While Wise has gone through the cumbersome process of getting licensed to practice medicine in about 20 states -- far more than your average M.D. -- 26 remain in which he cannot write prescriptions. (The numbers don't add up to 50 because of the states with OTC status and those with more flexible laws about prescriptions.) He has also decided that Getthepill.com will provide prescriptions only to patients 18 and older, even though many argue -- counter to the FDA's stated concerns -- that teenagers need easy access to E.C. as much, if not more, than adults do. "From a moral standpoint, I have no problem at all prescribing to younger patients," he says, noting that he does so -- along with plenty of counseling -- in his own practice. "But I realize that what we're doing already places us under increased scrutiny from medical boards, citizens and so forth, and we want to be cautious. So we made a difficult decision -- one not based on law, but just to make sure that we are able to continue the services that we provide -- that we're going to provide medical consults and prescribe EC only for legal adults." For minors and those in the 26 off-the-list states, Wise or his staff will at least try to guide them to a Planned Parenthood or other available resource.

Squeezing online clients in between and after his work commitments, Wise also takes follow-up calls or e-mails, talking patients through pregnancy scares or bouts of nausea (one of the drug's few side effects). "If I ever have a patient who comes back a second time needing emergency contraception, she always gets a phone call from me," he adds. "I'm not trying to make her feel guilty, obviously; I'm trying to make sure she does all she can to sort of replan her sexual activities so that she doesn't find herself in that situation again."

Wise makes himself available for such calls 24/362. The site is "closed" on Christmas and Thanksgiving, and from about 3 p.m. New Year's Eve to 3 p.m. New Year's Day -- but only because that's when pharmacies are closed. In the five years since the site's launched, he's taken one vacation -- sort of. "I had to get a hotel room right in the Grand Canyon, go out for a couple hours for a hike, come back up to check my e-mail, cellphone and pager," he says.

Who are all the women keeping him so busy? Why aren't they calling their own doctors? "First of all, it's actually surprising how many actually don't have a women's healthcare provider at all," says Wise. Some have changed jobs or insurance; some just don't have one. Other women simply find themselves unable to contact their provider (or college health service) over a weekend or holiday. Still others feel much more comfortable talking to Dr. Internet than to Dr. Disapproval. Remarkably, says Wise, there are doctors out there who still confuse emergency contraception with mifepristone, and refuse to dispense it. Then there are those, he says, who "give their patients an enormous guilt trip before prescribing the medication."

Wise cites one recent patient, a nurse at a small hospital who knew every doctor in town and felt uncomfortable approaching them "for fear she'd be judged in some way," he says -- for having unprotected sex, for having sex at all, for dodging the "consequences" when she does. "This is clearly a woman who has a provider, who has major access, who has good health insurance -- but because of the stigma that's out there, she chose to get the medication through us."

Dr. Joe DeCook is one doctor who does not prescribe emergency contraception, and who hopes Wise is careful when he does. "If he's going to give people this medication, he better give them informed consent, because [E.C.] doesn't hardly work," says DeCook, who is vice president of the American Association of Pro-Life Obstetricians and Gynecologists. DeCook cites several studies that appear to call the effectiveness of E.C. into question, and bemoans what he sees as a dearth of information on side effects on women and on pregnancies undetected before E.C. is taken. "It probably does prevent some pregnancies some of the time, but women are fertile for only about 36 hours a month," so it's unclear, he says, when the pill is actually doing its job -- and what it's doing to women's bodies when it's not.

Of course, given that emergency contraception (also often used: Lo/Ovral) is on the market in the first place, the FDA has already deemed it safe and effective. By and large, studies that question the drug's effectiveness find fault not with its medical properties but with the way the drug is presented and described to women -- and, indeed, with the stigmas that prevent them from asking for it when they need it.

Some physicians unfamiliar with Getthepill.com declined to comment on the Web site directly. But by reiterating the organization's support of over-the-counter status for Plan B, a spokesperson for the American College of Obstetricians and Gynecologists implied that if the drug should be available with no prescription at all, then a prescription from an online doctor would be more than sufficient.

Dr. Beth Jordan is willing to go further. "The fact that this site exists tells you something about the great need for it," says Jordan, medical director of the pro-abortion rights Association of Reproductive Health Professionals. "Any mechanism that makes emergency contraception more available is a good thing, so that women have timely access to a very time-sensitive reproductive technology." Jordan's only concern? "What about women who don't have the computer technology? We need over-the-counter access for them."

Having been the Web site's only doctor for five years, Wise is now considering the possibility of incorporating others who can prescribe in states where he's not licensed; doctors in Idaho and Kentucky have already offered their help. Expansion of the site's services in this way would reflect Dr. Wise's own transformation as its founder. "When I started this project I was doing it as a doctor. I viewed it as a huge unmet need, and I found a creative way to solve that problem," he says. "But as time has gone on and I've realized the politics involved in getting Plan B over-the-counter, frankly, I've become more of an activist."

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