Telemedicine has long been discussed as a possibility of where our healthcare future lies: the ability to log into your computer and see and speak with a doctor in your town, the next town over, or even several states away, holds promise for those who have difficulty traveling or those who live in rural areas where medical facilities are few and far between.
However, as technology becomes more pervasive and telemedicine becomes more commonplace, gray areas are starting to arise that may lead to trouble down the road. One of those gray areas can be found in online websites where patients seem to self-diagnose and select the drug they want, a doctor reviews the information input by the patient and assesses their choice, and if approved, the medication is put in the mail to the patient. There are a handful of these websites and they vary in their medication offerings, but most only purport to offer one drug at this time.
However, while the companies believe they comply with all health laws, there are others who disagree with that assessment.
The Websites
One website, Kick Health, sells propranolol, a generic blood pressure drug, for the off-label use of treating anxiety. “Beta-blockers have been scientifically shown to minimize the shakiness, sweaty palms, and rapid heartbeat many of us experience before a big moment,” Dr. Alex Dimitriu, Kick’s medical advisor, said in a statement. According to Kick’s website, the pill can help you to “nail the interview,” “speak confidently,” or even “just say hi.”
Roman, an online men’s health platform focused on ED, is trying to battle the stigma behind ED that keeps men from seeking treatment or drives them to seek treatment outside the healthcare system. Avoiding treatment or seeking treatment outside the healthcare system can result in serious health issues down the road, as ED can be an early warning sign of diabetes, heart disease, high cholesterol, high blood pressure, obesity, or depression. Roman hopes to alert men to a potentially more serious underlying issue by providing them a “safe” way to discuss their concerns with a doctor and receive medication to resolve the issue. Zachariah Reitano, Roman CEO and cofounder, hopes to eventually discover other conditions that disproportionately affect men because of their reluctance to seek care and gradually add them to the platform.
The Argument for the Websites
Websites like these argue that they are not running afoul of the law because they do not make the medicine but instead act as a platform to connect a service (doctors, who prescribe what they would like, off-label or not) to customers (patients).
They follow arguments similar to Uber (which argues it is not a transportation company but instead a platform to connect drivers to customers). These new companies connect consumers and physicians who can prescribe drugs and pharmacies that can ship the medication. Typically, the doctors are paid per consultation or by the hour, not per prescription written.
“We never touch the drugs. We’re not a distributor,” Kick founder and Chief Executive Officer Justin Ip said in an interview. “I wish it was 100 percent crystal-clear. We’ll see how things go, but we think we’re on the right side of the law. If not, we’ll be happy to adjust.”
The Argument Against the Websites
One of the first doctors who has found themselves in trouble by seeming to associate themselves with this type of practice has surrendered his medical license after prescribing Viagra online and was accused of failing to provide standard medical care like examining the patient and taking vital signs by the state medical board.
Whether websites like these are breaking drug-promotion rules may depend on whether they’re selling the services of a physician who can prescribe a drug as they see fit, or if they are actually directly advertising a prescription drug that comes with benefits and risks.