E-drug: Is internet prescribing safe? (cont)
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When trying to decide whether Internet prescribing is safe, the key
question is whether the rate of serious adverse events is higher in
the group prescribed sildenafil (Viagra) on the Internet compared to
people prescribed it through a visit to their doctor.
In other words, is adherence to prescription-only status preventing
any unnecessary deaths or serious injury? There are many reasons to
think that it might, especially with a drug like sildenafil. However,
US pharmaceutical market research companies such as Scott-Levin
report very high prescribing rates in response to patient requests
for advertised drugs. If these reports are true, they may reflect a
shift in the meaning of prescription-only status in the face of
aggressive direct-to-consumer advertising, and less attention than
might be hoped to ensuring proper diagnosis and treatment. Given the
relatively small number of drugs with large advertising budgets, they
are unlikely to be the best possible treatment for a patient 80 to
90% of the time they are requested.
The second question is: what sample size is needed to detect a
difference in the rate of serious injury and death following an
Internet prescription for sildenafil vs prescribing in an office
visit? 2100 patients is likely to be far too few. A third question:
is the Midwestern inner city control group likely in any way to be
comparable to the group requesting Viagra via the Internet? In the US
'inner city' often means an impoverished urban area, which would have
a relatively high rate of heart disease. I don't know
whether this is the case for this study group.
Barbara Mintzes
Centre for Health Services and Policy Research
University of British Columbia
bjmintzes@cs.com
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