Will spam overwhelm our defenses? Evaluating offerings for drugs and natural health products

Income-Generating Processes of Free Web-Based Digital Health Tools to Engage Patients: Qualitative Analysis

Background

In recent years, digital tools have become a viable means for patients to address their health and information needs. Governments and health care organizations are offering digital tools such as self-assessment tools, symptom tracking tools, or chatbots. Other sources of digital tools, such as those offered through patient platforms, are available on the internet free of charge. We define patient platforms as health-specific websites that offer tools to anyone with internet access to engage them in their health care process with peer networks to support their learning. Although numerous social media platforms engage users without up-front charges, patient platforms are specific to health. As little is known about their business model, there is a need to understand what else these platforms are trying to achieve beyond supporting patients so that patients can make informed decisions about the benefits and risks of using the digital tools they offer.

Objective

The aim of this study is to explore what patient platforms are trying to achieve beyond supporting patients and how their digital tools can be used to generate income.

Methods

Textual and visual data collected from a purposeful selection of 11 patient platforms from September 2013 to August 2014 were analyzed using framework analysis. Data were systematically and rigorously coded and categorized according to key issues and themes by following 5 steps: familiarizing, identifying a thematic framework, indexing, charting, and mapping and interpretation. We used open coding to identify additional concepts not captured in the initial thematic framework. This paper reports on emergent findings on the business models of the platforms and their income-generating processes.

Results

Our analysis revealed that in addition to patients, the platforms support other parties with interests in health and information exchanges. Patient platforms did not charge up-front fees but generated income from other sources, such as advertising, sponsorship, marketing (eg, sending information to users on behalf of sponsors or providing means for sponsors to reach patients directly), supporting other portals, and providing research services.

Conclusions

This study reports on the mechanisms by which some patient platforms generate income to support their operations, gain profit, or both. Although income-generating processes exist elsewhere on social media platforms in general, they pose unique challenges in the health context because digital tools engage patients in health and information exchanges. This study highlights the need to minimize the potential for unintended consequences that can pose health risks to patients or can lead to increased health expenses. By understanding other interests that patient platforms support, our findings point to important policy implications, such as whether (and how) authorities might protect users from processes that may not always be in their best interests and can potentially incur costs to the health system.

Searching the internet for health information about bipolar disorder: some cautionary issues

Adults routinely use the Internet as a source of health information. Patients with bipolar disorder and caregivers should be encouraged to increase their knowledge of this complex illness, including through the Internet. However, patients, caregivers, and physicians should be aware of potential perils when searching the Internet for health information, including loss of privacy, quality of web site content, and Internet scams. This review summarizes these cautionary issues. The digital divide remains and includes a lack of technical skills and competency in searching and appraising web sites, in addition to limited access to the Internet. Physicians should provide patients with a list of trustworthy web sites and a brief printed handout on concerns related to searching the Internet. More studies of the use of the Internet by patients with bipolar disorder are needed.

Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health

BACKGROUND

Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted.

DISCUSSION

Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established.

SUMMARY

Effective global "eHealth Governance" focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence.

Quality of online pharmacies and websites selling prescription drugs: a systematic review

BACKGROUND

Online pharmacies are companies that sell pharmaceutical preparations, including prescription-only drugs, on the Internet. Very little is known about this phenomenon because many online pharmacies operate from remote countries, where legal bases and business practices are largely inaccessible to international research.

OBJECTIVE

The aim of the study was to perform an up-to-date and comprehensive review of the scientific literature focusing on the broader picture of online pharmacies by scanning several scientific and institutional databases, with no publication time limits.

METHODS

We searched 4 electronic databases up to January 2011 and the gray literature on the Internet using the Google search engine and its tool Google Scholar. We also investigated the official websites of institutional agencies (World Health Organization, and US and European centers for disease control and drug regulation authorities). We focused specifically on online pharmacies offering prescription-only drugs. We decided to analyze and report only articles with original data, in order to review all the available data regarding online pharmacies and their usage.

RESULTS

We selected 193 relevant articles: 76 articles with original data, and 117 articles without original data (editorials, regulation articles, or the like) including 5 reviews. The articles with original data cover samples of online pharmacies in 47 cases, online drug purchases in 13, consumer characteristics in 15, and case reports on adverse effects of online drugs in 12. The studies show that random samples with no specific limits to prescription requirements found that at least some websites sold drugs without a prescription and that an online questionnaire was a frequent tool to replace prescription. Data about geographical characteristics show that this information can be concealed in many websites. The analysis of drug offer showed that online a consumer can get virtually everything. Regarding quality of drugs, researchers very often found inappropriate packaging and labeling, whereas the chemical composition usually was not as expected in a minority of the studies' samples. Regarding consumers, the majority of studies found that not more than 6% of the samples had bought drugs online.

CONCLUSIONS

Online pharmacies are an important phenomenon that is continuing to spread, despite partial regulation, due to intrinsic difficulties linked to the impalpable and evanescent nature of the Web and its global dimension. To enhance the benefits and minimize the risks of online pharmacies, a 2-level approach could be adopted. The first level should focus on policy, with laws regulating the phenomenon at an international level. The second level needs to focus on the individual. This approach should aim to increase health literacy, required for making appropriate health choices, recognizing risks and making the most of the multitude of opportunities offered by the world of medicine 2.0.

"Save 30% if you buy today". Online pharmacies and the enhancement of peripheral thinking in consumers

PURPOSE

Online pharmacies (OPs) are recognized as a potential threat to public health. The growth of an unregulated global drugs market risks increasing the spread of counterfeit medicines which are often delivered to consumers without a medical prescription. The aim of the study was to assess the strategies of argumentation that OPs adopt in their marketing.

METHODS

A sample of 175 OPs was analyzed using the content-analysis method, and evaluated by relying on the Elaboration Likelihood Model (ELM) of persuasion.

RESULTS

Almost 80% of the sample of OPs did not ask for a medical prescription by the consumer's physician. The selling arguments used included privacy policy, economic, quality, and service issues. About one-third of the OPs did not declare any side-effects regarding the drugs offered.

CONCLUSION

Our results show that OPs advertise their products in an argumentative fashion that enhances consumers' peripheral reflection: by analogically playing with the selling of other commodities, they magnify aspects of the online trade that consumers might find convenient, but overshadow the nature and risks of the actual products they sell.

Dirt cheap and without prescription: how susceptible are young US consumers to purchasing drugs from rogue internet pharmacies?

Background

Websites of many rogue sellers of medications are accessible through links in email spam messages or via web search engines. This study examined how well students enrolled in a U.S. higher education institution could identify clearly unsafe pharmacies.

Objective

The aim is to estimate these health consumers´ vulnerability to fraud by illegitimate Internet pharmacies.

Methods

Two Internet pharmacy websites, created specifically for this study, displayed multiple untrustworthy features modeled after five actual Internet drug sellers which the authors considered to be potentially dangerous to consumers. The websites had none of the safe pharmacy signs and nearly all of the danger signs specified in the Food and Drug Administration´s (FDA´s) guide to consumers. Participants were told that a neighborhood pharmacy charged US$165 for a one-month supply of Beozine, a bogus drug to ensure no pre-existing knowledge. After checking its price at two Internet pharmacies—$37.99 in pharmacy A and $57.60 in pharmacy B—the respondents were asked to indicate if each seller was a good place to buy the drug. Responses came from 1,914 undergraduate students who completed an online eHealth literacy assessment in 2005-2008. Participation rate was 78%.

Results

In response to "On a scale from 0-10, how good is this pharmacy as a place for buying Beozine?" many respondents gave favorable ratings. Specifically, 50% of students who reviewed pharmacy A and 37% of students who reviewed pharmacy B chose a rating above the scale midpoint. When explaining a low drug cost, these raters related it to low operation costs, ad revenue, pressure to lower costs due to comparison shopping, and/or high sales volume. Those who said that pharmacy A or B was "a very bad place" for purchasing the drug (25%), as defined by a score of 1 or less, related low drug cost to lack of regulation, low drug quality, and/or customer information sales. About 16% of students thought that people should be advised to buy cheaper drugs at pharmacies such as these but the majority (62%) suggested that people should be warned against buying drugs from such internet sellers. Over 22% of respondents would recommend pharmacy A to friends and family (10% pharmacy B). One-third of participants supplied online health information to others for decision-making purposes. After controlling for the effects of education, health major, and age, these respondents had significantly worse judgment of Internet pharmacies than those who did not act as information suppliers.

Conclusions

At least a quarter of students, including those in health programs, cannot see multiple signs of danger displayed by rogue Internet pharmacies. Many more are likely to be misled by online sellers that use professional design, veil untrustworthy features, and mimic reputable websites. Online health information consumers would benefit from education initiatives that (1) communicate why it can be dangerous to buy medications online and that (2) develop their information evaluation skills. This study highlights the importance of regulating rogue Internet pharmacies and curbing the danger they pose to consumers.

Cyberdrugs: a cross-sectional study of online pharmacies characteristics

As e-commerce and online pharmacies (OPs) arose, the potential impact of the Internet on the world of health shifted from merely the spread of information to a real opportunity to acquire health services directly. Aim of the study was to investigate the offer of prescription drugs in OPs, analysing their characteristics, using the content analysis method. The research performed using the Google search engine led to an analysis of 118 online pharmacies. Only 51 (43.2%) of them stated their precise location. Ninety-six (81.4%) online pharmacies did not require a medical prescription from the customer's physician. Online pharmacies rise complex issues in terms of patient-doctor relationship, consumer empowerment, drug quality, regulation and public health implications.

Internet treatment of sexually transmitted infections - a public health hazard?

BACKGROUND

Owing to the stigma associated with sexually transmitted infections, patients may prefer to keep their illness private, and choose instead to try self-treatment remedies from the internet. However, such remedies may prove hazardous if the sellers do not provide detailed advice on adverse effects, or on avoiding transmission and re-infection. We conducted an internet search to determine the availability of treatments for STIs and the nature of information provided by vendors of these treatments.

METHODS

We conducted a systematic internet search using five different search engines in February 2007. The search term included the words "self treatment" and the name of six different common STIs. We visited the vendors' websites and recorded any information on the formulation, adverse effects, cautions, and prevention of infection.

RESULTS

We identified a total of 77 treatments from 52 different companies, most of which were sold from the UK and US. The available remedies were predominantly for topical use and consisted mainly of homeopathic remedies. Only a small proportion of the web-listed products gave details on adverse effects, contraindications and interactions (22%, 25% and 9% respectively). Similarly, web vendors seldom provided advice on treatment of sexual contacts (20% of chlamydia and 25% of gonorrhea treatments) or on preventive measures (13%). Conversely, evidence of effectiveness was claimed for approximately 50% of the products.

CONCLUSION

While treatments for certain STIs are widely available on the internet, purchasers of such products may potentially suffer harm because of the lack of information on adverse effects, interactions and contra-indications. Moreover, we consider the paucity of preventive health advice to be a serious omission, thereby leading to patients being needlessly exposed to, and potentially re-infected with the causative pathogens.