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Recommendations for Evaluating Online Resources:
Advice for Healthcare Consumers - Part 2

The Not-so Legitimate Online "Practitioners" and "Practices"
It easy to create a professional appearing presence in cyberspace, so non-professionals and Internet entrepreneurs have flooded the Internet, offering "mentoring" or "counseling" services, "miracle cures" or other products. These "mentors" or "life counselors" are hawking their experiences to those who are willing to pay for their so-called expertise. There is a growing, unspoken concern that with the invasion of online health sites the health field has returned to the time at the beginning of the 20th century, when crassly commercial businessmen, quacks and charlatans were promoting themselves as first-rate health care providers and peddling their products and potions as "safe," "effective," "natural," and "health promoting." Since these unlicensed, unqualified online information providers are not professionals there is no professional regulatory organization to which they can be reported for professional misconduct. These are examples of people working outside the ethical boundaries on the Internet committing health fraud, who are difficult to discipline without some enforceable regulations from regulatory bodies. [1,3]

Misleading offers and advice can be costly in several ways: consumers can lose money. More importantly they can increase their health risk, especially if they delay or forego a medical treatment prescribed by their physician. There also is a risk that these products may have dangerous interactions with other medicines. Healthcare consumers need to be protected from those who might take advantage of them. The not-so legitimate "practitioners," "practices" and "peddlers" flooding the Internet and may be detrimental to healthcare consumers need to be exposed and their practices brought under legitimate regulations or closed. The FTC advises healthcare consumers to consult their doctor, pharmacist, other healthcare professional, or public health organizations before purchasing any online product or following any online treatment. [1, 10]

Tip-offs to Rip-offs [10] and How to Spot False Claims [11]
The Federal Trade Commission offers the following tips to help in evaluating health-related claims and avoid getting ripped off by online products.

  • Claims that the product is "natural" or "non-toxic." "Natural" or "non-toxic" does not necessarily mean safe.
  • Undocumented case histories or personal testimonials by consumers or doctors claiming "amazing" results.
  • Promotions that use words like "scientific breakthrough," "miraculous cure," "exclusive products," "secret ingredient" or "ancient remedy."
  • Claims that the product is a quick and effective cure-all for several ailments.
  • Impressive-sounding but generally meaningless scientific terms.
  • Claims of limited availability and advance payment requirements.
  • Promises of no-risk "money-back guarantees."
Some signs of false or fraudulent claims:
  • Statements that the product is a quick and effective cure-all or diagnostic tool for a wide variety of ailments. For example: "Extremely beneficial in the treatment of rheumatism, arthritis, infections, prostate problems, ulcers, cancer, heart trouble, hardening of the arteries and more." 
  • Statements that suggest the product can treat or cure diseases. For example: "shrinks tumors" or "cures impotency."
  • Promotions that use words like "scientific breakthrough," "miraculous cure," "exclusive product," "secret ingredient" or "ancient remedy." For example: "A revolutionary innovation formulated by using proven principles of natural health-based medical science."
  • Text that uses impressive-sounding terms like these for a weight-loss product: "hunger stimulation point" and "thermogenesis."
  • Undocumented case histories or personal testimonials by consumers or doctors claiming amazing results. For example: "My husband has Alzheimer's disease. He began eating a teaspoonful of this product each day. And now in just 22 days he mowed the grass, cleaned out the garage, weeded the flower beds and we take our morning walk again."
  • Limited availability and advance payment requirements. For example: "Hurry. This offer will not last. Send us a check now to reserve your supply."
  • Promises of no-risk "money-back guarantees." For example: "If after 30 days you have not lost at least 4 pounds each week, your uncashed check will be returned to you."
Tips to Consumers who buy Health Products Online [12]
Food and Drug Administration offers the following tips to healthcare consumers interested in buying health products, including prescriptions online:
  • Check with the National Association of Boards of Pharmacy, http://www.nabp.net Leaving Site or call (847) 698-6227 to determine whether a website is a licensed pharmacy in good standing.
  • Don't buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription, or sell drugs not approved by FDA.
  • Don't do business with sites that have no access to a registered pharmacist to answer questions.
  • Avoid sites that do not identify with whom you are dealing and do not provide a U.S. address and phone number to contact if there's a problem.
  • Don't purchase from foreign websites at this time because generally it will be illegal to import the drugs bought from these sites, the risks are greater, and there is very little the U.S. government can do if you get ripped off.
  • Beware of sites that advertise a "new cure" for a serious disorder or a quick cure-all for a wide range of ailments.
  • Be careful of sites that use impressive-sounding terminology to disguise a lack of good science or those that claim the government, the medical profession, or research scientists have conspired to suppress a product.
  • Steer clear of sites that include undocumented case histories claiming "amazing" results.
  • Talk to your health-care professional before using any medications for the first time.
Discovering or Reporting Internet Health Fraud or Unlawful Sales of Medical Products
The Food and Drug Administration and the Federal Trade Commission maintain information about actions against the promoter of a online products. This information can be found by visiting their websites at: http://www.fda.gov/oc/enforcement.html Leaving Site or http://www.ftc.govLeaving Site[11]

Internet fraud can be reported to the Internet Fraud Complaint Center (IFCC) on their website at http://www1.ifccfbi.gov/index.aspLeaving Site This government agency addresses issues of fraud committed over the Internet including both criminal and civil violations. [12] The online charlatans can also be reported for health fraud online to the Federal Trade Commission, http://www.ftc.govLeaving Site[13] Unlawful sales of medical products on the Internet can be reported to the Food and Drug Administration at: http://www.fda.gov/oc/buyonline/buyonlineform.htmLeaving Site[14]

Resources:
1.  Dyer KA. Cyberspace: The Final Frontier The Internet as an Untapped Medium of Medical Web-Education A Physician's Perspective. JAMIP: November 1, 1999. Available at: http://www.journeyofhearts.org/jofh/about/cyberspace.
2.  Ferguson T. DocTom's Top Tips for Online Health Searching. The Ferguson Report: Number 8, January 2002. Available at: http://www.fergusonreport.com/articles/fr00804.htm Leaving Site 
3. Dyer KA. Ethical Challenges of Medicine and Health on the Internet: A Review. Journal of Medical Internet Research. 2001;3(2):e23 Available at: http://www.jmir.org/2001/2/e23/index.htm Leaving Site 
4.  Kapoun, Jim. "Teaching undergrads WEB evaluation: A guide for library instruction." C&RL News 
(July/August 1998): 522-523. Available at: http://www.library.cornell.edu/okuref/webcrit.html Leaving Site 
5.  Beck, Susan. "Evaluation Criteria." The Good, The Bad & The Ugly: or, Why Itís a Good Idea to Evaluate Web Sources. New Mexico State University Library. 1997. Last updated March 5, 2002. Available at: http://lib.nmsu.edu/instruction/evalcrit.html Leaving Site 
6.  Lister Hill Library of the Health Sciences. Evaluating Web Resources: A Bibliography. Last updated Wednesday, August 29, 2001 Available at: http://www.uab.edu/lister/evalnet.htm Leaving Site 
7. Kaiser Permanente's Health Information Checkup Website. Finding Healthy Information Online. May 2001. Available at: http://www.kp.org/hicheckup Leaving Site and at: http://www.kp.org/hicheckup/consumer/consumer_frameset.html Leaving Site 
8.  National Cancer Institute. 10 Things to Know about Evaluating Medical Resources on the Web. Updated March 23, 2001. Available at: http://cancertrials.nci.nih.gov/beyond/evaluating.html Leaving Site 
9.  Internet Healthcare Coalition. Tips For Health Consumers Finding Quality Health Information on the Internet. 2000. Available at: http://www.ihealthcoalition.org/content/tips.html Leaving Site 
10. Federal Trade Commission. Virtual Health "Treatments" Tip-offs to Rip-offs. Available at: http://www.ftc.gov/bcp/conline/edcams/miracle/index.html Leaving Site 
11. Federal Trade Commission with the Food and Drug Administration. "Miracle" Health Claims: Add a Dose of Skepticism. September 2001. Available at: http://www.ftc.gov/bcp/conline/pubs/health/frdheal.htm Leaving Site 
12. U.S. Food and Drug Administration. Buying Medicines and Medical Products Online. Available at: http://www.fda.gov/oc/buyonline/default.htm Leaving Site 
13. Internet Fraud Complaint Center (IFCC). Available at: http://www1.ifccfbi.gov/index.asp Leaving Site 
14. Federal Trade Commission. Available at: http://www.ftc.gov  Leaving Site 
15. U.S. Food and Drug Administration. Reporting Unlawful Sales of Medical Products on the Internet. Available at:
http://www.fda.gov/oc/buyonline/buyonlineform.htm Leaving Site 

Article originated in Part 1.


The Internet has the potential to be an excellent adjunctive resource for patient web- education. It also has the unfortunate potential of exposing the public to an unprecedented, unregulated volume of misleading information on health and illness. The goal for medical professionals in the next millennium will be to help sway the balance towards good, reliable medical web-information.
Kirsti A. Dyer, MD, MS

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