ABSTRACT
A cartoon published in the New Yorker in 1993 1 is apposite: ‘On the Internet, no one knows you’re a dog’, says one dog seated at a computer screen to another watching close by. Indeed, on the Internet, anyone can be an author, and for much information, there is no clear way to verify its provenance or the author’s credentials. Equally concerning, however, is the speed with which information can be spread via the Internet making it remarkably easy for medical misinformation to be disseminated. Concerns such as these are highlighted in an FDA Consumer Reprint:
The fact that it is easy to publish health and medical information and reach vast audiences without having the information verified by other sources presents potential issues for FDA and other government agencies. 2
Delegates at the 50th World Health Assembly were particularly concerned that advertising, promotion and sale through the Internet might result in uncontrolled cross-border trade of medical products or fraudulent imitations that may be unevaluated, unapproved, unsafe or ineffective, or used inappropriately:
This phenomenon…may present a hazard for the public health as well as a risk for the individual patient, particularly with regard to misleading or fraudulent product information and lack of individual counselling for consumers. 3
At the first International Health Claim Surf Day held in late 1998, more than 1, 200 Internet sites worldwide were identified as containing potentially false or deceptive advertising claims about the treatment, cure or prevention of six major diseases-arthritis, cancer, diabetes, heart disease, HIV/AIDS and multiple sclerosis. 4 The sites were sent email messages informing advertisers that they must have evidence to support their claims and the US Federal Trade Commission (FTC) warned that site designers may be liable for making or
disseminating deceptive or false claims. Especially vulnerable, according to the FTC, are patients diagnosed with diseases that have no medical cure, such as AIDS, arthritis, multiple sclerosis, and certain forms of cancer. 5
Authors elsewhere have also expressed concerns about the ease with which unverified health claims can be made on the Internet, 6 and the ease with which substances with toxic and pharmacological potential can be obtained electronically and across borders. 7 Furthermore, many Web sites now offer commercial or free medical advice in response to unsolicited patient enquiries. Attention has been drawn to the medico-legal and other implications for clinical practice of providing information to patients in such a fashion. 8 According to the Science Panel on Interactive Communication and Health (SciPICH), faulty information or advice can lead to unnecessary or harmful treatment, a delay in proper treatment, or an unwise health decision. 9 The quality of information exchanged electronically via discussion lists and newsgroups has also given rise to concerns that appropriate diagnosis and treatment may elude participants in such discussion fora on a scale that is unprecedented. 10
Information on the Web
A number of studies have examined the variable quality of information available via the Internet, some of which are summarised in Figure 19.1.
