Internet prescription draws state complaint

A state investigative panel has filed a complaint against a Missouri doctor for allegedly prescribing Viagra to a North Dakota patient over the Internet without an examination.

The panel, which is made up of members of the state Board of Medical Examiners, alleges that Dr. Miles Jones "has repeatedly written prescriptions for patients over the Internet without first examining the patient or obtaining appropriate information from the patient."

Rolf Sletten, the board's executive secretary, said the Internet lends itself to many good applications in medicine. "But the concern here is that people are prescribing medications for people they haven't seen and haven't evaluated -- and that can be very dangerous," he said.

In 1998, Viagra became a huge seller when it became the only oral treatment for male impotence.

The drug has been linked to contributing to heart attacks in patients who use it while taking nitrates, because the combination can lead to a sudden, severe drop in blood pressure. But a study financed by the drug's maker published in the New England Journal of Medicine found that Viagra caused no harmful changes in the blood flow of men with severe heart disease.

Dr. Russ Felker, a Cape Girardeau urologist, agrees that Viagra is a safe medication but worries about another danger of prescribing over the Internet. Diagnosing erectile dysfunction is much more complicated than reading the information in a form supplied through the Internet and may allow the underlying cause to go untreated, he says.

"Diabetes may be identified by a problem with erectile dysfunction. Sometimes a brain tumor may manifest as a problem with erectile dysfunction," he said. "To simply pass out a medication that may be effective in dealing with symptoms without trying to elucidate the underlying cause can be fatal."

The inadvisability of prescribing any medication over the Internet without an examination should be common sense, Felker says.

"With regards to Viagra ... I think the practice of giving it out in the absence of the opportunity to apply responsible medical judgment is ill-advised and unethical."

Can be part of aging

Erectile dysfunction is the inability to attain erection and hold erection long enough to have satisfactory intercourse. But a lessening of this ability can be a normal part of aging, Felker says, or could be due to a problem in the relationship.

"If you don't treat all of those underlying problems you haven't really done the patient a favor," he said.

John T. McMullin, a pharmacist at John's Pharmacy in Cape Girardeau, said writing prescriptions over the Internet is "probably not a good a medical practice.

"If I knew it was an Internet doctor, I would question it," he said, but added it would be difficult to make that determination.

Jones, who lives in Lee's Summit, Mo., and has a North Dakota medical license, declined to comment on the case because he said Saturday he had not seen the complaint.

He is entitled to a hearing before an administrative law judge, who would make a recommendation. The board will decide what action, if any, should be taken.

A hearing date has not been scheduled.

The North Dakota Board of Medical Examiners found out about Jones after being notified by the Federation of State Medical Boards, a Texas-based association that provides support to 70 medical regulatory boards throughout the nation.

The federation has a full-time investigator who looks into Internet sites that prescribe drugs online, said Dale L. Austin, interim chief executive officer of the federation.

The investigator fills out questionnaires and buys medication over the Internet, so that the group can identify names of physicians and turn them over to authorities, Austin said.

Austin said online questionnaires for many drugs are inadequate.

"All sorts of problems come into play where individuals can lie about who they are, what they are, what their other health problems might be, and these are not benign drugs," Austin said.

The association has looked at more than 250 sites on the Internet since the group formed its Internet Clearinghouse division in September 2000.

Staff writer Sam Blackwell contributed to this report.