Health and disease are very important topics on the World Wide Web these days. The advent of computers and information technology has redesigned every sector and scope of services. Health care is no exception. There are thousands of health care and medical information websites delivering all sorts of medical information to their clients. They have seen exponential growth, and some of them are really valued for their authentic and well-researched medical information.
The medical information websites and blogs have changed and galvanized the way health care information is accessed, used, provided and analyzed. It has improved the interactivity and communication process, thereby making the general public better informed.
The sites offer targeted and easily accessible information and capture their consumer’s reactions and expectations through emails, discussion forums, comments, etc. They influence, sell, promote, critique and advise on health-related concerns and issues.
Consumers get a platform in which to seek answers, increase knowledge, get support and guidance and offer an opinion. They are able to connect with the professionals from the anonymity of their homes.
How important are these websites?
Sonnenberg writes in his paper that the health-related net applications have a scope as ‘vast as the medicine itself.’ He identifies three primary ways that the consumers access health care information online: to search precisely for health information, to join a support group or to consult a medical professional.
Academic and literature professionals use these internet-based health information websites for the following reasons:
• To stay updated and informed–it is used for this purpose by all factions of society, including medical professionals, media professionals, patients, the general public, etc.
• Collaboration, diagnosis and practice: this is generally utilized by professionals such as physicians, nurses and other allied professionals. According to a 2005 study, those physicians and nurses who used the Internet to make a diagnosis were correct 58% of the time!
• For continuing medical education.
• Research, data sharing and reporting studies. It is also used to recruit participants into clinical trials.
• Disease management. This type of information is generally accessed by the general public to manage a particular disease. It can also be accessed by medical professionals to refresh their knowledge and keep them up-to-date on the latest trends.
Clinic-based care has become frustrating. Patients are receiving as little as 15 minutes with their physicians, who are pressed for time due to a large number of OPD cases. The classical duties of physicians—listening to their patients’ complaints, resolving their queries no matter how minor, discussing the side effects of their diseases, symptoms and treatment and, last but not least, counseling and consoling, have all taken a back seat due to time constraints.
The confused, frustrated yet action-oriented patients are increasingly turning towards medical information websites to read, understand and resolve their queries.
According to the Pew Research Center project in 2002, almost 80% of Americans have searched for some kind of medical or health information online. These figures have been growing over the years. Almost 64% of Americans searched for a specific disease or condition followed closely by a specific treatment or procedure (51%).
According to a review published in the Oxford Journals, there are close to 70,000 health information websites that reach almost 50 million people every day.
Wendy Moore writes in the Guardian that health advice is the second most popular topic on the Internet, followed by pornography.
According to a study, over-the-counter drugs are the fifth most popular search online, and almost 4% of Americans purchase medications online. A 2009 survey found that approximately one-third of Europeans use online consultation, and almost one in ten Europeans purchase medications online. In Germany, the online sale of medications accounts for 8-10% of total pharmaceutical sales. In the United Kingdom, approximately 2 million people are regularly purchasing medications online.
The growth of medical information websites has really taken the health care sector by storm and has bridged the gap between the physician and patient. They are important because:
• They have made medical information readily accessible and within reach. Patients can read everything they want to from the anonymity of their home.
• The availability of medications at an economical rate has alleviated the financial burden of patients.
• Consumers have reliable medical/health information at the click of a mouse, and they are better informed about their disease/condition, its requirements, treatment and everything there is to know.
• They know the right questions to ask of their physicians during their 15-minute appointments.
• Basic health information regarding weight loss, nutrition, diet, healthy living, exercise routines and fitness, child care and home remedies are easily available, and consumers do not have to consult their physicians for everything. It has reduced the load of the already haggard and overworked physicians.
Types of medical information websites
Every medical information website has a niche. It can be a personalized site, a journal type or an information site. Various services provided by these websites can range from providing information about diseases, medications, health, fitness, nutrition and diet, training and running, healthy living and addiction treatment, etc. to selling specific products and services. People can conduct online consulting with physicians through video conferencing, message boards, maintaining electronic health records, etc. This access is far-reaching.
Broadly, these websites can be identified as:
1. Health communication websites: These are specifically designed to communicate medical information to patients and professionals, and may target a specific audience. These include:
Medical information regarding the disease, medications, procedures, pre- and post-care, etc. They are usually written by medical, pharmaceutical, research and/or nursing professionals who are experts in their fields. These websites can also provide online consultation and prescriptions and can be free, or they can charge fees for registration and consultation.
Online physician websites are owned and controlled by medical specialists who may provide information, consultation and prescriptions to their patients. They also use their websites to market their names and services. MDLIVE, Sherpaa, Teladoc are some of the famous online medical sites in the U.S. In the U.K, DrThom and Dr Fox are available online physician websites.
2. Behavior-modification websites: These websites have forums, communities and blogs and support those who require behavior modification, including alcohol and drug addiction treatment, smoking cessation, weight loss, nutrition and diet planning and exercise and fitness sites. The content is generally available to a target audience and can be written by either a professional in the field or by a content developer.
3. Online product websites: These deal in products, medications and services and provide information regarding these products. They generally sell their products at an economical rate. These may include online pharmacies, health care applications, health care software or health care IT solutions. The content is generally developed by marketing professionals who generate content with a sales pitch and target specific audiences.
4. Health care organization websites: These sites are dedicated to a specific hospital, organization or health care institution that can be government owned or private. They communicate information regarding the hospital or organization, provide telemedicine services, maintain online records and manage appointments online. They generally hire medical writers and software managers to generate specific content and manage their sites.
5. Public health databases: These sites post information about specific programs, events, genetic databases or public health services for clients and/or health professionals. These are often government-controlled sites for public and professional use.
6. Research websites: These sites inform consumers about current and upcoming clinical studies and trials. They also recruit participants into the ongoing or upcoming studies. They post updates about the progress of the trials and phases for the benefit of the participants, and provide a directory of all the studies that can be accessed by the users. The content is developed by research professionals and dedicated medical writers.
Some of the more popular medical information websites are:
Who generates the content on medical information websites?
Many studies have targeted the rapid growth of the medical information websites and their profound impact on people globally. Some studies have raised some doubt about the authenticity and quality of the content and its potential dangers. Other studies have concluded that the content is comparable to the information available in other media. These contradictory conclusions are understandable due to the vast and varied sources of medical information on the net.
Owing to this confusion and doubt regarding the quality of content, it is extremely important for medical information websites to generate content that is authentic, reliable and evidence-based. For that purpose, it is paramount to hire professionals and experts to prepare and scrutinize the content for its reliability and quality.
The website can be informative, journalistic or evidence-based. It can be written and hosted by an expert or by a lay content developer. So who writes and develops the content?
Medical Writing or Communication Agencies
A medical writing or communication agency offers to provide services to its clients and hires professionals who are qualified and certified medical content generators. These professionals can include physicians, nurses, members of the scientific community or an allied health professional. They are able to segregate authentic data from the plethora of information, and their content complies with the requirements of a journal, regulatory body or a website.
A medical writing agency provides writing support in the form of regulatory writing, educational writing, marketing and journalism. Some of the renowned medical writing services employ world-class writers on their team, and these agencies take the time to verify the credentials of their writers to ensure quality services to the client.
These medical writing services employ medical specialists, general practitioners, trained nurses, clinical research professionals, doctorates and Ph.D.s to prepare the evidence-based content.
These writers extensively research every topic from valid sources (e.g., primary research papers published in authentic journals, reviews and meta-analysis papers and world-class print material) and develop content that is genuine, dependable and extremely beneficial to their audience. One such medical writing agency is Scribomeds Medical Writing and Research Services, which has a team of talented and qualified medical professionals as writers and researchers to generate information. Their client list includes global prestigious names.
Content Development/Writing Services
These agencies employ content developers and writers and may provide their services to medical information websites. A content developer or writer may be a lay writer who prepares content by researching online and through other media. He may or may not have any experience in the medical field. The content developed by them may or may not be valid, updated and authentic.
Self-Authored Websites or Blogs
Certain individuals and professionals have websites/blogs in which they discuss their achievements and experience and offer advice based on their expertise. These websites may include advice related to weight loss, nutrition and diet, fitness, running, training and exercise, motivation, behavior modification, parenting and life management.
How are these medical information websites monetized?
The Internet is full of free websites. The truly free websites belong to a government institution, non-profit organization, religious institution or school. Rest assured, all of them generate revenue. The primary goal of a website is to generate money.
The website owner can generate income by:
1. Selling products/services: websites having dedicated services/products like medications, herbal remedies, eBooks, advice, consultation, etc., generating money through direct payments from their consumers.
2. Advertising: they sell advertising spaces on the site to other websites/companies for placing ads, and they generate revenue by pay-per-click and pay-per-impression advertising.
3. Affiliate income: affiliate income or affiliate marketing means that they sell products/information about other sites/blogs on their page and get paid a fixed income/commission on every purchase on the affiliate sponsor’s site.
4. Selling information: Most of the websites sell information about their visitors to third parties like research agencies, marketing and advertising agencies. The actions and information of a visitor/client act as a commodity and are sold by the website. This information may be used to send targeted ads based upon a consumer’s needs and interests. It can also be used to design new products and services.
Benefits and drawbacks of medical information websites
Potential benefits to a client/consumer are manifold. Since the advent of the Internet, health care has, perhaps, benefitted the most. The benefits of a medical information website can be summed up as follows:
1. Widespread reach and access of information
The Internet has broken all barriers in the traditional educational and information-seeking process. It has grown exponentially and offers endless options to teach, inform and bond professionals and public alike. Available at an inexpensive cost, it has the potential to reach remote areas and audiences.
2. Tailoring of content
Online medical information is quite inexpensive to place and access. It can be tailored according to an individual’s needs and requirements. A consumer can select information according to his/her needs by clicking on an exact link, site or message on the Internet.
3. Social support and interaction
The Internet has a huge potential for interactive modification behavior. The availability of interactive sessions available online has initiated more and more consumers opting for discussions and consultations with peers and professionals online. It has enabled people seeking behavioral changes to join online forums and support groups to improve their interaction and modify their behaviors.
Internet-based consultations and information are a godsend for those who are dealing with orsuffering from sensitive and/or stigmatized problems. The web-based interactions offer complete anonymity compared to a face-to-face interaction.
In addition, some consumers who have problems with communication in a face-to-face scenario hold quite an effective communication online.
5. Cost effectiveness
Many websites offer consultations and medicines at a fraction of the cost of a physical clinic or pharmacy. This helps in reducing the consumer’s financial burden.
However, nothing is perfect in this world. The disadvantages are that there are lots of roadblocks, dangers and problems with medical information websites, including the following:
1. Obstruction to access
The World Wide Web is not available to everyone and is based on socioeconomic status. The Internet is quite impartial as it has information for everyone, but it has not yet reached isolated, remote, rural and underserved areas and populations.
2. Overload of information
The growth of the Internet has led to an information glut and traffic jam on the web. The overload of information leaves consumers confused and wary. It has become difficult to filter valid information.
3. Disorganized content
The search engine yields hundreds of sites in answer to every search. The content is disorganized, leaving the consumer to filter through tons of information. The search engine may deliver too few or too many sites and may fail to target the specific audience.
4. Technical jargon
Most of the health information available online is of a high reading quality. It contains technical language and medical jargon that is not understood by the general public and, sometimes, even professionals. One study found that 48% of trained nurses were unable to understand online information.
5. Outdated information
Many sites are considered unreliable because they do not continuously update their medical information. Many sites move out, close or disappear without any warning due to the fickle nature of the Internet. These pose a problem related to the validity of the content.
6. Potential dangers
The traditional followers of medicine argue that the online information and consultation cannot provide proper examination and treatment to its clients. It can harm the patient by making an incorrect diagnosis.
There is also concern that anonymity and lack of proximity leads to unqualified physicians treating patients.
Patients provide false information and details to secure prescriptions for medications that are hazardous or dangerous.
Future potentials and scope of a medical information website
Despite concerns, these medical information websites are here to stay and are expected to steadily grow. There is a need to make the content on these sites reliable, user-friendly and understandable.
These websites should update information periodically and should incorporate the latest research in their content.
The future should be directed towards developing a framework/ method to capture relevant content and filter out obsolete content and practices.
Future advances in digital and information technology may lead to these websites offering online diagnostic services.
The online physicians will be able to visualize all the laboratory and imaging reports of patients through applications, thereby offering more accurate advice and treatment.
Future research should be directed towards assessing the effectiveness of the online support and behavior-modification groups, so that future care can be improved and more individualized.
The future scope should extend to studying and understanding the impact of online health communication on the general public and develop mechanisms to organize and tailor its content.
1. R. J. W. Cline; K. M. Haynes (2001). Consumer health information seeking on the Internet: the state of the art. Oxford Journals: Health Educ. Res. 16 (6):671-692.
2. House call – No appointments, no waiting, speedy diagnosis and prescription – online doctors are flourishing. But are they safe? The Guardian, 4 June 2000
3. Online health search S. Fox, 2006. Prescription drugs online S. Fox, 2004
4. Buying Drugs Online: It’s Convenient and Private, But Beware of ‘Rogue Sites’ Food and Drug Administration, U.S. Department of Agriculture, 2001
6. Millions risk health buying drugs online, Royal Pharmaceutical Society of Great Britain, 2008
7. Online Patient Safety Climate Survey: Tool Development and Lessons Learned, Lynne M. Connelly and Judy L. Powers, U.S. National Library of Medicine National Institutes of Health
8. Get Real, Get a Prescription campaign, Royal Pharmaceutical Society of Great Britain, 2009
9. Top 100 List: Health Websites You Can Trust. http://caphis.mlanet.org/
10. Quality of health information on the internet (QHII)
Health Website Ratings (HWR) project: Types of health websites. http://www.hii.org/.
11. American Medical Informatics Association. “Consumer Health Informatics”, Bethesda, Maryland 2014. Retrieved on 20 October 2014.
12. History of NHS Direct NHS Direct, retrieved 23 November 2015.
13. GP treats patients ‘over the internet,’ BBC, 23 July 2000.
14. British websites are pushing boundaries of online medicine, ‘USA Today’, 8 July 2011.
15. The doctor will see you now . . . over the internet, The Times quoting Professor Sir Bruce Keogh, NHS Medical Director, 29 August 2011.
16. Are Online Doctors The Best Medicine?, USA Today quoting Roland Goertz of the American Academy of Family Physicians, 20 November 2010.
17. Eysenbach G Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. J Med Internet Res 2008;10(3):e22.
18. Economist, The. 2007. Health 2.0: Technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of “user generated” medical information a healthy trend? The Economist, September 6: 73-74.
19. “www.ncbi.nlm.nih.gov”. “Ethical and Legal Issues in Interactive Health Communications: A Call for International Cooperation”. J Med Internet Res 2 (1): E8.
20. Sonnenberg, F. A. (1997) Health information on the Internet: opportunities and pitfalls. Archives of Internal Medicine, 157, 151–152.
21. Tan H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. BMJ 2006; 333:1143-5.
22. Ferguson, T. ePatients white paper. www.e-patients.net. 2007.
23. Frost JH, Massagli MP, Wicks P, Heywood J (2008). How the social web supports patient experimentation with a new therapy: The demand for patient-controlled and patient-centered informatics, AMIA Annu Symp Proc 6:217-21.
24. Allain, P. Y., Schuck, S., Beaufils, C., Zekri, O., Ganilsy, M. and Allain, H. (1998) Drugs on the Internet. Hazards of public health. 27, 117–121.
25. Sandvik, H. (1999) Health information and interaction on the internet: a survey of female urinary incontinence. British Medical Journal, 319, 29–32.
26. Hellawell, G. O., Turner, K. J., Le Monnier, K. J. and Brewster, S. F. (2000) Urology and the Internet: an evaluation of internet use by urology patients and of information available on urological topics. BJU International, 86, 191–194.
27. AWHONN (1997) Nurses speak out: are you using the Internet for nursing? Association of Women’s Health, Obstetric, and Neonatal Services, 1(4), 17.