There’s long been a gray market in the U.S. for prescription medications that can be had online without actually having a prescription. Erectile dysfunction medications are the most common such prescriptions.

This practice has commonly been done on websites based in India or another country. The prescription is then forwarded to a pharmacy clearinghouse in the U.S. that has contracted with physicians to write prescriptions for such orders. How can a doctor do this without a physical exam? Easy! It’s called a form that the customer fills out on the prescription website. The doc reviews the form and ostensibly ensures the customer has no pre-existing condition that may cause untoward side effects with the sought-after prescription.

But this business, which has been going on for years now, is a bit of an ethical gray area for doctors. Physicians in the U.S. are supposed to have an existing relationship with a patient before they prescribe a medication. A part of that relationship includes a physical examination and health history questions. While arguably one might obtain a health history from a form, it’s harder to argue that one can obtain a physical exam from a different form.

And that’s the problem Dr. Christian Hageseth faced when he was brought up on charges for prescribing Prozac to a college student who later killed himself:

Christian Hageseth, 68, who had practiced in Colorado, pleaded no contest Feb. 24 to a felony count of practicing medicine illegally in the case of John McKay, a 19-year-old Stanford University student who killed himself in August 2005 by inhaling car exhaust fumes at his mother’s home in Menlo Park, the San Francisco Chronicle reported Monday. Hageseth faces up to one year in jail when he is sentenced April 17 in San Mateo County.

Physicians who continue to fill prescriptions for patients they’ve never actually seen are likely going to see more wrongful death and medical malpractice suits as a result. As soon as physicians realize such prescriptions can result in their losing their license or jail time, you’re going to see the available pool of physicians willing to do this in the U.S. dry up pretty quickly.

Which is as it should be… If a medication is safe enough it no longer needs a prescription, then its maker should seek having it removed from the list of drugs needing a prescription. Otherwise, a prescription implies a physician relationship and physical exam, and there’s just no two ways around that.

Hat tip to Furious Seasons for the story.

Read the full article: Ex-doctor guilty in Prozac-related suicide

Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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    Last reviewed: By John M. Grohol, Psy.D. on 12 Mar 2009
    Published on PsychCentral.com. All rights reserved.