Many health advocates, however, worry that direct-to-consumer drug companies are facilitating cursory—or worse, transactional—relationships with doctors, which in some cases begin after the consumer has put the medication in his or her online shopping cart. “The primary interaction is now happening directly between the company that has a huge financial interest in people taking their drugs and consumers who are approaching these websites with not a lot of medical knowledge,” says Matthew McCoy, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “The idea of requiring a prescription is that you talk to a doctor—somebody who’s an expert in these issues—and they help advise you based on particular needs you have. So it’s concerning that companies might be moving the physician to the back of this process.”