My computer, my doctor: a constitutional call for federal regulation of cybermedicine.

I. INTRODUCTION Color it green. In a health care era driven by consumer demand, consumers are increasingly seeking Internet-based health services.1 Every day approximately seventy-three million Americans access the Internet in search of health information, with an average of six-million people seeking health advice.2 At present, a supply of over one-hundred thousand health-related websites serve the public's demand for information and advice, with an average of one-thousand five hundred new sites added monthly. 3 Surprisingly, consumers and students make up more than 30% of all healthrelated website users.4 From this union of cyberspace and the medical field, cybermedicine has emerged. What does cybermedicine encompass? Cybermedicine is "the science of applying Internet and global networking technologies to medicine and public health, of studying the impact and implications of the Internet, and of evaluating opportunities and the challenges for health care."5 General use of the Internet under this definition encompasses exploration and exploitation of the Internet for consumer health education, patient self-support, and professional medical education and research.6 Issues raised by cybermedicine include the evaluation of the quality of medical information on the Internet, the impact of the Internet on the patient-physician relationship and quality of health care, and the use of global networking for evidence-based medicine.7 These issues are exacerbated by the fact that cybermedicine is a "wholly different and global discipline, which is powerful, efficient and consumer friendly, incorporating individual and cultural wisdom of world experts."8 Identifying the limits of cybermedicine poses a problem given cybermedicine's resemblance to its predecessor: telemedicine. The American Medical Association defines telemedicine as "the provision of health care consultation and education using telecommunications networks to communicate information."9 Telemedicine more narrowly embodies "the use of electronic communication and information technologies to provide or support clinical care at a distance."10 Although the terms are often erroneously used interchangeably, telemedicine differs from cybermedicine in many ways. Telemedicine refers to a more "restricted exchange of clinical and confidential data with a limited number of patients and physicians," and includes patient management and diagnosis.11 A doctor's advice to her patient over the telephone illustrates the kind of exchange of information telemedicine encompasses.12 Cybermedicine, on the other hand, focuses on the global exchange of information in the realm of "research, primary prevention of diseases (e.g. health-education websites), tertiary prevention of diseases" and much more.13 Cybermedicine describes a patient and physician interaction over the Internet, either through an online forum or a commercial website offering medical advice.14 Cybermedical service "includes nearly every facet of the practice of medicine, such as 'marketing, relationship creation, advice and prescribing and selling drugs and devices.'"15 Clinical computing and medical informatics - the "use of computing to enhance communication in the field of medicine"16 - allow patients to communicate with physicians via email or online posts to virtual bulletin boards. 17 Cybermedicine and telemedicine together comprise e-health, or, "health services and information delivered or enhanced through the Internet and related technologies."18 A limited number of entities provide internal controls on cybermedicine. The health care industry created three agencies to regulate all e-health websites on the Internet and develop codes of conduct for e-health providers, including Health on the Net (HON) Foundation, Health Internet Ethics (HiEthics), and the Internet Health care Coalition (IHC).19 Non-governmental agencies concerned with medicine and ethics, such as the American Medical Association (AMA) and the Federation of State Medical Boards (FSMB), offer aid to states in filling the statutory gaps created by cybermedicine through proposed model regulations to overcome inconsistencies between state Medical Practice Acts. …