I. INTRODUCTION . . . . . . . . . . . . . . . . . 1

II. ONLINE PHYSICIAN DIAGNOSIS AND THE PRESCRIPTION PROCESS . . . . . . . . . . . . . 2

III. JURISDICTIONAL ISSUES

A. IN GENERAL. . . . . . . . . . . . . . . . 4
B. INTERNET-RELATED JURISDICTIONAL ISSUES. . 7

V. DELIVERY OF MEDICATION TO THE PATIENT. . . . . 16

VI. POSSIBLE BENEFITS OF INTERNET PHARMACEUTICALS. 18

VII. CONCLUSIONS. . . . . . . . . . . . . . . . . . 18

VIII.ENDNOTES . . . . . . . . . . . . . . . . . . . 19

"U.S. and Thai officials in crackdown on sales of drugs over Internet"1

"Dragnet Catches Web Drug Sellers"2

"FDA Chief Urges Web Drug Regulation"3
 

 Americans waking up to their morning papers have been greeted with headlines such as these.  They exemplify the recent interest of both law enforcement and government agencies in the expanding marketing and sale of prescription pharmaceuticals over the Internet.  With the number of Americans today using the Internet estimated at around 77 million,4 any governmental concern relating to the ready availability of Internet prescription pharmaceuticals would appear well-founded.

 While a complete examination and analysis of all of the issues involved in the online marketing and sale of prescription pharmaceuticals would be extremely useful, this paper necessarily is limited to a few of the many involved issues.  Among these issues are: online diagnosis and prescription; related liability claims; issues associated with the delivery of pharmaceuticals; and the possible benefits of pharmaceutical-dispensing websites.

One issue and distinction between pharmaceutical dispensing websites, is the extent of physician diagnosis and consultation. Indeed, some websites do need and require a doctor's prescription to dispense pharmaceuticals to their Internet consumers.

 In turning specifically to an examination of those websites requiring a prescription to dispense pharmaceuticals, there appear to be two principal methods by which a consumer can obtain a prescription recognized as valid by these websites.  Some websites require that the consumer first obtain a prescription from a locally licensed physician.5  Other websites will accept a prescription from a physician associated with the website.

 In obtaining a prescription via the Internet, the consumer may be asked to choose from symptoms listed on the website, or asked to answer a series of fill-in the blank questions.6  Presumably, the website physicians examine the information, make a diagnosis, and then prescribe the appropriate medication.

 Some websites go further and require the customer to write a detailed description of the symptoms, the length of the illness, current medications, and other related medical information.  Presumably, the Internet physician then follows the same diagnosis and prescription process described previously.

 A problem with any of these online consultation procedures is that the physician never has any direct contact with the patient.  A family doctor may prescribe pharmaceuticals for a regular patient by telephone.  The difference however, is that the family doctor has personal knowledge of the patient, access to detailed medical records, and takes both of these sources of information into account when making a diagnosis and writing a prescription.

 In an article by Bloom and Iannacone, the authors express the concern that the absence of personal contact between consumer and Internet physician would appear to facilitate the act of "provid[ing] false or incorrect information to obtain a prescription..."7 not appropriate for the consumer for which it is prescribed.  This appears to be a valid concern in that the authors then go on to support their statement by relating that the "[g]iving [of] incorrect or false information...[is] not encouraged, but it...[is] indirectly facilitated [by the pharmaceutical- dispensing websites through their providing] ... preselected click-off choices [that are then utilized by the consumer when describing the illness and symptoms]..."8 (emphasis added)

A. IN GENERAL

The main obstacle to filing a lawsuit is that the Internet offers users anonymity not otherwise normally available.  The plaintiff must be able to determine the identity of the defendant and its location.

In the above mentioned article by Bloom and Iannacone, the authors indicate that of the forty-six websites they surveyed, "only 5 (10.7%) would reveal their geographic location (city and country)..."9 and "[n]o Web site would reveal the specific address of consulting physicians."10

While many of the pharmaceutical-dispensing websites may be headquartered outside the United States, and thus hard to sue, even domestic suits must establish jurisdiction.

To establish personal jurisdiction over a defendant, the courts have adopted the principle reiterated in Compuserve Incorporated v. Patterson,11 that an injured plaintiff must prove that "[t]he defendant...[is]amenable to suit under the forum state's long-arm statute and the due process requirements of the Constitution must be met."12  The long-arm statutes of many states are similar to that of Texas, which provides that "the exercise of personal jurisdiction [is available] whenever it is consistent with constitutional due process."13

In examining what constitutes constitutional due process, "[t]he Supreme Court has determined that in the context of personal jurisdiction due process requires that: (1) a defendant have 'minimum contacts' with the forum state; and (2) exercising personal jurisdiction does not offend 'traditional notions of fair play and substantial justice.'"14

In examining how a plaintiff can establish that the defendant has had minimum contacts with a forum state, it is important to note, as did the court in Mieczkowski v. Masco Corporation,15 that the requirement of "'minimum contacts'...may be subdivided 'into contacts that give rise to 'specific' personal jurisdiction and those that give rise to 'general' person jurisdiction."16

The court in Mieczkowski v. Masco Corporation,17 stated that "[s]pecific jurisdiction exists when the nonresident defendant's contacts with the forum state arise from, or are directly related to, the cause of action [being brought by the plaintiff].18"  The court then went on to state that "[g]eneral jurisdiction exists when a defendant's contacts with the forum state are unrelated to the cause of action but are 'continuous and systematic' and considered substantial."19

The second component of constitutional due process required to establish personal jurisdiction involves the judicial determination that "exercising personal jurisdiction does not offend 'traditional notions of fair play and substantial justice.'"20  The court in Zippo Manufacturing Company v. Zippo Dot Com, Inc.,21 further developed this definition as it applies to specific personal jurisdiction by adding that the "exercise of jurisdiction [over the defendant] must be reasonable."22  The Zippo23 court then indicates that:

[In] determining the reasonableness...the court must consider the burden on the defendant in light of other factors including: "the forum state's interest in adjudicating the dispute; the plaintiff's interest in obtaining convenient and effective relief...; the interstate judicial system's interest in obtaining the most efficient resolution of controversies; and the shared interest of the several states in furthering fundamental substantial social policies."24

In considering the application of personal jurisdiction as it applies to defendant parties involved with Internet websites, one of the most important existing court cases, indicative of the direction that Internet personal jurisdiction cases will take, is the previously mentioned case of Zippo Manufacturing Company v. Zippo Dot Com.27  The court in Zippo28 stated that "when an entity intentionally reaches beyond its boundaries to conduct business with foreign residents, the exercise of specific jurisdiction is proper,"29(emphasis added) "[d]ifferent results should not be reached simply because business is conducted over the internet."30  While the assertion of the Zippo31 court in the previous statement was directed towards specific jurisdiction, a plaintiff could attempt make a parallel argument with respect to Internet issues concerning general jurisdiction.  Thus, as acknowledged by the United States District Court in Mieczkowski v. Masco Corporation,32 "there is the possibility that certain uses of the Internet can provide the type of 'minimum contacts' sufficient to allow a court to exercise personal jurisdiction,"33 while other uses may not amount to sufficient minimum contacts.

In addressing the relation between the Internet and personal jurisdiction, the court in Zippo34 stated that "the likelihood that personal jurisdiction can be constitutionally exercised is directly proportionate to the nature and quality of commercial activity that an entity conducts over the internet."35  The Zippo36 court then went on to create a sliding-scale applicable to Internet personal jurisdiction issues.37

The sliding scale set forth by the Zippo38 court begins "[at] one end...[with those] situations where a defendant clearly does business over the Internet.  If the defendant enters into contracts with residents of a foreign jurisdiction that involve knowing and repeated transmission of computer files over the Internet, personal jurisdiction [over the defendant] is proper."39(emphasis added)

Zippo40 then goes on to establish that "the opposite end [of the sliding-scale] ...[includes] situations where a defendant has simply posted information on an Internet Web site which is accessible to users in foreign jurisdictions."41   The Zippo42 court refers to these information-based sites as "passive Web site[s]"43 and indicates that they are "not grounds for the exercise [sic] jurisdiction."44

Finally, the Zippo45 court addresses the type of web site that falls between these two endpoints on its sliding-scale, by explaining that the "middle ground is occupied by interactive Web sites where a user can exchange information with the host computer.  In these cases, the exercise of jurisdiction is determined by examining the level of interactivity and commercial nature of the exchange of information that occurs on the Web site."46

After discussing the traditional issues involved in the determination of personal jurisdiction as it relates to the Internet, we can now turn to a discussion of the application of personal jurisdiction to defendants involved in pharmaceutical-related web sites.  Of the many pharmaceutical-related web site parties against which a lawsuit might be brought, the most obvious would be the deep pockets of the website itself. The next most likely defendant would be the individual physician working for the web site.

To bring a civil claim against any of these parties, an injured plaintiff will attempt to prove that the defendant falls within the jurisdiction of the presiding court.  Due to the nature of many pharmaceutical-dispensing websites, it would appear that plaintiffs might be able to assert personal jurisdiction over nearly all of these website defendants.  The basis for this statement derives from the application of the Zippo47 court's sliding scale of personal jurisdiction to the nature of the commercial transactions conducted by the parties involved in the pharmaceutical websites.

 In applying the language of the Zippo48 court to pharmaceutical websites, these websites conduct "business over the internet...[and] enter into contracts with residents of...foreign jurisdiction[s] that involve the knowing and repeated transmission of computer files over the Internet."49 (emphasis added)  In conducting business in this manner, the pharmaceutical-dispensing websites would then acquire the requisite forum contacts for personal jurisdiction under the analysis of the Zippo50 court's sliding-scale.  The plaintiff filing a lawsuit under this theory would be likely to attempt to establish that the transmission of medical, payment, and delivery information from the consumer to the website provider, for the purposes of medical diagnosis and prescription, constitutes the Zippo51 court's "transmission of computer files over the Internet."52  The plaintiff could then attempt to apply this same theory to the Internet physician, by asserting that the physician is also conducting business over the Internet by providing his medical diagnostic services, for a fee in many cases, over the Internet, while utilizing transmitted medical information.  In the context of the liability of Internet physician, the plaintiff will essentially be attempting to prove the existence of a physician-client relationship.

 Additionally, the plaintiff may chose to proceed with a claim against the Internet physician by attempting to establish personal jurisdiction by means of a middle ground analysis of the Zippo53 court's sliding-scale continuum.  Though not necessarily a perfect fit for determining personal jurisdiction over the Internet physician, the plaintiff here will have the best chance of proving personal jurisdiction over this type of defendant by proving to the court that the "level of interactivity and [the] commercial nature of the exchange of information [between the plaintiff and the defendant physician] that occurs on the Web site"54 is sufficient to establish personal jurisdiction over the defendant.

 After establishing jurisdiction over the defendant web site and physician, the next concern of the plaintiff will be to decide what specific type of action to file against these defendants.  For the sake of discussion, we will assume that a plaintiff, Jill, a resident of Goodsville, has utilized the services of Pharmcom, a pharmaceutical-dispensing web site, located in Cyberland, that requires a prescription to fill medications for consumers.  Pharmcom will accept prescriptions from non-web site physicians, but it also provides Internet physician consultation and prescription services.  Pharmcom consultation services require the consumer to fill out an online medical form that gives the Internet physician a description of the consumer's symptoms and medical background.  After completing the necessary forms, and paying a typical medical consultation fee, a prescription is then prescribed for Jill by the treating physician, Dr. Dumb.  The web site then fills the prescribed medication commonly known by the name "badpill".  After paying for the prescribed pharmaceutical by credit card, Jill then receives her prescription in the mail a few days later.  After taking the medication for 25 days, Jill becomes violently ill, and is admitted to the local hospital, where it is determined that she has had a severe allergic reaction to badpill.  After leaving the hospital, Jill decides that she would like to file suit against the parties that provided and prescribed badpill for her.  For the sake of discussion, we will acknowledge that Jill will most likely file suit against the web site on a variety of claims applicable under the state laws of Goodsville.  However, only a very brief discussion of these possible claims against the web site will be undertaken, because the focus of this section will be Jill's potential malpractice claim against the web site physician that prescribed badpill.

 In first addressing the potential claims against the web site, it is important to note that many of the pharmaceutical-prescribing web sites require a consumer to "agree" to some type of waiver of liability before they will prescribe and dispense pharmaceuticals to the consumer.  However, as many first-year law students know, courts do not typically look favorably upon corporate waivers that would allow corporations to escape liability for negligent acts of the corporation.  Thus, Jill's attorney will likely attempt to negate the waiver of liability for negligence, under the applicable laws of Goodsville.  In addition to potential negligence claims, Jill's attorney might chose to file state claims under such theories as recklessness, reckless infliction of emotional distress, and malpractice, in addition to claims for assault and battery, depending on which causes of action are available under the state laws of Goodsville.

 Jill will be likely to also file a claim for malpractice against the physician, who prescribed badpill.  For the sake of our discussion, we will assume that personal jurisdiction has been established to bring Dr. Dumb within the jurisdiction of the Goodsville court system.  However, the writer acknowledges that establishing such jurisdiction could conceivably be extremely difficult given the anonymity inherent in the Internet.55  In examining this potential lawsuit, we will not be discussing the particular elements of a malpractice lawsuit against Dr. Dumb, but will instead be examining only the issue as to whether a legal duty was created by the relationship, if any, between Jill and Dr. Dumb.

According to the Court of Appeals of Michigan, in the case of Burston v. Kokosky, M.D.,56 "a professional physician-patient relationship is a legal prerequisite to basing a cause of action in professional malpractice against a physician."57  This view is followed by other states as well, as exemplified by the nearly identical finding by the Texas Supreme Court, in the case of St. John, M.D. v. Pope.58

After establishing the prerequisite physician-patient relationship requirement in Burston,59 the Michigan court of appeals then went on to state that "[a] physician-patient relationship exists where a doctor renders professional services to a person who has contracted for such services."60 (emphasis added)  However, other states take a differing view, as expressed by the Texas Supreme Court in St. John, M.D. v. Pope,61 where the court stated that the "[c]reation of the physician-patient relationship does not require the formalities of a contract."62 (emphasis added) The Texas court asserts that "[t]he fact that a physician does not deal directly with a patient does not necessarily preclude the existence of a physician-patient relationship."63  Thus, although the courts in Michigan and Texas both agree that doctor malpractice liability requires the existence of a physician-patient relationship, the states differ considerably as to what constitutes such a relationship.

 It is apparent that the requirements for establishing the existence of a physician-patient relationship between Jill and Dr. Dumb, depend largely on whether the state of Goodsville follows the example of Michigan or Texas.  However, even if Goodsville were to follow the example of Michigan, requiring some type of contract between Jill and Dr. Dumb, Jill would likely have a valid claim that a contract establishing the physician-patient relationship was created when Jill was billed for the physician's consultation fee.

 Another serious public safety concern associated with the convenience of the at-home delivery of prescription pharmaceuticals is the regulation of the quality of the pharmaceuticals delivered to the patient's doorstep.  As was briefly noted in the earlier discussion concerned with personal jurisdiction, there is considerable anonymity associated with the Internet.  This anonymity may provide both a conduit and a cover for those persons in society wishing to earn money by selling prescription pharmaceuticals that do not meet the FDA standards of the pharmaceuticals dispensed at the local pharmacy.
 

Despite the above mentioned public safety concerns associated with the convenience of the at-home delivery of prescription pharmaceuticals, there are potential benefits arising from the Internet pharmaceutical industry.  Aside from the obvious conveniences available to the average prescription consumer, one of the most important services that these Internet pharmaceutical sites provide is access to prescription drugs, and Internet physician consultation in many cases, for those Americans who reside in remote locations, where the medical and pharmaceutical services enjoyed by many Americans are simply unavailable.

 After addressing the online diagnosis and prescription of pharmaceuticals; the potential liability claims arising against Internet physicians and the Internet websites dispensing pharmaceuticals; the potential problems and related issues associated with the direct delivery of the prescription pharmaceuticals to the consumer; and the possible benefits of websites that allow consumers to purchase prescription pharmaceuticals online, it becomes readily apparent that the Internet is moving into areas of American life never before contemplated.  As this cyber-medical arena continues to grow and develop, the government will be forced to adapt accordingly.  Whether this adaptation takes the form of newly enacted legislation, regulating the online sale of prescription pharmaceuticals to average American citizens, or takes the form of special-licensing requirements for courier services delivering these pharmaceuticals to the home of the consuming patient, it is clear that with the number of Americans today using the Internet estimated at around 77 million,64 the number of issues related to Internet pharmaceutical disbursement will continue to grow, as the number of Internet patients continues to grow.

1 Kevin Harris, U.S. and Thai officials in crackdown on sales of drugs over Internet, THE SEATTLE TIMES, Mar. 22, 2000, at A14, available in 2000 WL 5526832.

2 Matthew Pennington, Dragnet Catches web Drug Sellers, AP ONLINE, Mar. 21, 2000, available in 2000 WL 16861449.

3 FDA Chief Urges Web Drug Regulation, AP ONLINE, Mar. 22, 2000, available in 2000 WL 16861852.
 
 
 

4 Impact of Technology on Banking, Before the Subcomm. on Capital Mkts. Sec., and Gov't Sponsored Enters. Comm. on Banking and Fin. Servs., (2000) (statement of Laura S. Unger, Commissioner U.S. SEC).
(According to this source, it has been estimated that "21 percent of all domestic households have Internet access." Id.).

5 Two such websites are:  PlanetRx.com and Drugstore.com.

6 Bernard S. Bloom, Ph.D., and Ronald C. Iannacone, B.S., Internet Availability of Prescription Pharmaceuticals to the Public (Sep. 27, 1999) http://www.acponline.org/journals/annals/05oct99/ bloom.htm.  (In this article, Bloom and Iannacone label the list of symptoms methodology utilized by some websites, as the "preselected click-off" Id.).

7 Id.

8 Id.

9 Id.

10 Id.
 

11 Compuserve, Incorp. v. S. Patterson, 89 F.3d 1257 (6th Circ. 1996).

12 Id. at 1262 (6th Circ. 1996) (Citing to World-Wide Volkswagen, 44 U.S. at 297, 100 S. Ct at 567 (citing In-Flight Devices Corp. v. Van Dusen Air, Inc., 466 F.2d 220, 224 (6th Cir. 1972)).

13 Mieczkowski v. Masco Corp., 997 F.Supp.782, 784 (D.Tex. 1998) (Referring to Schlobohm v. Shapiro, 784 S.W.2d 355, 357 (Tex. 1990))(See also Compuserve, Incorp. v. Patterson, 89 F.3d 1257, 1262 (6th Cir. 1996) (examining Ohio's long-arm jurisdictional statute); Zippo Mfg. Co. v. Zippo Dot Com., Inc., 952 F.Supp. 1119, 1122 (D.Pa. 1997)(examining Pennsylvania's long-arm jurisdictional statute).

14 Id. (Referring to Asahi Metal Indus. v.  Superior Court, 480 U.S. 102, 107 S.Ct. 1026, 94 L.Ed.2d 92, (1987)(citing Int'l Shoe Co. v. Washington, 326 U.S. 310, 316, 66 S.Ct. 154, 158, 90 L.Ed. 95, (1945)); Burger King Corp. v. Rudzewicz, 471 U.S. 462, 105 S.Ct. 2174, 85 L.Ed.2d 528 (1985); Wilson, 20 F.3d at 647; Polythane Sys. v. Marina Ventures Int'l, 993 F.2d 1201 (5th Cir. 1993)).

15 Mieczkowski v. Masco Corp., 997 F.Supp.782, 784 (D.Tex. 1998).

16  Id. at 784 (citing to Wilson v. Belin, 20 F.3d 644, 647 (5th Cir. 1994)).

17 Mieczkowski v. Masco Corp., 997 F.Supp 782 (D. Tex. 1998).

18 Id. at 784. (Referring to Helicopteros Nacionales de Colombia, S.A. v. Hall, 466 U.S. 408, 414 n. 8, 104 S.Ct. 1868, 1872 b.8, 80 L.Ed.2d 404 (1984); Wilson, 20 F.3d at 647.).

19 Id. at 784. (Referring to Hall, 466 U.S. at 414 n.9. 104 S.Ct. at 1872 n.9 (1984); Keeton v. Hustler Magazine, Inc., 465 U.S. 770, 779 n.11, 104 S.Ct. 1473, 1481 n.11, 79 L.Ed.2d 790 (1984); Wilson, 20 F.3d at 647.).

20 Id. (Referring to Asahi Metal Indus. v Superior Court, 480 U.S. 102, 107 S.Ct. 1026, 94 L.Ed.2d 92, (1987)(citing Int'l Shoe Co. v. Washington, 326 U.S. 310, 316, 66 S.Ct. 154, 158, 90 L.Ed. 95, (1945)); Burger King Corp. v. Rudzewicz, 471 U.S. 462, 105 S.Ct. 2174, 85 L.Ed.2d 528 (1985); Wilson, 20 F.3d at 647; Polythane Sys. v. Marina Ventures Int'l., 993 F.2d 1201 (5th Cir. 1993)).

21 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).
 
22 Id. at 1123. (referring to Int'l Shoe Co. v. Washington, 326 U.S. 310, 66 S.Ct. 154, 90 L.Ed. 95 (1945) and its progeny.  Mellon, 960 F.2d at 1221.)

23 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

24 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119, 1123 (D. Penn. 1997) (Referring to World-Wide Volkswagen, 444 U.S. at 292, 100 S.Ct. at 564 (internal citations omitted)).

25 Mieczkowski v. Masco Corp., 997 F.Supp.782 (D.Tex. 1998).

26 Id. at 788 (Referring to Asahi Metal, 480 U.S. at 105, 107 S.Ct. at 1033; Ruston Gas Turbines, 9 F.3d at 421).

27 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

28 Id.

29 Id. at 1124 (D. Penn. 1997) (Referring to Burger King, 471 U.S. at 475, 105 S.Ct. at 2183-84).

30 Id. at 1124.

31 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

32 Mieczkowski v. Masco Corp., 997 F.Supp.782 (D. Tex. 1998).

33 Id. at 786.

34 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

35 Id. at 1124 (The court there indicated that its assessment was based on its "review of the available cases and materials" (Referring the reader to see, generally, Robert A. Bourque and Kerry L. Konrad, Avoiding Jurisdiction Based on Internet Web Site, New York Law Journal (Dec. 10, 1996); David Bender, Emerging Personal jurisdiction Issues on the internet, 453 PLI/Pat 7 (1996); Comment, Richard S. Zembek, Jurisdiction and the Internet: Fundamental Fairness in the Networked World of Cyberspace, 6 Alb.L.J.Sci. & Tech. 339 (1996)) (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998)).

36 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

37 Id. at 1124 (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998)).

38 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

39 Id. at 1124 (Referring to Compuserve, Inc. v. Patterson, 89 f3d 1257 (6th Cir. 1996) (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998).

40 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

41 Id. at 1124 (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998).

42 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

43 Id. at 1124 (Referring to Bensusan Restaurant Corp., v. King, 937 F.Supp. 295 (S.D.N.Y.1996)) (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998)).

44 Id.

45 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

46 Id. at 1124 (Referring to Maritz, Inc. v. Cybergold, Inc., 947 F. Supp.1328 (E.D.Mo.1996) (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998).

47 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

48 Id.

49 Id. at 1124 (Referring to Compuserve, Incorp. v. S. Patterson, 89 F.3d 1257 (6th Circ. 1996)).

50 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

51 Id.

52 Id. at 1124 (Referring to Compuserve, Incorp. v. S. Patterson, 89 F.3d 1257 (6th Circ. 1996)).

53 Zippo Mfg. Co. v. Zippo Dot Com, Inc., 952 F.Supp. 1119 (D. Penn. 1997).

54 Id. at 1124 (Referring to Maritz, Inc. v. Cybergold, Inc., 947 F. Supp.1328 (E.D.Mo.1996) (See also, Mieczkowski v. Masco Corp., 997 F.Supp.782, 786 (D.Tex. 1998).

55 In their article, Bloom and Iannacone indicate that out of the forty-six websites included in their survey of pharmaceutical-dispensing websites, "[n]o website would reveal the specific address of consulting physicians." Bernard S. Bloom, Ph.D., and Ronald C. Iannacone, B.S., Internet Availability of Prescription Pharmaceuticals to the Public (Sep. 27, 1999) http://www.acponline.org/journals/annals/05oct99/ bloom.htm.

56 Burston v. Kokosky, M.D., 463 N.W.2d 265  (Mich. Ct. App. 1990).

57 Id. at 303 (Referring to Rogers v. Harvath, 65 Mich.App. 644, 646, 237 N.W.2d 595).

58 St. John, M.D. v. Pope, 901 S.W.2d 420, 424 (Tex. 1995).

59 Burston v. Kokosky, M.D., 463 N.W.2d 265 (Mich. Ct. App. 1990).

60 Id. at 303 (Referring to Rogers v. Harvath, 65 Mich.App. 644, 646-647, 237 N.W.2d 595).

61 St. John, M.D. v. Pope, 901 S.W.2d 420 (Tex. 1995).

62 Id at. 424.

63 Id.

64 Impact of Technology on Banking, Before the Subcomm. on Capital Mkts. Sec., and Gov't Sponsored Enters. Comm. on Banking and Fin. Servs., (2000) (statement of Laura S. Unger, Commissioner U.S. SEC).
(According to this source, it has been estimated that "21 percent of all domestic households have Internet access." Id.).