Yes, medical records can be altered -- and symptoms can be faked. However, the person who alters medical records -- or fakes symptoms for that matter -- commits a fraud. By requiring medical records, online clinics force drug seekers lacking a legitimate need for controlled drugs to either buy their drugs from marginal operators who don't require records, or to forge or fraudulently alter medical records to get medication from honest clinics. Either way, costs and legal risks increase for the recreational users, while pain sufferers can be confident that they will not be getting prescriptions willy-nilly without consideration of their health history.

In any event, the argument that online ops are bad because bad people can forge records or fake symptoms doesn't hold up at all. Frauds will patronize whatever kind of operation will let them get away with it -- online or brick and mortar. Indeed, the most egregious pill mills, like the ones who service Hollywood stars and certain massively hypocritical radio commentators, always seem to be walk-in or "cash and carry" operations. The honest and effective ops will continue to require medical records and/or evaluations (including physicals) of prospective patients.