Medicine Online: Health or Hazard
Net News: February 1999

Candy Day candy@healthlink.org.za

With the rapid advancement of information technology, particularly the dramatic growth in the Internet, comes an unparalleled opportunity to educate and "empower" patients and medical practitioners. However this very medium opens the door to a potentially dangerous, virtually unregulated area and one which knows no boundaries.

• Easy access to clinical information systems:
  The October 21 (1998) issue of JAMA ( http://www.ama-assn.org/public/journals/jama/jamahome.htm ) describes technology available to create a unified electronic medical record system on the WWW that provides coordinated access to regularly updated patient information, diagnostic images, and the medical literature. There are many other articles on the impact of the Internet in Medicine.
• Empowering patients:
  The HELP project (Health Education Library for People, http://www.healthlibrary.com ) aims to empower patients with information to encourage rational drug use

[Source: E-drug 29/12/98, http://www.healthnet.org/programs/edrug.html ].
The creators of this Indian Consumer Health Education Resource felt: "In order to encourage the rational use of drugs, rather than focus only on medical practitioners, … we need to concentrate on patients as well - after all, they have the most to lose if drugs are used unwisely for them!"

• Sharing information with colleagues and other professionals:
  The Internet (using a combination of the web and email mailing lists) has enabled the sharing of work in the development of drug management systems more widely than would have been possible. A Kwik Skwiz (series of publications by the Health Systems Trust targeted at district staff) recently focused on Using Stock Cards to Improve Drug Management - the text is available at http://hst.org.za/isds/kwikskz/kwik13.htm . As another example, practical issues surrounding the recent launch of the new Essential Drugs Lists were discussed on the DRUGINFO email list (more information at http://www.healthlink.org.za/hlink/info/hlelists.asp ).

• Providing advice electronically without seeing the patient:
  A subscriber on the Pharmacoinformatics Network commented (27/12/98),
  "There's certainly nothing inappropriate with providing products/information to patient's already using one's pharmacy as a convenience (i.e. questions about a drug which has been dispensed from the pharmacy or using the 'net to reorder drugs/supplies). Where people start to shudder is when one solicits new business in localities where personal attention can't be delivered." A situation not that different in principle to mail order pharmacy!
• Web sites selling services or medicines online:
  Try http://www.walgreens.com  and www.cyberpharmacy.com .
• Advertising:
  An interesting article in the BMJ concluded that the Internet is a new environment that will need specific interventions; "The uncontrolled advertising of drugs and nutritional supplements in electronic media such as the Internet poses new problems for drug regulation. The distribution of these products circumvents national laws and authorities, and substances are circulated that have never been checked for effectiveness and safety. Furthermore, it is impossible to ensure correct use of such products…". (http://www.bmj.com/cgi/content/full/317/7165/1069 )
• Web sites providing health information of unknown quality:
  The examples of this are innumerable. Without intending to pick on any one in particular, try http://health.co.za . While the creators of this site are probably not intentionally providing misleading information, one feels that the site exists more for the sake of a "presence" than to serve the country’s need for reliable health information – this site, like many others, still has a predominance of non-SA information.

Since we can increasingly expect both health professionals and patients to turn to the Internet as a readily available source of health information, we need to raise awareness of the potential dangers, and continuously encourage people to assess the validity of sources of information that they find.

Some pointers to validating information sources and well-reputed starting points include:

• The changing face of information ( http://www.healthlink.org.za/hlink/info/internet1.htm )

• MaLAM (Medical Lobby for Appropriate Marketing ( http://www.camtech.net.au/malam ) is an international organisation which aims to defend health professionals and the public from marketing practices which may be detrimental to health.

• Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet, JAMA (Editorial, 16/4/97)

• For your patients: Finding health information on the Internet (JAMA 21/10/1998) and Rating Health Information on the Internet (JAMA 25/2/1998)

• The Centre for Health Information Quality has listed some of the available criteria and checklists (and the Health on the Net http://www.hon.ch   code of conduct) for quality assessment of Internet sites on their web site at http://www.centreforhiq.demon.co.uk
• Look for electronic information from sources that you already regard as credible for other reasons.

It has taken many years for issues of quality of printed medical information (e.g. Journals) to evolve. How much more can we therefore expect the debate around the quality of online information to persist, where the variables are inherently so much broader, more complex and more rapidly changing?

Enhanced connectivity options: Satellite is here!

The limitations of modems and telephone lines mean that the top speed for downloading information from the Internet is around 56Kbps under ideal circumstances. However, the option of Satellite Internet that has recently become available in SA is not affected by the same limitations. Using the PAS4 satellite it's possible to relay data at rates of up to 2MegaBits/second.

The cost of this service is understandably higher than a standard dial-up Internet account, at nearly R300/month - hopefully the faster download speed will mean that you spend less time online with a corresponding saving in Telkom charges! More information at http://www.satellite.co.za/

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