for example, is sold over-the-counter in Taiwan.

According to Crawford (2004) "Consumers who purchase drugs acessível thinking that they are they are getting the same drugs as they would from their local brick-and-mortar pharmacy are being misled, and as com destino a result are putting their health, and eventually their lives at risk" Crawford cites examples of Rede mundial de computadores pharmacies supplying drugs that were under strength, contaminated and mislabeled (Crawford 2004).

According to Won (2005) Drug-industry executives think the Web and mail-order operations will be the biggest source of counterfeit drugs over the next five years, according to caso report released today by Ernst & Young. According to James G Dickinson (2005):
The federal government in July shut down an alleged illegal World wide web pharmacy for selling counterfeit drugs and issued autor warning em conexão other counterfeits found to have been sold in Mexican border pharmacies to individual patients from the U.S. The Rede de computadores interligados pharmacy had sold more than $7 million in counterfeit Viagra and other prescription drugs over the past five years, according to the San Diego Union-Tribune. The San Diego-based operation required individuals to complete por $35 "doctor consultation" survey before receiving the prescriptions, but the survey was never shown to e health professional to evaluate whether em safety risk existed, the paper says (Dickson, 2005).

In em direção a separate action, the FDA warned Americans about counterfeit versions of Merck's cholesterol drug Zocor and generic Carisoprodol - used for treating musculoskeletal conditions - that had been imported from Mexico by individual Americans (FDA, 2005).
Over the last year patients suffering from pain, and other conditions that they are reluctant to see em direção a doctor face-to-face, have had the option of consulting se doctor disponível. The ability to consult with autor doctor acessível, and then to receive drugs as se result has come under much controversy.

This has for the most part been as a result of not adequately screening patient's records, or ordering from unregulated overseas pharmacies.
The World wide web - em new way of marketing
Not all Rede pharmacies are illegitimate, however, and there are many pharmacies that provide the consumer with em direção a legitimate prescription by overnight service. My last prescription came by mail. The whole transaction was completed over the Web.

It was lá prescription that my doctor had given to me personally, however. As discussed, what constitutes em doctor patient relationship is at the crux of the em linha pharmacy debate. This of course has implications as to what constitutes se legitimate prescription. What constitutes em direção a legitimate prescription is na direção de hotly debated topic.

The Future
As noted, being able to consult para doctor over the phone, and then have one's prescription filled by an Web pharmacy is convenient for many people. As the American population ages, more and more people will have trouble getting to the doctors office, not to mention driving to the pharmacy.

Clearly safeguards are needed if relativo à Internet-medicine is to raise the quality of medical care available to Americans. The em conexão pharmaceutical industry has taken se number of steps to ensure that consumers are protected against unscrupulous em conexão pharmacy operators including the certification of on pharmacies.

According to Henkel (2000) "One way consumers can ensure the quality of an on pharmacy is to look for the Verified Net Pharmacy Practice Sites (VIPPS) seal." According to Henkel (2000) any site bearing this seal has gone through com destino a rigorous series of quality checks which are part of the Verified Rede mundial de computadores Pharmacy Practice Sites program.

Unfortunately as Henkel (2000) notes, "Because VIPPS certification is fairly new and voluntary, only caso few sites have been certified so far." Recognizing the problem of 'rouge' pharmacies, SquareTrade, has also implemented com destino a program to protect consumers from 'rouge' pharmacies.
According to SquareTrade, "The Licensed Pharmacy program verifies that your business is na direção de pharmacy in good standing. Verified pharmacies can display the Licensed Pharmacy Seal em linha their websites - distinguishing themselves from unverified and rogue pharmacies."

If these safe guards are not put in place, and legislation is enacted that makes it illegal to obtain caso prescription from an acessível pharmacy based na Internet an online consult, the black market for drugs will continue to thrive. Customs by its own admission only catches approximately 2% of all illicit prescription drugs that enter the US.

Negating the fact that through technology, one could enter into para doctor patient relationship that may be affordable. Security, as some have suggested could be accomplished through the use of video cameras and biometric scanners which would cut down em conexão the number of fraudulent prescriptions written. Measures like these would put the convenience of using an on pharmacy out of the reach of those without the technology.

One could also not prevent consumers from using off shore na Internet pharmacies. While the FDA is presently trying very hard to get the Canadian government to enact legislation that would prohibit the export of drugs from Canada by mail it appears that the profit that results from the sale of drugs is causing the legislation to stall.
As one Canadian pharmacy owner noted, however "We will just move to the UK."

Ironically, the Canadian's are offering to crack down, not because of any concerns relating to the sale of drugs em rede, but because Canada controls drug prices, making them far cheaper than the same drug in the US. The Canadian authorities are planning online cracking down "arguing that the system was created to help Canadians, not Americans." The drug industry itself has gone so far as to black list Canadian pharmacies that sell to American customers over the Web.

With all the paranoia relating to terrorism there is para concern that any drug coming in from another country may be contaminated. There are no interior de instances disponível record of se consumer having received com destino a contaminated drug from Canada (Matthews, 2003).
Even more ironically with all the talk about the dangers of drugs purchased from overseas, some legitimate companies are now being forced to buy from other than US sources because they have been black listed by US drug manufactures (Matthews, 2003). Mathews (2003) goes on to illustrate this by pointing out that "Canadian suppliers, in pessoal, that have been blacklisted, are now turning to sources in Europe." Mathews (2003) notes that while for the most part these European sources are legitimate and make no sentido de high quality drug.

In some cases, however Mathews et al. (2003) note that the pharmacies are having to go 'farther lá field' to find product.
Conclusion
While there need for controls to be put in place to regulate the practice of both medicine em linha and World wide web pharmacies, we also need to acknowledge that science and technology has furthered the practice of medicine, and that the Web will further it yet.

The Internet has the potential of expanding medical care to those that may not routinely seek it, or are too infirm to travel to the doctor's office. While the present trend appears to be to make it illegal for em direção a doctor to prescribe drugs without seeing the patient face-to-face there is also ao preço de move to establish rules and regulations that ensure that patients receive quality care over the Rede.

Unfortunately medicine and politics have become so intertwined and doctors have inadvertently become unwilling agents in the war against drugs.
One can't turn back the clock though, and according to Larkin (1999) "At com destino a July 30 US Department of Commerce hearing em conexão the benefits and risks of 'drugstores on the net', the question was examined." The main issue was how to shutdown the em linha pharmacies run by unscrupulous individuals, while still fostering the legitimate disponível pharmacy business in order to both promote commerce and still protect the consumer (Larkin, 1999).

According to Larkin (1999) "What's new here is not the practice of pharmacy, but the way we communicate with and inform customers."
At em January 26th 2004 FDCH Congressional Testimony Jeff Kimmell who is vice President and Chief Pharmacy Officer at drugstore.com, inc. commented, "There is little doubt that as consumers increasingly bear the burden of paying for prescription drugs, they will turn to the Rede de computadores interligados for cost- effective alternatives." As discussed, however, measures need to be taken to ensure that consumers don't receive counterfeit, tainted or expired drugs.

For more up-to-date information conectado doctors that practice telemedicine, pending legislation, and more visit: conjunto de páginas da Internet
Copyright (2005) sítio da Internet
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