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Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’

The sites promise easy and embarrassment-free access to erectile dysfunction and libido pills. “E.D. meds prescribed online, delivered to your door,” one said recently. “Starting at $2 per dose.”

“Low sex drive? That can be optional,” another one said. “Try today — $99.”

The sites, Roman and Hers, as well as others now make obtaining lifestyle drugs for sexual health, hair loss and anxiety nearly as easy as ordering dinner online.

On the sites, people self-diagnose and select the drug they want, then enter some personal health and credit card information. A doctor then assesses their choice, with no in-person consultation. If approved, the medicine arrives in the mail days or weeks later.

The sites invert the usual practice of medicine by turning the act of prescribing drugs into a service. Instead of doctors making diagnoses and then suggesting treatments, patients request drugs and physicians serve largely as gatekeepers.

Some of these companies operate in a regulatory vacuum that could increase public health risks, according to interviews with physicians, former federal health regulators and legal experts. And federal and state health laws, written to ensure competent medical care and drug safety, have not kept pace with online services, they say.

“It’s restaurant-menu medicine,” said Arthur L. Caplan, a medical ethics professor at New York University School of Medicine.

After answering questions online, two reporters for The New York Times in California gained approval for generic Viagra prescriptions through Roman and Hims, a site run by the same start-up that owns the Hers site. A third Times reporter ordered Addyi, the libido drug, through Hers.

Whether the sites’ screening processes are sufficient is open to interpretation. This year, a doctor in California, who had prescribed Viagra online through a site called KwikMed.com, surrendered his medical license after the state’s medical board accused him of failing to provide standard medical care like examining the patient and taking vital signs.

Some start-ups, like Kick Health, sell blood pressure pills or other prescription drugs for unapproved uses like calming the symptoms of performance anxiety.

One drug, Addyi, which can cause fainting if taken with alcohol, arrived without the necessary safety warning protocols created by the drug’s manufacturer.

Much like Uber, which argues that it is not a transportation company even as it connects drivers and passengers, the drug sites argue that they are tech platforms, not health providers. The sites connect consumers — and often process their payments — to doctors who may prescribe drugs and pharmacies that can ship the medications.

To comply with state laws, the doctors work for separate companies that cater to the sites. The doctors are typically paid for each health consultation, or by the hour, not the number of prescriptions written. The sites generate revenue for themselves by charging service or processing fees to consumers, the doctors or both.

Kick, Roman and Hims each said they complied with laws and did not influence the doctors’ prescribing decisions.

Zachariah Reitano, the chief executive of Ro, the owner of Roman, said his site encouraged people to tend to their health who might not otherwise have done so.

“It provides more convenient, higher-quality, more affordable care for certain conditions and saves people a lot of time and energy,” Mr. Reitano said.