 
Professor at School of Law
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Years ago, patients might have seen one doctor from cradle to grave. But today, managed care has led the trend toward the depersonalization of medical services. As medical services continue to shift to the World Wide Web, that depersonalization may continue; a visit to the doctor might be replaced with a visit to database administered by non-physicians.
"Managed care organizations have taken over," said Nicolas Terry, professor of law. "And the role of the individual doctor and the continuing personal relationship with the patient has declined."
With HMOs interfering with the selection of drugs physicians can prescribe, drug companies have been pressed to market their products directly to consumers. Television advertising has been only the beginning; pharmaceutical manufacturers now are establishing a robust Web presence combining health advice, marketing and detailed drug information.
These migrations to the Web by health care providers and drug companies are symptomatic of cybermedicine, Terry said.
Terry, a pioneer in teaching cyberspace law, also teaches health care law and is an expert at SLU's Center for Health Law Studies. His interest in both fields led him to the issue of cybermedicine and its implications for both the courts and consumers. Terry is considered one of the nation's leading experts on the issue. He recently wrote a lengthy article on the subject for the American Journal of Law & Medicine.
Cybermedicine seemingly has advantages: more informed customers and expeditious service. After all, who wants to wait in the doctor's office reading three-week-old magazines when you can click on a mouse, day or night?
But this growing trend disturbs many members of the medical community, including American Medical Association leaders, who, in 1998, called the practice "not good medicine."
Terry has his own concerns. He said that unlike "real space" medicine, regulatory agencies are unsure who is supposed to be overseeing cybermedicine activity, much less which state's or country's rules providers should be following. In cyberspace it is frequently difficult to define who the players are. In real space, there is usually an obvious distinction between the doctor's office, the pharmacy and the drug manufacturer. A cybermedicine site may blur those lines, leaving the customer unclear about whom he or she is dealing with. Regulatory agencies are sometimes equally puzzled.
"My concerns also relate to the quality of the health care that is provided," Terry said. "As a health care lawyer, I see legal structures as tools for ensuring the quality of health care. I am concerned that the existing legal structures we have are inapplicable to the business models appearing on the Web, and thereby are not able to play their role in ensuring the quality of health care."
While information on the Web is undoubtedly helping to make health consumers smarter about treatments and drugs, Terry said there is a downside. The growing number of advice sites may cause particular concern because the giver of the advice may not be known -- and it may, in fact, be a pharmaceutical manufacturer pushing a person toward a particular drug. Sometimes the information shared with Web consumers is incomplete or even incorrect. In August the American Cancer Society found abundant non-peer-reviewed material and a 6-percent rate of factual inaccuracies. Bogus information on the Web is another dilemma. CNN reported in April that the number of health scares posted on the Internet has become increasingly common.
A 6 percent rate of factual inaccuracies may not seem like a significant number, but considering the vastness of cyberspace, the misinformation certainly is flowing.
Just as real life medicine may put physicians, pharmacists and drug makers in court, so cybermedicine may result in cyber-malpractice. Terry said courts will have a difficult time sorting out cyber-malpractice cases. With such a significant shift in medicine and the relationship between patient, doctor and pharmacist, the "old rules don't make sense any more and the new roles haven't been defined yet," Terry said.
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