One of the justifications for the Ryan Haight Act was that doctors performing face to face examinations can determine the veracity of a patient’s claim of chronic pain before prescribing medication much better than an internet pharmacy doctor performing an online consultation. This is likely true with respect to internet pharmacies that do not require medical records or online medical history questionnaires. However, is this so undoubtedly true for online pharmacy doctors requiring medical records and a phone consulation prior to writing a prescription to justify attempting to outlaw the practice altogether? I don’t think so.
Is there really any way to medically assess and objectively verify claims of pain? Is there a test one can perform, such as an MRI or other brain imaging technique? Is there anything that a face to face doctor performing a medical evaluation in his or her office could do that an online physician could not, assuming all else is equal? Let’s take back pain, for instance. What more does a face to face doctor do in the five minutes he or she sees you than look at the medical records, a patient’s medical and prescription history, and ask the patient what, where, and how long?
Today I came across a very interesting article written by the Boston Globe in 2006 noting that that researchers were attempting to utilize advanced brain imaging to detect prolonged, chronic pain.
Recent studies suggest that prolonged, ongoing pain leaves a signature in the brain that can be detected using advanced imaging techniques. In other work, researchers at Massachusetts General Hospital and elsewhere have found that excruciating nerve damage can be detected in bits of skin the size of a pinhead. And genetic tests may someday prove useful, researchers believe: Certain genes appear to be linked to lower pain thresholds and a tendency to develop chronic pain.
Most of the research remains years from helping patients, but as it comes to fruition, “what it means is that no longer can they say, ‘it’s all in your head,’ ” said Jim Broatch , who leads an advocacy group for people with a specific chronic pain disorder.
“With these objective and reproducible correlates in brain imaging, chronic pain may no longer be a subjective experience,” Lutz said in a press release.
As the article states, this technology is years away. Even if it wasn’t, I seriously doubt your local practitioner is going to perform, for example, an expensive MRI or a genetic test prior to issuing pain medication.
Thus, I once again ask the question, how can a face to face medical examination, as required by the Ryan Haight Act, verify claims of pain any better than an internet pharmacy doctor via an online phone, fax, or e-mail consultation after the review of a patient’s medical records, history, and prescriptions? I appreciate and welcome any thoughts.
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