Establishing guidelines for Internet-based prescribing

The American Medical Association called for the establishment of guidelines to allow electronic prescription of medications "for established patients." Based on experience writing more than 10,000 Internet-based prescriptions, we agree that guidelines are long overdue. Restricting such prescribing to patients with whom a face-to-face relationship has previously been established violates patient autonomy and distorts the physician-patient relationship without improving patient safety or convenience. A study comparing information obtained and used by Internet-based physicians prescribing sildenafil with that obtained by clinic-based physicians writing similar prescriptions suggests that safety may be greater on the Internet. Data regarding the appropriateness of prescriptions for other medications suggest that the in-office visit is not the panacea it is often assumed to be. Guidelines for electronic prescribing, like guidelines for other aspects of medical practice, need to be based on evidence. Such evidence is currently lacking, and a serious effort to obtain it should be a top priority.