While it is unlikely that we will ever be able to receive comprehensive treatment for cancer, heart disease and other complex medical conditions via cyberspace, the internet is bulging with organisations offering "lifestyle medical checkups" targeted at the cash-rich, time-poor, worried well. These services can also be valuable for people who live in rural areas far from a surgery and for those in a hurry to get test results. Some sites will send out a testing kit on the day it is requested and dispatch the results by email within 24 hours of receiving the sample back. The whole process takes only three or four days while the NHS can take several weeks from the time the appointment is booked.
There are tests to screen for a plethora of sexually transmitted infections, for stomach ulcers, prostate cancer, infertility, diabetes and many more, while DIY cervical screening, and tests to identify abdominal disorders such as irritable bowel syndrome and Crohn's disease are in the pipeline. And you can pay anything from £25 for an online consultation that could lead to a prescription for drugs such as Viagra, the morning-after pill or anti-obesity medication. But in the unregulated internet universe, how can you separate the worthwhile, safe services from the useless rip-offs and the downright dangerous?
Doctor Julian Eden of E-med, a London-based firm, was recently suspended from practising for nine months after the General Medical Council upheld a string of charges against him for prescribing drugs such as a year's supply of the highly addictive painkiller dihydrocodeine and the sedative diazepam, or Valium, and 51 repeat prescriptions for two highly addictive sleeping tablets, Zolpidem and Zopiclone, to a patient with only a five-minute consultation in nearly two years of treatment. In one case he ordered 60 sedatives for a suicidal 16-year-old boy with a history of self-harming and psychiatric care. The boy attempted to kill himself by overdosing on the drug two months later.
A GMC spokeswoman says the body had dealt with a handful of similar cases involving doctors working on the internet who had breached good-practice guidelines and the United Nations has this month issued a warning to women of the dangers of buying appetite-suppressant pills over the internet, particularly prescription drugs offered without a prescription.
The Medicines and Healthcare Products Regulatory Agency is monitoring the growth of online medical services. Officials undertake covert surveillance of websites using sophisticated search tools to identify rogue traders. They can only, however, police sites based in the UK. If anything suspicious is found relating to websites based in other countries they pass information to their counterparts in those countries.
A Healthcare Commission spokeswoman says that only "one or two" services have been registered and while all UK internet health services should be registered it doesn't have a specific remit to work with these organisations and is reviewing its procedures.
Dr Thomas van Every - whose online health service, Dr Thom, is registered with, and regulated by, the Healthcare Commission - believes that the internet will play a vital and growing role in healthcare. He hopes "the regulatory spotlight will fall more and more on online medicine. "The internet is increasingly becoming part of a package of healthcare," says Van Every, also an obstetrician and gynaecologist at the Chelsea and Westminster Hospital in London. "For some conditions, patients don't need to be sitting in front of a specialist. The unit costs of providing certain health checks over the internet are much cheaper than face-to-face consultations and it may be an area the NHS moves towards. With our [Dr Thom] service we are trying to replicate a visit to the doctor".
How to consult a cyber doctor
Before an online consultation, accepting a prescription or ordering a screening test, make the following checks.
· Is the service registered with the Healthcare Commission?
· Do you know the name of the doctor who is offering the consultation or prescription? If so, you can check if he or she is registered with the GMC at gmc-uk.org
· Does the service have insurance and a complaints procedure?
· Does it comply with data protection legislation?
· Doctors are permitted under GMC rules to prescribe medication online but it is illegal to promote the purchase of prescription medication. A doctor must not sell you a drug before a diagnosis is made
· A doctor should prescribe a very small quantity of a drug for you to try rather than handing over a year's supply
· Be wary of prescription drugs which seem too cheap. They may be counterfeit
· Obesity drugs should only be prescribed as part of a carefully monitored package of nutritional and exercise advice
· No medical test, even those carried out in hospitals, is 100% accurate. However, the website offering the test should state the percentage of accuracy you can expect. This should be more than 90%
· Do-it-yourself HIV testing kits are illegal. However, there is a legal saliva swab test which is sent away for analysis. If the results turn out to be positive, a blood test is recommended along with counselling