Ordering Viagra Online, Without Visiting a Doctor's Office

Through KwikMed, you fill out a lengthy assessment form, and the drugs come in the mail.

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While many websites sell drugs online illegally, one company called KwikMed offers consumers the option of buying certain medications—the erectile dysfunction drugs Cialis, Viagra, Levitra; the hair loss drug Propecia; and the smoking cessation—without ever seeing a doctor face to face. Though KwikMed hopes to offer additional drugs in the future, these five drugs are the only ones that have been approved by regulators to date. And it's all perfectly legal, the company says—though quite unusual. The arrangement that KwikMed has reached with the Utah Legislature allows the company's doctors to offer valid prescriptions through cyberspace; other states require that patients see a doctor in person, KwikMed says, before they can receive a prescription. Still, even if you don't live in Utah, you can probably order KwikMed's drugs. The company has received mail order licenses from many other states, and it has shipped medications to 46 states so far. A preliminary study of KwikMed (led by an independent researcher but including a company employee as a coauthor), published recently in Mayo Clinic Proceedings, shows the system is just as safe as having in-the-flesh primary physicians examine patients and prescribe erectile drugs.

Given concerns about "rogue" Internet pharmacies (online pharmacies that sell prescription drugs without requiring a prescription) and all the erectile dysfunction spam they generate, it might sound shady. Actually, it's not at all, argues KwikMed's CEO, Peter Ax. "We have to fight against the knee-jerk reaction that online pharmacies are unsafe. We have worked with regulators from Day 1. If a company has been vetted and well regulated—like ours has been—it's a safe, if not safer, way of doing business," he says. Here's how it works: After you fill out a relatively lengthy medical assessment form (think questions like "How long have you had erectile dysfunction problems?" or "How much difficulty have you had getting an erection during the last 30 days?") one of KwikMed's five medical doctors will review your order. The company says the online assessment is designed to ferret out people trying to game the system—for example, a teen who intends to take Viagra in conjunction with ecstasy or as an attempt to enhance his virility. If the company's doctors do notice anything suspicious, they follow up with phone call or E-mail. In certain situations, KwikMed may even run a background check on prospective buyers. If everything checks out, you'll get your drugs in the mail in the next few days. The company requires an adult signature upon delivery to safeguard against minors ordering drugs.

Since erectile dysfunction is a problem that men and their doctors are often embarrassed to discuss, an online assessment tool might actually be more thorough and comprehensive, proponents of Internet pharmacies argue. The KwikMed assessment tool for erectile dysfunction drugs, for example, asks a number of questions that try to parse out whether a man's sexual complaints stem from erectile dysfunction or premature ejaculation, an important distinction that's easily glossed over during the rush of a typical office visit, doctors say. (If you're curious, this U.S. News story about sex explores some of the differences). Some research suggests that people may actually be more honest in cyberspace when it comes to disclosing embarrassing health conditions than they are in real life. (Thus the rise of services like this one, an E-card company that allows people to alert others they may have exposed to an STD.)

Still, the new system has some formidable critics. KwikMed had to fend off a number of bills in the Utah Legislature aimed at shutting it down. In 2007, the state of Arkansas threatened the company with a lawsuit for sending medicine there. (KwikMed, says Ax, has stopped delivering medicine to Arkansas, and the suit has been dropped. The American Pharmacists Association, a trade group of professional pharmacists, maintains that doctors should examine their patients in person before prescribing drugs and considers companies that do not require that to be "rogue online pharmacies," as this report explains. In the past, Pfizer has opposed KwikMed's efforts to prescribe drugs online. And, just recently, President Bush signed a new law that will make it easier for regulators to crack down on rogue online pharmacies. (However, the new law doesn't address noncontrolled prescription drugs such as those for ED or hair loss, which are less prone to abuse than controlled drugs like morphine or oxycodone.)

Would you order your drugs from an Internet pharmacy like KwikMed? I'm a bit conflicted on this one. On one hand, in some of my recent visits to the doctor, my physician seemed so busy he hardly looked at me. It would be convenient, and I do pretty much everything else online, including communicating with my doctor and ordering my contact lenses. But what might you miss by not being there in person? As I've blogged about before, erectile dysfunction is often an early warning sign of heart trouble, for example, and a visit with the doctor to discuss that is a good chance for a doctor to give you a full checkup to make sure something more serious isn't brewing.

Other opinions?