Prescription for Trouble

By Postrel, Virginia | Reason, March 2000 | Go to article overview

Prescription for Trouble


Postrel, Virginia, Reason


Online pharmacies challenge traditional medical models, and the regulatory backlash threatens broader Internet freedoms.

Ah, the Internet! A new world of pure thought, free of the limits and coercion of the physical world. "Ours is a world that is both everywhere and nowhere, but it is not where bodies live," wrote John Perry Barlow four years ago in "A Declaration of the Independence of Cyberspace."

Barlow had no monopoly on Internet euphoria--the idea that cyberspace is too intangible, too slippery, too ubiquitous to be controlled by government. Even today, sober analysts make much the same argument in less hyperbolic language, and technologists talk about "building the future" to bypass political barriers.

But human beings do not exist apart from their bodies. We are matter-bound creatures. And given a tool as powerful as the Internet, we soon turn it to the service of our physical selves.

Hence the latest clash between Internet dynamism and government controls: the regulatory attack on online pharmacies that don't honor traditional gatekeeping procedures.

Over the past year, attorneys general and medical regulators in several states have gone after online pharmacies that allow customers to obtain prescriptions by filling out a questionnaire rather than seeing a doctor in person. They've obtained injunctions and levied fines, driving such online pharmacies out of their states or even out of business.

In one case, the Illinois Department of Professional Regulation temporarily revoked the license of a physician, Robert Filice, who reviewed questionnaires and issued prescriptions for Viagra without seeing patients. In response to the state's action, Filice issued a statement saying that he was guilty only of "being a pioneer in a new and unexplored area" and that regulators had taken his license "with the hope and intention of crushing innovation and seeing to it that as a result of his experience no other qualified, competent and caring physician will dare enter the area of online medicine." (Filice was eventually fined $1,000 and given two years' probation for "unprofessional conduct.")

Now President Clinton is calling for new federal laws to require pharmacy Web sites to get licenses from the Food and Drug Administration before they can go online--a chilling precedent. He's also proposing large new federal fines, up to $500,000 per sale, for selling prescription drugs "without a valid prescription." To enforce these new rules, the administration would give the FDA subpoena powers and $10 million in fiscal 2001.

The same desires for independence, expression, and identity that cyberutopians like Barlow celebrate in the world of bits operate in the world of cells. People want control not only of their words and thoughts but of their bodies. We're a long way from having such control--our bodies have a nasty habit of failing us--but biology is clearly the next great technological frontier.

Already, medicine has gone beyond the traditional realm of curing illnesses to give us tools for enhancing our capabilities. Rather than hewing to a clear-cut model of "disease," we are increasingly changing biological conditions we simply don't like. Sometimes we treat these conditions with pharmaceuticals, such as birth control pills, hormone replacement therapy, or Viagra. In other cases, we just wax our eyebrows or dye our hair.

Once we leave the disease model, the doctor-patient relationship changes. When a condition does not require a diagnosis, there is less detective work involved, and hence less expertise. Certainly, physicians usually know more than patients about possible treatments, just as hairdressers know more about color combinations. But the Internet makes medical information accessible and abundant, and in many cases patients would rather take care of themselves. They may have already seen a physician and just want more of what was prescribed at that time. …

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