Websites offering medical advice are appearing all over the Net. But can they benefit patients and practitioners? Patrick Barkham You can hardly take a train or visit your favourite website these days without tender inquiries into your health from intrusive adverts. Embarrassing itch? Sexual impotence? Are you a healthy eater? There is a rash of new British health sites blowing a substantial wad of venture capitalists’ cash on their push for the online medical market. Meanwhile, many of their United States counterparts are in a critical condition. Can anxious consumers really hope to find good health advice online?
If health portals were a disease they would have been declared an epidemic in the United Kingdom by now. Hot on the heels of Health in Focus and the launch of the Internet arm of NHS Direct last December came Surgery Door and NetDoctor, offering the latest health news, medical advice, self-testing questionnaires, e-mail services and online chats with doctors. Doctors can switch on the Medical Channel, a new digital television channel for health professionals, which buys its news from Health- Media.Net, another flourishing online health information provider.
These new ventures have been encouraged by the excellent prognosis for the online health industry – worth $10-billion by 2004, says Jupiter Communications. Forrester Research’s calculations are closer to $37- billion, suggesting that a money-spinning 8% of all retail health sales will move online by 2004. Yet the latest news from the US sounds less lucrative. Despite a million registered users and quarterly revenue of more than $5-million, Drkoop.com, a health portal founded by a former US surgeon general C Everett Koop, has funds for only another four months. Healthshop.com recently laid off workers and halted sales, despite having more than 1,1-million unique users each month and receiving $25-million last year. Unable to subsist on advertising alone, these sites’ wait for the predicted boom in medicinal e-commerce may be a long one. The Internet appears an ideal medium for dispensing medical advice (and pills): interactive and, crucially, for those embarrassing itches, anonymous. But more than half the 1 600 consumers surveyed by Jupiter Communications prefer the convenience of the high street when buying drugs. More importantly, they are likely to trust their chemist more than the Internet, which is renowned for its virulent rumours and scare stories. An investigation by American gastroenterologists concluded that one in 10 sites in the field contained treatment information that was “unproven or outright quackery”.
In the UK, an investigation by the Consumers’ Association this week found online chemists only too willing to dole out drugs without thoroughly checking patients’ medical histories. Five UK prescription drug sites supplied a slimming drug to a researcher posing as someone whose medical history made it an inappropriate treatment.
Another site supplied Viagra to a researcher, when a doctor would have looked at his record of nitrate therapy for heart trouble and declared the drug too risky. The Health Which? report also criticised sites for not naming doctors or showing their qualifications. The US online health industry fell sick by failing to involve medical professionals, says Tim Nater, executive director of Health on the Net Foundation, a not-for-profit Web watchdog based in Geneva. “In the States, e-health has been built up largely in the absence of doctors and nurses,” he says. “A lot of companies are rising to the wrong challenge. They are in it for the money and not for the public service.” A Health on the Net study found lack of time to be the biggest obstacle to doctors and nurses getting involved in e-health. With a couple of days a week in his Stroud surgery and media work for BBC1, Radio 2, the Sunday Mirror
and Women’s Realm, it is surprising Dr Mark Porter has any time to devote to Surgery Door, the UK health portal of which he is medical editor. Porter’s consumer-friendly face is the lynchpin of Surgery Door’s appeal for the trust of the British consumer. “His career would be dead overnight if we overstepped the line between ethical health and commercialism,” says managing director Paul Blackburn. UK health sites could learn from American mistakes. Koop’s professional standing was tarnished when his website got its knuckles rapped for failing to label clearly advertising content. US sites were also hit by a recent privacy scare, after the California HealthCare Foundation discovered that many, including Drkoop, OnHealth and WebMD, were sharing information about their users with third parties. This could be used to compile medical profiles of those who turned to the Net precisely because of its supposed anonymity. Surgery Door “doesn’t collect any information about users”, says Blackburn. Porter is equally anxious to ensure that commercial imperatives do not cloud its health information. “We go to great lengths to show who we are involved with and why we are pukka,” says Porter. “Good sites provide information and services for free. Alongside that we’ll run links, sponsorship and advertising, but that should not interfere with any of the content, exactly the same as with a newspaper.” Nater hopes “there is no way the American e-health model is going to be picked up and used in Europe”. But the National Health Service’s online offering has, so far, disappointed doctors. Online health provision should not go too far, suggests Porter, dismissing the possibility of online consultations: “I don’t know a decent doctor who reckons he or she could do a proper job during an online consultation. To pretend you can and charge money for it is wrong.” Nevertheless, the Internet’s potential to improve health services is “unlimited”, he believes. For example, patients could book their own appointments online or use a wireless application protocol phone to find out where their nearest hospital is and who sells aspirin at 1am. In the meantime, while the public is faced with fairly ordinary online health services which Porter admits “are still finding their feet”, in the UK medical professionals can access information of cast-iron integrity on sites such as the US-based Medline and Health-Media.Net. Alongside the question of how online health services can benefit those without Internet access, the success of exclusive professional sites suggests the Web may not be the hoped-for panacea for reducing the inequalities in public health. However, health professionals say there has to be some separation between what they and the public can get on the Internet. Gill Shearer, editor-in-chief of subscriber- based Health-Media.Net, says they must offer a private platform for doctors. “We can’t have consumers entering [online] discussions they would be confused and misled by. There are patient confidentiality issues as well.” Porter agrees, pointing out that professional sites also have to be restricted because many contain adverts which would break the strict UK rules for advertising medicines direct to the public. But Nater believes global rules are really needed to shape up the Internet. Four years ago, Health on the Net “recognised the need for a basic ethical standard”; 3 000 sites now subscribe to its code in 36 different countries. Three similar ethics codes have been published in the US this year and Nater fears this proliferation risks confusing users. “We should work for a single global code,” says Nater, although he hopes for more. Ethical standards are all very well, but “what is much more important is compliance and enforcement”. Until we have this, punters seeking good health online had best beware.
Dos and don’ts: Do consult the site’s privacy policy – it could be collecting information about you.
l Do check the date of publication of health advice. Medical information that is several years old could be out of date. Reliable websites should date their material. l Don’t buy drugs from sites based abroad. l Don’t risk paying for online consultations. l Remember that online tests, questionnaires and health advice are no substitute for a face-to-face diagnosis by a proper doctor.