Feature

Wanted: a net benefit for health

The internet is a major source of health information – but it urgently needs a public health perspective, says Geof Rayner

Look up ‘nurse’ on an internet search engine, complained the Royal College of Nursing recently and, as often as not, you turn up pornography. Type the word ‘drugs’ into a search engine and you are likely to be directed to websites selling pharmaceuticals – typically Viagra – which are prescription-only in the UK but can be delivered to your door from the US.

The internet is a mess. No single search engine catalogues more than 17 per cent of the web so the chances of finding what you want – unless you know the name of the site – are pretty remote. Add to that the fact that most search engines are American, and US companies pay dear to gain top billing. Like a few other good ideas the web may have been invented by a Brit but it is now as American as McDonald’s – or GM corn.

Potentially the internet is a terrific communication medium, allowing users to download reports and publications and swap information on special interests, all for the price of a phone call. But its rapid commercialisation – even UK government websites carry advertising – means that its educational or scientific uses risk being subverted by the internet gold rush.

It is strongly predicted that the internet will become the source for health information for all of us. The deferential, knowledge-poor patient will give way to the self-help expert (as happened with many HIV patients a decade ago), potentially promoting a new electronic medical consumerism. There are already more alternative ‘healers’ in Britain than practitioners of orthodox medicine and, given the public’s increasing willingness to spurn ‘official’ advice, the internet represents a big opportunity for purveyors of quack cures, quick rip-offs and misleading or simply false information, in a medium that lacks basic controls or regulations.

The Health on the Net Foundation, based in Geneva, conducted a survey of people seeking health information on the internet between March and April this year, and found that:

• the largest group (60 per cent) was people aged over 40;
• the number of women using the internet has risen from 22 per cent in 1997 to 32 per cent this year;
• 67 per cent prefer to visit non-profit web sites;
• use of the internet for medical and health-related information is growing strongly in Europe, especially in the medical profession;
• medical and health information on the web is increasingly seen as ‘useful’ by consumers;
• a majority believe the quality of information needs to improve – and the longer people use the net, the more they appear to emphasise this need;
• 34 per cent of respondents from non-medical professions had no opinion on the quality of information – suggesting that poor quality information might not be recognised by users.

While the threat of rampant commercialisation is real, the good news is that, so far, the best and most popular UK website is run by the BBC. Why? Because the BBC has the best content and provides updates in real time. What is so far lacking is a comprehensive health ‘site of sites’ – a ‘portal’ to use web jargon – that authenticates or signposts valid sources, yet also presents an appealing and easy system of ‘navigation’ to the widest possible audience.

A health portal can be designed to engage the public, cater to specialist interests by developing different ‘zones’ (for example, personal health, neighbourhoods, environment, healthcare and so on), incorporate a dedicated search engine, as well as newsfeeds, job advertising and all sorts of other ideas – all done in style that keeps the public coming back for more. There are sites that claim to do this but none of them does so satisfactorily.

All this summer the website WebMD.com was heavily advertised on US television. It is sold as one-stop shop for health (in fact, medical) information. And it is not a bad site; it is just that it does not contain a whisker of a public health perspective. Plus you have to pay for detailed advice (that’s the point of it).

But more malign influences are also appearing. The large pharmaceutical companies are pouring millions into consumer advertising and getting patients to lobby their doctors for the latest ‘cures’ – allowing them to bypass spending restrictions.

These companies have the cash to develop health portals which will make non-profit rivals look staid and amateur. One company paid more than $800,000 just to secure the website name ‘drugs.com’. Either drug companies will be behind the health portals of the future or some other well-funded corporation will muscle in.

The government is developing its own health websites (the Our Healthier Nation website) while the Health Education Authority, British Medical Association and so on have developed their own. There are also plans for an electronic library. But none of these can really be called a ‘health portal’ – matching information to a broad public audience as well as to special interests.

The UK Public Health Association has been promoting the idea of a UK ‘health portal’ as an entry point to health resources on the web, and similar ideas have been circulating from other sources. The plan is to pull together diverse health organisations, NGOs, health publishers, government organisations, even commercial sponsors. But what may hold the idea back is that the idea lacks proper resources, and organisations are too busy paddling their own canoe to see that everyone else is paddling in the same direction.