title: Sildenafil and the Internet.
abstract: OBJECTIVE
  The Internet is changing the way medicine is being practiced and challenging our notions of the doctor-patient relationship. We analyze the development of online prescriptions and propose guidelines for the sale of sildenafil over the Internet.
  
  
  METHODS
  Using MEDLINE, Medscape and Lexis-Nexis search engines we reviewed pertinent materials from January 1996 to July 1999 focusing on the keywords Viagra, prescription and Internet. The review included press releases, law review articles, case law, medical literature, pending litigation, proposed legislation, and federal and state statutes.
  
  
  RESULTS
  Online prescriptions are an outgrowth of the mail order drug business. This development continues the historic innovations in communications and transportation that have enabled physicians to practice medicine over long distances while maintaining ties to hospitals and other specialists. While the sale of sildenafil over the Internet may be profitable and convenient, it raises a variety of legal, ethical and safety concerns. Many federal and state organizations have addressed the issue without establishing a clear standard.
  
  
  CONCLUSIONS
  A clear distinction exists between online prescriptions and pharmacies. While it may be acceptable for sildenafil to be sold over the Internet given current technologies, it must be done within the confines of a traditional doctor-patient relationship. Online prescriptions must be limited to patients who live in states in which the prescribing physician is licensed. Failure to establish a doctor patient relationship in this context breeches ethical standards, and may give rise to potential civil and criminal liabilities.
authors.affiliation: Department of Urology, Case Western Reserve University, Cleveland, Ohio 44106-5046, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Kahan
authors.forename: A D
authors.initials: AD
authors.lastname: Seftel
authors.forename: M I
authors.initials: MI
authors.lastname: Resnick
mesh_terms: D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D020407:Internet; D016365:Liability, Legal; D008389:Marketing of Health Services / Q000331:legislation & jurisprudence / Q000379:methods*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D014481:United States
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate