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All dating guide teen rights reserved In May 1999, Dr Leandro Pasos, an orthopedic surgeon, dating guide teen was accused of unprofessional conduct by dating guide teen the Washington State dating guide teen Health Department for dating guide online dating agency for single teen prescribing sildenafil (Viagra) over the Internet to patients he dating guide teen had dating guide teen neither seen nor examined1,2 This case was one of the first to highlight changes in medical practice resulting from the expanding dating guide teen use dating guide teen of the Internet3,4,5 Although the Internet may improve patients' dating guide teen access to medical information and other medical services, some Internet-based services, such as those involving the direct sale of medications, bypass protections normally associated dating guide teen with conventional medical dating guide teen practices The availability of prescription medicines over the Internet may dating gay teen increase the inappropriate use of medications and the risk of adverse events dating guide teen by limiting physicians' ability to dating issue teen identify contraindications, patients' ability to learn about the risks and benefits of medications, and pharmacists' ability to identify drug dating guide teen interactions and educate patients Patients can obtain prescription dating guide teen medications over advice dating girl teen the Internet in several ways First, they can request direct delivery of medications over the Internet after their doctors have submitted prescriptions by telephone or on paper This approach bypasses dating guide teen neither the visit to the physician advice dating online teen nor the pharmacy intermediary Second, dating parent teen patients can contact advice christian dating teen their physicians over the Internet, request a medication, and have the dating guide teen physicians dating guide teen send the prescription to the pharmacy Although this approach retains the safeguard of having the patient's pharmacist dating guide teen review the prescription, it bypasses the visit to the physician Third, consumers can dating site teen young order medications directly over the Internet without seeing a physician or a pharmacist Because the direct sale of medications to consumers christian dating service teen bypasses both a visit to the physician and a review by a pharmacist, it is associated with dating guide teen the greatest potential risk of dating guide teen dating free online services teen adverse effects6 Direct sales of sildenafil over the dating guide teen Internet are a particularly alarming prospect because of the drug's potential appeal to consumers and its medical risks.


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7,8,9 Erectile dysfunction is both easily recognizable by a patient and potentially embarrassing to discuss in dating guide teen conventional doctor朴atient settings10 Sildenafil is dating guide teen well known to consumers8,11 The cost of sildenafil may not be covered by insurance companies, reducing a patient's incentive dating guide teen to obtain dating guide teen the drug through a dating guide teen visit to the physician10 dating guide teen At the same time, the use of sildenafil poses dating guide teen serious risks to some patients, including potentially online dating agency in uk life-threatening hypotension when used with nitrates9,12 dating guide teen The purpose of our study was dating guide teen to evaluate the availability of sildenafil over the Internet with dating guide teen the use of reasonable benchmarks for medical care Methods We conducted a systematic search of the World Wide Web to identify all sites that were selling sildenafil dating guide teen directly to consumers between dating guide teen April 14 and dating guide teen April 28, 1999 We used three search engines (AltaVista, HotBot, and WebCrawler) and the terms "Viagra" and "deliver" or "order" We reviewed 4400 potentially dating guide teen eligible Internet sites dating guide teen and included all sites that offered dating guide teen direct delivery of sildenafil to consumers, did not make a visit to a physician dating love quiz teen a requirement, and did not require consumers to have a prescription for the drug All potentially relevant links at each dating russian teen eligible site were explored dating guide teen We developed a site-abstraction form to collect data on key characteristics, including the geographic location of the Web site, the costs of the service and of the drug itself, and whether it provided information about dating guide teen sildenafil, requested information from consumers, provided disclaimers and warnings, and required a "medical consultation" (review of information about medical dating teen violence history by dating guide teen a physician) Data from eligible Internet sites were abstracted dating guide teen between April 28 dating guide teen and May 7, 1999 All variables were examined dating guide teen with the use of descriptive statistics We used International Monetary dating guide teen Fund exchange rates for May 12, 1999, to convert costs into dating information teen dollars13 Web sites were categorized as outside the United States if their address was dating guide teen outside the United States, they did not use US currency, or they specifically stated their lack dating guide teen of liability for the confiscation of sildenafil by U.


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S customs All other Web sites were categorized as being within dating guide teen the United States for the purposes of analysis, although the actual location of all the companies could not be determined Relevant characteristics dating guide teen were compared dating guide teen between sites outside the United States and US sites dating guide teen with use of the chi-square test Results We dating guide dating pre teen teen dating idea teen identified 86 sites that offered to deliver sildenafil directly dating guide teen to consumers without a visit to a physician In the dating help teen 10-day interval between identification of the sites and dating guide teen data collection, nine black dating teen of the sites ceased operating All nine of these Web sites were classified as being within the dating guide teen United States The characteristics of dating guide teen the 77 remaining sites are reported in Table 1 View dating russian teen this table: [in this window] [in a new window] Table 1 Characteristics advice dating girl teen of dating guide teen 77 Web Sites Offering Direct Sale of Sildenafil to Consumers Forty-two sites (55 percent) provided some type of information about sildenafil dating guide teen Approximately one third of the sites also pointed out the advantages of ordering dating guide teen sildenafil over the Internet, including confidentiality, ease of ordering, and lower cost Forty-two sites (55 dating guide teen percent) required consumers to undergo an on-line medical evaluation, consisting of a dating local service teen questionnaire Four sites dating guide teen (5 percent) offered but did not require such dating teen tip an evaluation, and 31 sites (40 dating guide dating online service teen teen percent) did not offer such an evaluation Thirty-eight sites (49 percent) asked whether the respondent had erectile dysfunction (most commonly phrased in the following way: "Does an inability to maintain an erection dating teen tip prevent completion of intercourse?"); 35 of these sites asked whether the respondent had undergone a previous evaluation for impotence The average cost of the on-line evaluation was $64 (range, $5 to $89) and was separate from the cost of the drug Only 27 sites (35 percent) specified that a physician would review each questionnaire None dating free online teen of the sites provided specific dating guide dating quiz teen teen information about the dating guide teen qualifications of the physician The content and design of the best online dating web site questionnaire differed among the sites Of the 46 sites dating help teen (60 percent) that included a questionnaire, 34 (44 percent) required dating guide teen information about use of nitrates dating in minneapolis speed before the respondent could submit the questionnaire, and 10 (13 percent) merely dating guide teen requested such information.

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