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He said since the commission first began registering the websites several years ago, there have been few complaints. “They tend to treat conditions that are relatively straightforward,” he said. If patients indicate any worrying symptoms, the websites tell them they aren’t eligible for online treatment and need to see a doctor.

Dr. Patrick Cadigan, a cardiologist and spokesman for Britain’s Royal College of Physicians, described Internet-based medicine as “second-best,” and said it was particularly difficult to make a diagnosis without seeing a patient in person. “To lose personal contact with your patients means you lose clues about what may be wrong with them,” he said.

Cadigan worried some patients may not understand the difficulties of being treated online.

He said some people might need some more in-person prodding, as opposed to the standard questionnaires employed by most websites, to correctly answer questions about other health conditions or medical treatment they were already on.

“If you don’t get a thorough medical history from the patient, you could prescribe something that might have adverse effects,” he said. “I am concerned these websites could be steering patients to treatments for a financial incentive rather than for their own good.”

On the London-based website http://www.dr.thom.com, patients fill out forms to see if they are eligible for online treatment for things like impotence and birth control. Before getting mailed Viagra, for example, patients must fill in a questionnaire that covers their impotence, medical history, height, weight, and blood pressure.

About one in 11 patients doesn’t qualify, in which case the site recommends they see a doctor in person. The site has at least 100,000 patients, including those from a popular pharmacy chain with whom they are linked.

Dr. Thom Van Every, the site’s medical director, says patients give a medical history and are asked about other drugs they’re on to avoid any dangerous interactions. On his website, patients with acne or genital warts, rashes or other abnormalities, can also upload a couple of pictures of the affected area. Doctors then diagnose the condition and if appropriate, send drugs in the mail.

“Most of the people who report this as strange are doctors,” Van Every said. “People are so used to uploading pictures these days for things like Facebook that this is just not a big deal.”

Dr. Lori Heim, president of the American Academy of Family Physicians, said examining pictures to make some diagnoses may be OK, but warned of potential problems such as doctors missing symptoms elsewhere on the body the patient hasn’t photographed.

She said if patients had multiple symptoms or a condition that naturally required a physical exam, like listening to the heart, lungs or conducting joint exams, seeing a doctor virtually wouldn’t work. She said doctors should be particularly careful about prescribing drugs like Viagra and worried about the web sites becoming prescription mills.

“The best thing is to have a relationship with your physician because you’re more likely to get a better diagnosis,” she said.

She said the online sites were useful for people who don’t live close to a doctor, but said there were limits.

“If you have something that is potentially urgent, that’s not the time to be messing around with the Web or email.”

Heim predicted similar Web sites would pop up in the U.S. eventually.

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