Sildenafil and the Internet

Purpose: The Internet is changing the way medicine is being practiced and c hallenging our notions Of the doctor-patient relationship. We analyze the d evelopment of online prescriptions and propose guidelines for the sale of s ildenafil over the Internet. Materials and Methods: Using MEDLINE, Medscape and Lexis-Nexis search engin es we reviewed pertinent materials from January 1996 to July 1999 focusing on the keywords Viagra, prescription and Internet. The review included pres s releases, law review articles, case law, medical literature, pending liti gation, proposed legislation, and federal and state statutes. Results: Online prescriptions are an outgrowth of the,mail order drug busin ess. This development continues the historic innovations in communications and transportation that have enabled physicians to practice medicine over l ong distances while maintaining ties to hospitals and other specialists. Wh ile the sale of sildenafil over the Internet may be profitable and convenie nt, it raises a variety of legal, ethical and safety concerns. Many federal and state organizations have addressed the issue without establishing a cl ear standard. Conclusions: A clear distinction exists between online prescriptions and ph armacies. While it may be acceptable for sildenafil to be sold over the Int ernet given current technologies, it must be done within the confines of a traditional doctor-patient relationship. Online prescriptions must be limit ed to patients who live in states in which the prescribing physician is lic ensed. Failure to establish a doctor patient relationship in this context b reeches ethical standards, and may give rise to potential civil and crimina l liabilities.