Online Pharmacies and Telemedicine

Not a day goes by when our email inboxes do not fill with advertisements for prescription drugs. Many of these emails promise to deliver drugs of all classes by overnight courier without a prescription. While there are legitimate online pharmacies, and the practice of telemedicine or cyber-medicine is gaining acceptance, this change in the way medicine is being practiced is rocking the foundations of the medical establishment. Being able to consult a doctor online, and obtain prescription drugs delivered to your doorstep by UPS has broad social and legal implications. The Internet facilitates making drugs available to those who may not be able to afford to pay US prices, are embarrassed to see a doctor face-to-face, or are suffering from pain, the treatment of which puts most doctors in direct conflict with the ‘war on drugs’ but on the other hand there is the question whether these pharmacies make drugs available to recreational drug users without the oversight of a licensed medical practitioner.

The Need for Alternatives

Medical care in the US has reached a point where it is expensive and impersonal which has caused the consumer to become generally unsatisfied with the medical establishment as a whole. Examples include the huge differences between the cost of drugs in the US and Canada, long wait times in US pharmacies, and poor service in general. Perhaps realizing this, US customs appears to tolerate the millions of Americans that visit Canada every year to buy their medications, as for the most part, these ‘drug buyers’ are elderly American’s that can’t afford the high cost of filling their prescriptions in the US.

Rather than to travel to Canada or Mexico millions of Americans are now turning to the Internet for both their medical needs. Telemedicine (or cyber medicine) provides consumers with the ability to both consult with a doctor online and order drugs over the Internet at discounted prices. This has resulted in consumers turning to online pharmacies for their medical needs, and in particular pharmacies with a relationships with a physician, which allow the consumer to completely bypass the traditional brick and mortar pharmacies, with the added benefit of having their physician act as an intermediary between the consumer and the pharmacy. According to Johnson (2005) this is as a result of consumers becoming very dissatisfied when it comes to dealing with both brick and mortar pharmacies and medical practitioners. As Johnson, notes, “Consumers are more likely to know the name of their hairdresser than their pharmacist.” When Johnson (2005) rated the various professions within the health care system, he found that pharmacists had the lowest interaction with their patients than did any other group. Today, as a result of this “consumers are buying 25.5 percent of their prescriptions online, opposed to 13.5 percent of which are picked up at a brick and mortar pharmacy” (Johnson 2005).

Drugs and Society

What has brought so much attention to online pharmacies is that it is possible to obtain just about any drug without a prescription online. Many of these prescriptions are for legitimate purposes purchased through an online pharmacy because the buyer is too embarrassed to visit the doctor or for other reasons including the unavailability of FDA approved drugs to the consumer. These drugs may include steroids that due to their misuse and being classed as a classed a category three drugs, are seldom prescribed by physicians. These drugs have a useful purpose to those suffering from any wasting disease such as AIDS, they also play a role in ant-aging (FDA, 2004).

The Doctor Patient Relationship

Today a visit to a doctor is generally brief, much of the triage it is done by a nurse or a nurse practitioner with the doctor only dropping in for a few minutes, if at all. In many cases the patient is seen by a nurse practitioner. One of the arguments against telemedicine or perhaps a better term is cyber-medicine, is that the doctor does not have a physical relationship with the patients and thus is in no position to make a diagnosis, and thus can not legally prescribe drugs.

Ironically when one compares the work up that one has to go through to consult with an online physicians and compares this to a face-to-face visit with a brick and mortar doctor, one finds that the online physician, in many cases, has a better understanding of the patient’s medical condition than does the doctor who meets face-to-face with the patient. In most cases before an on-line a doctor prescribes any type of medication they insist on a full blood workup they may also require that one has additional tests performed, for example.

The AMA, the federal government, and various states claim, however, that it is illegal for a doctor to prescribe drugs without a valid doctor-patient relationship. While there are no laws at present that outlaw online pharmacies, various states have enacted legislation, or are in the process of enacting legislation to prohibit a doctor from prescribing drugs to a patient that they have not seen face to face. Some states also require that the doctor that prescribes the drugs be licensed in their state. This alone could hamper the development of cyber-medicine. According to William Hubbard (2004), FDA associate commissioner “The Food and Drug Administration says it is giving states first crack at legal action, though it will step in when states do not act” (FDA, 2004).

Internet Pharmacies

The reason that email boxes around the country fill up with offers to supply drugs of all kinds, at reduced prices, without prescriptions, and more is because people buy them as the billions of dollars the drug companies are making each year attest to. The Internet has become the drug store of choice for many.

Categories of Internet Pharmacies

Internet pharmacies are generally acknowledged to be comprised of the following five categories:

Internet pharmacies can be divided up into five different categories, as follows:

Licensed online pharmacies with a no medical affiliation.

Licensed online pharmacies with a medical affiliation

No record online pharmacies (NRP)

International online pharmacies (IOP)

Licensed compounding pharmacies

The licensed online pharmacies with a no medical affiliation are of course Drugstore.com, CVV, and others. They all require a prescription from a licensed doctor that the patient has a doctor patient relationship with. The prescription can be called in by the doctor.

The licensed online pharmacies with a medical affiliation often depend on a broker. The broker collects your medical information, and then assigns your case to one of their networked physicians. Many of these networked physicians are willing to prescribe pain killers as they believe that it is only through the use of these drugs that some people can live a harmonious life.

A Government Accountability Office (GAO) Committee on aging held in June 2004 found that “Unlicensed international pharmacies do not require a prescription, and are generally located off shore.” No prescription pharmacies can be found all over the world. Many of these sites have come under controversy as in some cases all it takes to have that prescription delivered to you by next day air, is to fill out a questionnaire online.

A study conducted by Henkle in 2002 to ascertain how easy it would be to obtain drugs over the Internet found that “37 of the 46″ pharmacy required a prescription from a licensed doctor. The emphasis was on the prescription and not on the doctor. Henkle (2002) in fact notes that some sites offered to recommend a doctor.” Henkle (2002) was able to obtain prescription drugs from nine sites outside the US during the study, without a prescription.

Online pharmacies with a doctor affiliation

There are a number of online pharmacies, with a medical affiliation is that take great pain to differentiate themselves form unlicensed overseas pharmacies. These pharmacies, stress that they are “American based companies that provides consumer’s easy access to FDA approved online prescriptions over the Internet and are quick to point out that “An online consultation can be just as relevant as an in-person consultation.” It is interesting to note that many of these online pharmacies also point out that “While they are committed to making access to online prescriptions easier, they believe that the Internet can not replace the importance of regular doctor visits to fully evaluate your health and any medical conditions.” Many of these online pharmacy sites also makes a wealth of drug information available on its web site that enables the consumer to educate themselves on drugs that may have been prescribed. The Internet has for all intensive purposes is quickly replacing the brick and mortar base physician as a patient’s primary health care provider.

A sales pitch, of course, or is it? Most of the legitimate online pharmacies ensure that they comply with state and federal regulation. The doctors are licensed in all 50 states and their pharmacies are too. These legitimate Internet pharmacies cater to those that are looking for a better price; for some it comes down to making the choice of eating cat food on crackers in order to afford their medications because of the high US drug prices. In other cases patients resort to cyber-medicine to avoid the embarrassment of having to deal with a physician or pharmacy that may be judgmental. Many of these online pharmacies will arrange a consult with a licensed, medical doctor over the phone and will then fill the prescription accordingly.

According to Henkel (2000) “More and more consumers are using the Internet for health reasons” and references a study carried out by a market research firm Cyber Dialogue Inc., “that found that “health concerns are the sixth most common reason people go online” (Henkel 2000).

For many people a trip to the pharmacy is an ordeal. In some cases the local pharmacy may also be located in the closest town which may mean a long drive if one lives in a rural community. Online pharmacies provide a means through which their prescriptions can be delivered conveniently and quickly. Being online also allows the consumer to shop for the best prices, an important factor if one is living on a pension.

The Internet has also created a more aware user. It is not unusual for a consumer to research drugs on the Internet. A consumer may have seen a TV or magazine advertisement advertising a new drug. Ultimately, the Internet also provides the consumer the opportunity to enter into a doctor patient relationship that may in fact be more legitimate than the doctor who makes a physical appearance. Further information on doctors that practice telemedicine can be found at: http://www.becomeone.com

It is interesting to note, as discussed previously, that consumers are becoming dissatisfied with the care and treatment they receive from both brick and mortar physicians and pharmacies. Zanf (2001), references a study by Lang and Fullerton that “Identified four factors related to outpatient pharmacy services: professional communication, physical and emotional comfort, demographics, and location and convenience.” All of which are contributing factors as to why more and more consumers are resorting to cyber-medicine.

The Dark Side

There is also a dark side to the Internet pharmacy, as previously discussed, spam email touting the availability of any prescription drug one could want, without a prescription, is something everyone is familiar with has reached epidemic proportions.

From Ambien, and of course Viagra to more powerful drugs such as Oxycontin, you can have it all. Over night shipping is available in most case, or so these emails proclaim.
In some instances this pharmacy spam originates from unscrupulous individuals who have no intention of delivering the drugs, realizing that very few people, if any, will complain about the non delivery of an illegal drug through the mail.

In other cases the drugs are sent without a prescription from countries where that particular drug may legally be sold without a prescription, or at least the laws are more relaxed. Valium, for example, is sold over-the-counter in Taiwan.

According to Crawford (2004) “Consumers who purchase drugs online thinking that they are they are getting the same drugs as they would from their local brick-and-mortar pharmacy are being misled, and as a result are putting their health, and eventually their lives at risk” Crawford cites examples of Internet pharmacies supplying drugs that were under strength, contaminated and mislabeled (Crawford 2004).

According to Won (2005) Drug-industry executives think the Internet and mail-order operations will be the biggest source of counterfeit drugs over the next five years, according to a report released today by Ernst & Young. According to James G Dickinson (2005):

The federal government in July shut down an alleged illegal Internet pharmacy for selling counterfeit drugs and issued a warning on other counterfeits found to have been sold in Mexican border pharmacies to individual patients from the U.S. The Internet pharmacy had sold more than $7 million in counterfeit Viagra and other prescription drugs over the past five years, according to the San Diego Union-Tribune. The San Diego-based operation required individuals to complete a $35 “doctor consultation” survey before receiving the prescriptions, but the survey was never shown to a health professional to evaluate whether a safety risk existed, the paper says (Dickson, 2005).

In a separate action, the FDA warned Americans about counterfeit versions of Merck’s cholesterol drug Zocor and generic Carisoprodol – used for treating musculoskeletal conditions – that had been imported from Mexico by individual Americans (FDA, 2005).

Over the last year patients suffering from pain, and other conditions that they are reluctant to see a doctor face-to-face, have had the option of consulting a doctor online. The ability to consult with a doctor online, and then to receive drugs as a result has come under much controversy. This has for the most part been as a result of not adequately screening patient’s records, or ordering from unregulated overseas pharmacies.

The Internet – a new way of marketing

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A Few Tips on How to Start a Career As a Pharmacy Technician

Pharmacy Technician is a solid career choice. Health-care jobs are predicted to steadily grow over the next decade. In fact, labor and industry forecasters all seem to agree that most health-care job numbers will keep increasing over the next decade. The aging baby-boom population reaching their golden years is a major indicator of health-care’s upcoming growth. And, pharmacy is tied into health-care at nearly every level, which means that being a pharmacy technician should prove the be a stable career path over both the short and long term. This article talks about some tips and ideas about how to become a pharmacy tech. First, lets talk about what pharmacy technicians do day-to-day?

What Do Pharmacy Techs do?

Pharmacy Technicians have a wide range of duties since they work in a variety of venues. The majority of techs work in retail stores. Other environments include Hospitals, Long-Term Care facilities, Mail-Order pharmacies and Military bases. Insurance companies also hire experienced pharmacy techs to audit paperwork and adjust claims. Most pharmacy technicians work directly with customers / patients under the direction of a pharmacist. They may perform many of the same duties as a Pharmacist and must have a good working knowledge of the pharmacy operations. Besides counting out tablets and ringing up orders, pharmacy technicians also decode prescriptions, enter data into computers, create labels, make and receive phone calls, rotate stock as well as countless other duties.

Pharmacy Technicians do much of the work in a pharmacy, but they can’t do everything. They may not answer questions about medications or give any advice whatsoever. They can tell a customer where to find “over-the-counter” products and even read the words from the packaging. However, they can never personally advise anyone to use any type of drug product. Overall, a pharmacy technician’s main goal is to assist the pharmacist in helping patients and customers. They are expected to be attentive and accurate, but also friendly and knowledgeable.

Do I have to get certified to become a pharmacy tech?

Most employers and states require National Certification. Someday, the regulations may be the same everywhere, but for now it’s different in every state. The first step is to find out what is required in your state and/or any prospective employers. At the minimum, Pharmacy Technicians are required to register and keep an updated license with the Board of Pharmacy in their respective state. Most U.S. states require national certification from either the PTCB or ICPT (ExCPT). However, even if the state doesn’t require national certification, most companies who employ pharmacy technicians do. In addition, even if neither the state or your employer require certification, it’s recommended that anyone planning on a career as a pharmacy tech should become nationally certified in order to be more qualified when applying for a tech position or promotion.

What is the pharmacy tech test like?

Taking the PTCB Exam:

Most states recognize the PTCB since it’s been around longer and has a solid reputation. The pharmacy technician test given by the PTCB is a 90 question multiple choice test. There are four answers to choose from, with one being the correct answer. You get 120 minutes to complete the exam. The exam is in random format, which means that the subject matter switches around nearly every question. The exam is constructed as:

66% – Assisting the pharmacist / serving22% – Maintaining Medication and Inventory Control Systems12% – Administration and management of pharmacy business practices

To pass the PTCB Exam:

You’ll need to score at least 650 out of 900. Whatever you do, don’t read online message boards (Yahoo groups, etc.) where people who have passed try to tell you what’s on the exam. There are several test batteries that change frequently. In fact, they’ve currently updated all of the exams in mid 2010. The best way to ensure you pass the PTCB exam is to study until you confidently know all of the subjects on the exam.

What do Pharmacy Technicians earn?

The Salary paid to pharmacy technicians really varies by geographical location. So, in an attempt to collect the best available data, an ongoing wage survey has been running on my website for several months and the results are listed individually by city and state. To see those results, go to the wage survey page.

Pharmacy Tech School vs. Online vs. Self Study

The best route to get trained and certified really depends on each person and their own situation. Each type of program offers different types of structure and flexibility. The biggest factors to consider are job placement assistance, program accreditation and your budget.

Community College – pharmacy technology programs

Many Community Colleges offer a 1-2 year pharmacy technician program designed to prepare students to jump right into a pharmacy technician position. These programs usually qualify for financial aid and other assistance / re-training programs. One of the big questions you’ll want to ask when considering this type of program is about placement assistance after program completion.

Trade School / Pharmacy Tech Colleges

The trade schools are all a little different from each other, so you’ll want to research all of them to find one that’s best for you. If they are accredited, you may also qualify for financial aid grants and loans. If you are serious about attending one of the pharmacy technician schools, make an appointment and take a tour of the school. Ask specific questions about the program and the career placement. When you go for a tour at a pharmacy tech school, be prepared for the big sales pitch and some pressure. Remember, these schools are businesses and the folks who give the tours are salespeople and often work for commissions.

Online pharmacy Technician Programs / Online Colleges

An increasing number of schools are offering online programs which can be completed at home. An online pharmacy technician program can be a great choice for a highly disciplined person. If you’re prone to getting side-tracked by other projects (or TV shows) while you are at home, Online study programs may not work for you. On the other hand, if you can focus and stay on a schedule online programs are flexible enough to work around any schedule. When considering an online pharmacy technician program, shop around and look at the benefits of each. Some of the online programs may have affiliations with community colleges or chain drug stores, which may provide assistance in finding an internship or externship.

Self Study / Pharmacy Tech Review Books

Similar to online programs, self study can be challenging for the focus deficient types. However, one really good strategy for succeeding with a self-study pharmacy tech program is to form a small group and meet on a schedule. Even just having one partner to study with on a consistent basis helps immensely. Self study is also a very good option for experienced technicians who are in need of getting certified because of a new law or employers policy.

What subjects do pharmacy technician students study?

The breakdown of the test doesn’t really give a clear picture of what subjects pharmacy tech students need to study. In pharmacy technician programs, some of the subjects are: Pharmacy Math, The Top 200 Drugs, DEA Controlled Substance Schedules, Pharmacy Laws and ethics, Prescription decoding and abbreviations, parenteral Nutrition, Pharma

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