Web Ethics: Another Challenge to Reliability
of Health Information on the Internet

By Ronald L. Scott

Former Surgeon General Dr. C. Everett Koop has been criticized in connection with the drkoop.com web site. On September 6, Koop responded to the criticism in an editorial titled Medical Content on the Internet available at http://drkoop.com/aboutus/koop/. Koop notes in the editorial that web sites "have a profound responsibility to clearly delineate advertising from editorial, and to provide credible, unbiased information." Previous Health Law Perspectives articles have examined some possible methods of evaluating the reliability of medical information on the Internet (see Finding Medical and Health Policy Information on the Internet) and discussed the Federal Trade Commission’s Consumer Alert warning Internet users of sites making fraudulent health claims. See Health Fraud Dot Com: Federal Authorities Warn of False Health Claims on the Internet.

Users of medical information web sites are faced with a number of challenges in evaluating any health information. Even if the information is unbiased, it may be out-of-date given advances in medical science. In some cases, it is impossible to determine the date information was posted—and an article could have been published years before it is posted on the Internet.

However, the issue of web ethics is subtly different than from other "reliability" issues. Critics of Koop charge that he has engaged in activities that constitute a conflict of interest, or at least the appearance of a conflict, e.g., by allowing "links" on his web site to advertisers ("partners") that pay the web site "referral fees" when visitors from Koop’s web site order goods or services from the partner. In fairness to Koop, critics should separate Dr. Koop (the individual) from drkoop.com (the business). Even though the business is benefiting from the individual, and vice versa, it is unrealistic to expect a publicly-traded concern to act as altruistically as a respected individual. After all, the business also has obligations to its shareholders. Koop has altered his arrangement with the web site so that he will no longer receive a percentage of revenues from services or products sold through the site.

The proper ethical balance is exactly as stated by Koop; i.e., the business has a responsibility to carefully and accurately delineate between advertising and editorial content. Sites should follow the good journalistic practice of labeling content as "advertising" when it may not be clear from the context. The "dot com" suffix gives fair warning to visitors that the Internet site is a for-profit concern.

Although commercial, the site is excellent. From the home page, a visitor can obtain information about more than fifty health topics ranging from anorexia to stroke. The innovative "drug checker" feature at http://www.drkoop.com/hcr/drugstore/interactions allows comparison of drug/drug (and in some cases drug/food) interactions for a wide variety of medications. Finally, the on-line medical encyclopedia can be helpful in understanding information obtained from this or other medical information web sites.