Medical Information on the Internet

smaley's picture

 Medical Information on the Internet

 

Internet Code of Ethics

 

Guiding Principles

 

1. Candor – Sites should clearly indicate who owns the site, what the purpose of the site is, and conflicting interests the site manager might have

 

 2. Honesty – Sites should honestly portray all claims about efficacy, performance, or benefits of products/services

 

 3. Quality – Sites should provide information that is accurate, easy to understand, and up-to-date

            To ensure this, sites should be constantly re-evaluating the information available, indicate the source of the information, acknowledge that some issues are controversial, and that there may be more data than just what they present. Sites should also make it known when they were last updated

 

 4. Informed Consent – Sites should disclose any potential risks to the viewers privacy, what information is being collected by the site from the viewer, and how this information will be used.

 

 5. Privacy – Sites should take care to prevent unauthorized access to or use of any personal info that is collected, make sure that users have easy access to their information, and to make sure that no information is identifying 

 

 6. Professionalism – Any sites or individuals providing medical information online should abide by the same professionals standards as if they were not online.

 

 7. Responsible Partnering – Sites should make an effort to make sure all sponsors, partners, etc., act professionally, and that users know when the information is provided by a partner, sponsor, etc.

 

 8. Accountability – All sites need to make it clear to users who to contact with problems, allow users to provide feedback, and to respond to feedback in a timely manner

 

http://www.ihealthcoalition.org/ehealth-code/

 

  • Is such a code of ethics a good idea?
  • Should websites be required to abide by such a code?
  • Are there any problems with such a code?

 

 

Alternative Solution

1.     Professionally validated information of varying complexity (targeting individuals of varying educational levels) available

2.     Education on search methods, and how to determine the validity of information by doctors/nurses/media, etc

 

Other Possible Solutions?

 

 

Buying Prescriptions Online

 

  1. International purchases have been made possible by the internet

They are currently illegal – should they be legalized?

 

            Pros

-       Prescriptions purchased from an international pharmacy are less expensive

      Cons

-       Dr’s from the country the pharmacy is based in co-sign prescriptions without ever seeing the patient in order to bypass the laws

-       Threatens drug supply in some countries

-       It is hard to determine what pharmacies are legitimate, and what are rogue on the internet

-       Counterfeit drugs are much more common when purchased online

 

 

“American consumers are increasingly unable or unwilling to pay these prices and are seeking better government coverage of pharmaceutical products as well as relief from unaffordable medicines.” Cohen

 

“Echoing the safety concern, the Canadian Pharmacists Association has stated that it does not support the international purchase of pharmaceuticals through the Internet because it compromises the relationship between the patient and the healthcare professional; it violates local (and international) laws; and it presents a threat to drug supply and to Canadian drug prices.” Cohen

 

“The prescriptions used in the Internet purchases are often co-signed by a Canadian physician who has never seen the patient receiving the prescription.” Cohen

 

“Consumers may have a hard time determining a legitimate Internet pharmacy from a rogue pharmacy.” Cohen

 

“we show differences in blend uniformity in simvastatin tablets obtained via the internet from five countries.” Veronin

 

“There is regulatory ambiguity in the US. ‘Personal Importation Policy,’ under which the FDA permits import of limited quantities of unapproved drugs for personal use.” Veronin

 

“many illegitimate Internet pharmacies exploit this by advertising ’90-day supply of prescription drugs allowed by US Federal Law’ to promote drug procurement without prescription of physician’s supervision.” Veronin

 

“Perhaps the most alarming aspect of online drug distribution is the risk of receiving counterfeit medications. Reportedly, as much as 10% of the worlds drug trade is in counterfeits.” Veronin

 

Conversations and Implications to Date: 

"I think it would be better let customer responses and feedback determine which international pharmacies stay in business. Maybe there could be some type of seal of approval from the FDA for international pharmacies that meet FDA guidelines." lbonnell

"Seems to me there is an interesting tension here between wanting individual choice/freedom and wanting some "authority" to assure quality/authenticity/safety/etc... I wonder whether there is a general way to deal with this tension or whether it actually needs to be negotiated separately in each individual situation? " Paul Grobstein

"it comes down to inexpensive medications that may or may not be safe and effective vs. more expensive medications that are approved by a regulatory agency. While I myself would be extremely uncomfortable purchasing medications from an unregulated internet pharmacy, if someone else is willing to take the risk then they should be allowed to." Crystal Leonard

"illegalizing it is their way of saying if you try it, you are on your own. Going by that, yeah, I think it makes perfect sense.  I don't think that it necessarily works that way in real life: I figure Pfizer Europe/Canada is produces the same quality drugs as Pfizer America...... whatever. I think it is more complicated sometimes than we think. And i don't know who is wrong - us who see things as simple, or the government, who makes everything complicated." kwarlizzie

  • Consumers need to take responsibility for their actions when they buy prescriptions from international sources
  • FDA regulation, or an international regulation agency, may be a valid solution as long as it does not result in significant price increases that would negate the purpose of purchasing medications internationally

Comments

Kwarlizzle's picture

I think that in a roundabout

I think that in a roundabout way, it makes perfect sense for countries to ban buying drugs from outside its borders - in a roundabout way. The government purports to be responsible for its citizens, so I am going by the assumption that they are saying that the drugs available within their borders have been certified and approved as "effective", or fit for consumption, in any case, and that they cannot vouch for the same in the cases of drugs marketed in other countries. So illegalizing it is their way of saying if you try it, you are on your own. Going by that, yeah, I think it makes perfect sense.  I don't think that it necessarily works that way in real life: I figure Pfizer Europe/Canada is produces the same quality drugs as Pfizer America...... whatever. I think it is more complicated sometimes than we think. And i don't know who is wrong - us who see things as simple, or the government, who makes everything complicated.

 

Crystal Leonard's picture

It seems to me that if the

It seems to me that if the international internet pharmacies are regulated the costs of their prescription medications will rise, perhaps to the point that they are not any more affordable than the medications available from domestic pharmacies. Thus, it comes down to inexpensive medications that may or may not be safe and effective vs. more expensive medications that are approved by a regulatory agency. While I myself would be extremely uncomfortable purchasing medications from an unregulated internet pharmacy, if someone else is willing to take the risk then they should be allowed to. Of course, if the prescription medication turns out to be little more than sawdust, or contains dangerous compounds, it should be the buyer's responsibility to pay for any acquired medical costs associated with consuming said unregulated medications.

Paul Grobstein's picture

autonomy versus authority as a general issue?

Seems to me there is an interesting tension here between wanting individual choice/freedom and wanting some "authority" to assure quality/authenticity/safety/etc. Tensions of this sort are, of course, not at all limited to the particular case at hand here.  They show up in lots of contexts, both in our discussions (eg human subjects, science education, etc) and in broader contexts (eg, health care legislation).  I wonder whether there is a general way to deal with this tension or whether it actually needs to be negotiated separately in each individual situation? 

lbonnell's picture

Regulation

 I think it would be difficult to regulate international pharmacies on the internet. Instead I think it would be better let customer responses and feedback determine which international pharmacies stay in business. Maybe there could be some type of seal of approval from the FDA for international pharmacies that meet FDA guidelines. Like we discussed in class, I don't think it would be beneficial to impose FDA guidelines to international pharmacies. Developing countries most likely can't afford the clinical trials the FDA requires. Authentic drugs can still come from developing countries, there just isn't a total guarantee of authenticity. 

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