Dina Wildey of Owings Mills, Md., is one wired woman. She uses e-mail every day to keep in touch with family members, and she spends hours browsing the Web--especially the health sites. She's not just reading brochures. Wildey recently discovered that she could chat, free of charge, with a cyberspace doctor. Curious to know about the possible side effects of a diet drug, she logged onto AmericasDoctor.com and posed her question to an anonymous physician. Within a few minutes she received information about the product--enough to convince her to forget about taking it. "I think it's wonderful," she says. "It's quick. You can do it just about any time and you don't have to catch a doctor between appointments."
Health sites are among the Web's biggest draws. Last year alone almost 25 million patients reported going online, and that number is expected to reach more than 33 million by the end of 2000. Until recently the offerings have consisted mainly of support groups, reference materials and product promotions. But now, as demand for information grows and competition among sites intensifies, the offerings are exploding. You can go to the Web for a diagnosis or a prescription. You can put your medical records online--or learn, in a matter of minutes, whether you're eligible for a clinical trial. The possibilities are awesome--and so are the potential hazards.
Many sites now put physicians online to answer message-board questions or to lead evening chats about, say, arthritis medications. And a few sites are making docs available for one-on-one consultation. AmericasDoctor.com, launched last fall, offers visitors a private, real-time doctor chat at any hour of the day--and, unlike medicine on terra firma, it's free. The site's doctors--all salaried employees--take a two-week training course, swapping stethoscope for mouse to become what CEO Dr. Scott Rifkin calls "personal health librarians." Ask a question about a particular illness and an anonymous physician will direct you to reliable sources of information. But don't expect a diagnosis or any direct advice on treatment.
Other sites are more personalized, and pricey. For $195, Mediconsult.com's doctors, called "MediXperts," will send you a report tailored to your own needs after you fill out a detailed health history. Your lab tests will be analyzed and specific treatment options laid out. The report, several pages long, will also provide information on which treatment offers the best results. Still, like AmericasDoctor.com, it stops short of making diagnoses or prescribing medication online.
CyberDocs.com goes all the way. For $50 to $75, you can schedule virtual appointments with doctors, exchanging information through keyboard chats or videoconferencing. The site, which has its own malpractice insurance, is intended for "minor" medical problems. Besides offering diagnoses and treatment recommendations, doctors will actually prescribe medications for common problems, such as allergies and high blood pressure.
These practices are, not surprisingly, controversial. CyberDocs CEO Dr. Tom Caffrey argues that certain medical practices can be performed more efficiently in cyberspace than in person. "Most of what a doctor does is talk to a patient," he says. But other experts insist that good care requires direct personal contact. "In five or 10 minutes face to face I can find out more about you than I can in an hour on the computer," says Dr. Thomas Reardon, president of the American Medical Association.
They may both be right. An online consultation is probably fine if you've got a question about your chronic insomnia, but it's a terrible idea if your child suddenly develops a high fever. If you're thinking of scheduling a session of your own, keep in mind that the person you talk to may not specialize in your condition. Check out the doctor's credentials (they should be posted), and if you have the slightest uncertainty about a recommendation, double-check it with a practitioner who knows you.
As you explore these sites you're sure to stumble into a pharmacy. Prescribing medications online can offer great convenience--but it's considered the true Wild West of the Web. Sites like drugstore.com and PlanetRx.com allow patients to fill prescriptions online that can be sent directly to their homes. But some other online "pharmacies," which now number in the hundreds, according to some estimates, prescribe Viagra and weight-loss drugs with virtually no screening or doctor consultation. In a complaint filed with the Federal Trade Commission, one woman reported that her teenage son bought Viagra online. And his young age was only part of the problem; the boy also had bipolar disorder and was taking blood-pressure medication at the time.
Now state and federal regulators are beginning to crack down. Last month a grand jury in Ohio indicted a local doctor for dispensing such drugs as Viagra and Propecia (for baldness) without an "appropriate medical consultation." (The doctor asserts he violated no laws.) Congress is considering legislation to regulate the practice, and the National Association of Boards of Pharmacy is planning to award a seal of approval to sites that meet strict criteria, not least of which is a license to practice. For now, it's up to patients to be careful. The best way to stay safe is to use the Internet solely for filling prescriptions written by your own flesh-and-blood doctor. Avoid using online pharmacies that don't provide contact information for their pharmacists. And keep in mind that overseas pharmacies may offer drugs not tested or approved in the United States.
Besides offering advice and medication, some of the new sites will even store your medical records online. At PersonalMD.com, you can keep your health history, emergency contacts, even your X-ray and EKG reports, on a personalized home page. The goal is not just to organize your documents in one place but to ensure that your medical information is always accessible during emergencies. PersonalMD issues every customer an ID card. It includes a password for Web access, as well as a fax number. If you show up unconscious in a faraway hospital, anyone caring for you could use it to get access to your records within minutes.
Placing personal information online raises obvious security questions. PersonalMD claims to have double-layered protection. Information is encrypted--even to company employees--and the system has virtual fire walls to protect against hackers. Still, until anyone can guarantee absolute safety, some experts worry about jumping in too soon. Before you place personal information on any site, at least make sure that it has a clear policy against selling its data to outside sources.
As a final perk, some of the new sites offer access to clinical trials. At sites like MedTrial.com, drkoop.com, clinicaltrials.com and nci.nih.gov, you can enter your illness and search for trials yourself. Some, like Center Watch.com, will even send you an e-mail if a good match comes up.
Whether you're looking for advice, medication or information, keep in mind that many of the most popular sights are funded by drug companies. Drkoop.com's "Tackling Tobacco" section, for example, is sponsored by NicoDerm, which advertises conspicuously on the site. Its nutrition center is funded by vitamin shoppe.com. WebMD, a site geared to both doctors and consumers, has a $220 million investment from Du Pont. The company has exclusive rights to provide information about products like nutritional supplements. Corporate sponsorship isn't necessarily bad, but it could mean you're getting limited information. Online medicine can mean high-quality advice, affordable drugs and more control over your own records. But, as with most things in cyberspace, what you see is not always what you get.