Prescription drugs on demand? "Restaurant-menu medicine" raises concerns

In today's Morning Rounds, "CBS This Morning " looks at direct-to-consumer medication services.

The paradigm of the doctor-patient relationship is changing. Companies like Hims and Roman allow people to order prescription drugs for conditions like hair loss and erectile dysfunction without seeing a doctor face-to-face. Customers simply pick out what medicine they want, fill out an online questionnaire, and then submit it for review by a doctor. 

After answering about 20 questions, a "CBS This Morning" producer was able to order generic Viagra from Roman in a couple of hours, without ever talking with a doctor. About an hour later, the drugs had shipped.

Dr. Arthur L. Caplan, a medical ethics professor at New York University School of Medicine, has called such online drug services "restaurant-menu medicine."

Dr. Tara Narula, a CBS News medical contributor, said, "We are living in a whole new world where people want things on demand; we want our Uber on demand, our food on demand. And now we want our prescription meds on demand. And there are companies that have millions of dollars backing them saying that this will work because it's easy, it's discreet, it's affordable, and it's streamlined, and they're betting on conditions that people want to maintain privacy around things like erectile dysfunction, hair loss, skin care, libido."

She said it is turning the practice of medicine on its head: "In the past it was the doctor prescribing and diagnosing; now, it's the patient self-diagnosing and self-describing. The doctor is [merely] a gateway."

Another concern is when medications are prescribed for reasons that are not included in the drug's FDA-approved labeling, known as "off-label use."

For example, "propranolol, a beta blocker sometimes used for blood pressure, they're marketing in an off-label way, which is for social performance anxiety," Narula said. "Drug companies and distributors cannot market off-label — it is illegal. But these companies are getting around this, they're flying under the radar, because they're saying, 'We're not a drug company, we're a platform.'"

Narula sees definite problems with self-prescribing. "First and foremost, it erodes the whole nature of a doctor-patient relationship, that trust-building, time you had together to work on things like prevention," she said. "There's a reason we have a physical exam. It really informs us about what we need to be doing and how to prescribe.

"In addition, people are filling out the information. They're putting in their blood pressure and their history. What if they're not being so truthful? I don't have a medical record to verify what they're telling me."

A person ordering meds might also be unaware of more serious medical issues a doctor might catch. "Some of the other concerns are that problems like erectile dysfunction, for example, may just be that, but they also may be indicative of underlying problems with an arterial disease or diabetes, so maybe you're missing the boat."

Safety and quality control are also concerns. "How do I verify who the doctor is on the other side, how qualified they are? Where are the meds coming from? Are they coming from China? And when I get my medications, am I going to get them with the important information about how to take them?"

"Also, with a drug like Viagra, there are a lot of counter-indications as well," said co-host Norah O'Donnell. "If you're just ordering that over the internet and your doctor doesn't go through them, you risk death."

"These are prescription meds," said Narula. "They have common side effects, rare side effects, black box warnings on certain ones. Things like Viagra can cause low blood pressure, sudden vision loss, maybe hearing loss. … Some of the anti-depressants, like Zoloft and Wellbutrin, comes with suicidal ideation warnings."

And the companies are not regulated.

"I'm very concerned," she said of obtaining prescription drugs with consulting a doctor. "I was pretty alarmed by the potential risk."

Roman sent CBS News a statement saying, "Roman is a complement to in-person care, not a replacement. Roman enables physicians to easily connect with patients and offer high-quality and accessible health care for certain conditions via telemedicine."

A Hims representative said: "Only a licensed physician is in the position to know the risks and benefits of a certain medication and whether it's the best option for a patient. We created the Hims/Hers platform to help make that conversation possible without judgment or stigmatization."