Elaha Hamidy ‘23 is a neuroscience major with a minor in public health at Santa Clara University and a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.
While scrolling through any social media platform, it is not uncommon to be bombarded with a wide variety of videos and images advertising quick and easy ways to get access to prescription drugs online. The prevalence of these advertisements is indicative of an upwards trend in the use of telemedicine and, specifically, the growing number of companies providing online, direct-to-consumer prescription services. Companies of this nature provide products of all sorts ranging from contraceptives to hair loss treatments. The popularity of these services demonstrates there is both a demand and a place in health care for online prescription services, however, it is critical to acknowledge their limitations. This blog post will explore the various ethical concerns of online, direct-to-consumer prescription services and consider what changes must be made to this system in order to mitigate these ethical pitfalls.
Most online prescription services project a similar message about the ease with which people can acquire access to prescription drugs. One such service, Done, which provides access to ADHD medications, breaks the process into three simple steps. First, there is a one-minute assessment, second, a 30-minute appointment with a licensed ADHD clinician, and the third step is that users get access to “worry-free refills”. To consumers, this process seems like a great deal compared to the usual lengthy process people need to go through, not only to receive a diagnosis but also to get access to medications.
This is one of the many appeals of online direct-to-consumer prescription services. Other benefits of such services include the removal of barriers to accessing medication, granting anonymity to users, and convenience due to its online modality. Proponents of these services also point out that many of the prescribed medications are already under consideration to be granted over-the-counter status, such as birth control and insulin. With the COVID-19 pandemic, certain restrictions were lifted, which enabled more controlled substances, such as ADHD medications, to also be a part of these online prescription services.
While these benefits seem groundbreaking on the surface, there are underlying issues with how these prescription services are set up that must be addressed. Companies offering direct-to-consumer prescriptions combine aspects of providing prescription drugs that are typically kept separate: prescribing the drugs and selling the drugs. In fact, many of these companies work based on a subscription service model, with people paying up to $250 a month to maintain their prescriptions and receive refills. This presents a conflict of interest because the healthcare providers working on the other side of the screen are incentivized, directly or indirectly, to prescribe medications to people through these services in order to ensure a steady revenue source for the company that employs them. This conflict of interest reveals that the primary purpose of these companies is not to treat individuals but rather to ensure that an ever-growing number of prescriptions are being filled.
This conflict of interest, combined with the skyrocketing number of advertisements displayed on various social media platforms, presents a new issue where these companies appear to be creating a demand for drugs rather than simply meeting one. For example, there are several documented cases of online prescription services for ADHD medications pushing advertisements on platforms such as TikTok, where the user base is mainly children and young adults. Advertising the ease of access to prescription drugs to impressionable young adults while also having little direct patient-physician interaction violates ethical principles of beneficence and nonmaleficence.
These principles push forth the idea that healthcare providers have an obligation to act for the benefit of patients and not inflict harm. The manner in which these prescription services are being pushed on potential patients breaks these principles since health care providers are motivated to err on the side of overprescribing rather than underprescribing, even if to the detriment of patients. It seems highly unlikely that a user would be able to fully understand and accept the potential risks associated with using these medications in a 30-minute appointment window, especially with a health care professional who has no knowledge of the patient’s medical history or values.
The way that online, direct-to-consumer prescription service companies are currently set up is to treat their users as a means to an end, with the end being higher profits and a larger subscription base. This violates Kant’s categorical imperative and highlights one of the main pitfalls of how these companies operate. The lack of separation between those providing prescriptions and those selling medicine is cause for concern. As it stands, patients are not being protected and their health is at risk for the benefit of a few companies.
Moving forward, it is vital to question whether or not this is a viable and ethical way of providing medicine to people. While these services may be beneficial for substances that are already being considered for over-the-counter status, it seems irresponsible to allow access to highly addictive drugs, such as ADHD medications, at the touch of a button and one online consultation. Greater regulation and attention must be paid to this emerging sector of the health care field to prevent issues with over-prescribing drugs and not properly informing patients of the potential complications of using these products.