Crossing Lines to Prescribe Online
From his suburban home in nearby Lee's Summit, Miles J. Jones has written tens of thousands of prescriptions for online customers seeking Viagra, Levitra, Xenical and a handful of other drugs. To the stocky 51-year-old pathologist's way of thinking, he is practicing cutting-edge medicine and providing a safe, convenient service.
State regulators across the country take a decidedly different view. To date, 13 states have revoked or suspended Jones's license for online prescribing. His home state of Missouri revoked his license in February.
So how is it that Jones, a self-described maverick who likens himself to Columbus and Galileo and earns most of his income performing private autopsies, continues to write prescriptions without a license -- including nearly 5,000 for Viagra this year?
The answer lies in the nature of the Internet. Although he may review patients' medical questionnaires from his home computer, Jones contends that he is not actually practicing medicine in Missouri. The server for his Web site, netdr.com, is in Pennsylvania, where he still holds a valid license. Therefore, Jones said, "the practice site is in Pennsylvania.
"That's the nature of the Internet," Jones added. "It doesn't matter where I am. I could be on a plane in California or in Geneva, Switzerland."
The ease with which Jones has maneuvered around state medical boards raises the question of what chance, if any, regulators have of keeping pace with the explosive growth of online prescribing. To judge by Jones, not much.
"There is no question that the Internet has brought a new dimension to regulating medical practice," said James Thompson, chief executive of the Federation of State Medical Boards. "But no matter where he is located, Miles Jones is violating the accepted standard of care by writing prescriptions for patients he has never seen and doesn't know."
Nonsense, counters Jones, who has likened the disciplinary actions against him to the Spanish Inquisition. "I thought their process was unfair, unscientific and not based on any principles that we as physicians hold," he said.
Yet even Jones, a 1977 graduate of Howard University College of Medicine, appears to recognize the challenges posed by the ephemeral nature of the Internet. "The Internet begs the question whether there should be some sort of federal license" for doctors, he said in an interview. "I look at this practice as national. In fact, it is international. It is a process that should be controlled and processed by the federal government."
Proposed federal legislation would allow state attorneys general to seek injunctive relief against online pharmacies and physicians operating across state lines. "If this legislation were in place," Thompson said, "Miles Jones would be out of business."
Jones said he plans to fight the state regulators until they can prove that what he is doing is unsafe. "I can be stubborn. I can be downright obstinate," he said.
Even as a child growing up in the Philadelphia suburb of Abington, Jones said, he "really didn't fit in. I was black, smart, not athletic." His love of science came from observing his father, who owned a cosmetic company that catered to blacks. "As a 5-year-old, my father helped me make aspirin," he recalled.
After attending Princeton University, Jones entered medical school and gravitated toward pathology. He worked for several hospitals before starting his own business specializing in private autopsies in cases in which no official autopsy is being done or the family wants a second opinion. "I probably do 50 to 100 a year," with an average fee of $3,500, he said.
Once or twice a year, Jones fills in as a temporary hospital pathologist, which explains why, at his peak, he maintained medical licenses in 27 states. On occasion, he also serves as an expert witness, he said, and for a brief time harvested fetal tissue for medical researchers.
Jones said he began to write online prescriptions in 1998. At first, he was paid $25 for each prescription. Now, he receives $5,000 every other month, he said. In five years, he estimated, he has collected about $100,000 from online prescribing.
Jones said he has never met the owners of netdr.comand does not know who they are. "One of the owners is in Brazil," he said. "As far as I know, the papers of incorporation are in the Bahamas. I know they are somewhere down in the Caribbean."
Jones said he has written online prescriptions for more than 35,000 patients for netdr.comand its affiliate maleclinic.com. Nearly eight of every 10 customers have requested Viagra, the popular drug for treating erectile dysfunction. All but about 100 of the requests have been approved. With computer efficiencies, Jones said, it takes him about a minute to review the online medical questionnaires filled out by patients. He has never asked for medical records of patients, Jones said, and he rarely speaks with customers on the phone.
Jones defends the process as thorough and safe. He said he does not prescribe narcotics and knows of no injuries to his patients from the drugs he has prescribed. "I'm only going to prescribe for conditions that can be managed without a physical diagnosis, without a physical examination," Jones said.
Jones contends that the state boards have punished him unjustly because they are protecting the old guard of medicine. "I am like Columbus," he said. "They said the Earth was flat. He would sail off the edge. . . . I am like Galileo . . . like Copernicus."
The medical boards counter that Jones has violated one of the basic tenets of medicine by failing to establish a valid physician-patient relationship. The North Dakota Board of Medical Examiners, which revoked Jones's license in September, calculated that Jones approved at least 72 prescriptions an hour in 2002, "perhaps considerably more." It also cited a case in which Jones wrote a prescription for Viagra for a 14-year-old posing as an adult.
Jones, who is appealing the decision, called the board's math "deeply flawed" and said he had no way of identifying the boy, who had properly filled out the questionnaire. "Admittedly, a physician in his office should be able to pick up [on] a 14-year-old boy coming in for erectile dysfunction," he said.
Thompson questioned how any doctor could prescribe Viagra to patients without determining whether their erectile dysfunction was caused by an underlying problem, such as diabetes or tumors. "I would think it would be important, for example, to check if the patient were presenting symptoms for one of these diseases," he said.
A spokesman for Pfizer Inc., the manufacturer of Viagra, agreed. "In general, it's irresponsible to circumvent the relationship between a patient and a doctor without going through a proper diagnosis as well as discussing the appropriateness for treatment," Daniel Watts said. "Certainly Pfizer doesn't endorse this. It's not the way to go."
Jones said Pfizer was "the perfect Janus," a reference to the Roman god said to have one head and two faces. "Pfizer will suck up to organized medicine but at the same time will certainly accept every dollar that comes in from Internet practice," he said. Watts said Pfizer would prefer not to get its sales from online prescriptions. "It's not about the numbers," he said.
Jones concludes that "if someone can show me in a scientific study that what I am doing is dangerous, I will stop tomorrow. That's the way to convince me."
Source: www.bizreport.com
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