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NEWS: Richard Smith Almost no evidence exists that the internet harms health BMJ 2001; 323: 651b [Full text]

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Some evidence that the Internet harms health

Robert Kiley   (22 September 2001)

A rumour of significance

Ian Shaw   (8 October 2001)

A Database of Adverse Events Related to the Internet

Gunther Eysenbach   (11 October 2001)

Cybersuicide: Technology being misused?

Kallur Suresh   (16 October 2001)

Some evidence that the Internet harms health 22 September 2001
Robert Kiley, Head of Systems Strategy Wellcome Library Send response to journal: Re: Some evidence that the Internet harms health	I'd take issue with the statement that there is almost no evidence to support the claim that the Internet harms health. A search of MEDLINE, for example, identifies a report in the Annals of Internet Medicine http://www.annals.org/issues/v133n11/nts/200012050- 00006.html that describes the case of a patient who died of kidney and liver failure after using hydrazine sulfate (as recommeneded by the Kathy Keeton Web site ( http://www.kathykeeton-cancer.com) as an alternative treatment for cancer. On another accasion a nurse in the US was charged with manslaugher after administering MICON therapy ( http://www.edensinstitute.com/micom.html) to a patient with cancer. See http://www.ncahf.org/digest/01-18.html In addition to these specific examples there are other cases when people find a "cure" on the Web and adopt this - possibly at the expense of conventional therapy. For example, a recent article in 'This is Wiltshire' newspaper http://www.thisiswiltshire.co.uk/wiltshire/archive/2000/11/23/devizes _news_county2ZM.html tells the tale of a local cancer patient who raised money to go to the Oasis of Hope private clinic in Mexico to receive laetrile (vitamin B17)therapy. The article quotes local (Mexican) doctors as being "confident" that this will cure the cancer. In contrast the National Cancer Institute report that "Laetrile has shown little anticancer activity in animal studies and no anticancer activity in human clinical trials" See: http://www.cancernet.nci.nih.gov/cam/laetrile.htm Medical misinformation is a problem on the Internet. The danger is that vulnerable people will adopt these unproven therapies at the expense of proven conventional medicine. Conflict of interest: none
A rumour of significance 8 October 2001
Ian Shaw, Senior Lecturer in Sociology University of Nottingham Send response to journal: Re: A rumour of significance	Smith's work complements a very recent survey undertaken at the University of Nottingham into the sources of preconsultation information obtained by patients prior to visiting GPs practices. This small scale survey involved 87 GPs in the Nottingham Area and had a 67% response rate. Although it would be inappropriate to report the full findings here, 54% of GP respondents claimed that patients who had consulted various internet sources found the information held by the patient was helpful, 26% stated they were neither helpful or unhelpful, 8% claimed these patients were unhelpful, and 9% had no view. However, the internet may have an impact on help seeking behaviour as 43% of GPs claimed that patients who had consulted the internet (including NHS-Direct on-line) had an increased level of anxiety compared to patients in general, 4% claimed that patients had showed no sign of change and 4 % claimed anxiety had decreased in comparison to patients in general.However, 50% of GP were unable to say. Perhaps it is more interesting to consider that the circulation of the original rumours of these `unknowledgeable patients' in the popular press coincided with the launch of government policies to increase user participation in services. One could speculate that they were circulated in an attempt to protect professional interests...
A Database of Adverse Events Related to the Internet 11 October 2001
Gunther Eysenbach, Head, Research Unit for Cybermedicine Dep of Clinical Social Medicine, Universtiy of Heidelberg Send response to journal: Re: A Database of Adverse Events Related to the Internet	Editor, the systematic review of Crocco [1] is likely biased by the fact that cases of harm are rarely reported in the peer-reviewed literature. Recognizing this fact, the Research Unit for Cybermedicine & E-health at the Dept. of Clinical Social Medicine, University of Heidelberg since January 2001 collects published and unpublished cases in the "Database of Adverse Events Related to the Internet" (http://www.medcertain.org/daeri). We solicit and collect cases submitted by practitioners and patients, but also include cases reported in lay publications such as newspapers. The cases stored in the database will be published as an aggregate, annual report. Cases include e.g. misdiagnosis or wrong treatments due to online prescription of drugs or medical consulting via the Internet, discontinuation of life-saving treatments due to misinterpretation of Internet information by patients, the addictive potential of the Internet, or the potential of the Internet to encourage suicide. As an incentive to submit cases we pay a small honorarium to the submitting physician.   Although we think that the positive effects on consumer health may well outweigh the negative effects, we think the medical profession should collect and assess such evidence of possible harm much as we collect rare but severe side-effects of drugs. The eventual aim of the DAERI database is to allow qualitative analysis of these stories, possibly to suggest measures which may minimize the risks involved in using the Internet by consumers for health information. The discussion about the quality of health information in the Internet is at present hampered by our lack of understanding of how consumers digest information and how mechanism of potential harm play out in practice. We also need such data to suggest and conduct further observational and experimental studies investigating possible problems related to the Internet in detail and to quantify (i.e. investigate the prevalence of) possible problems.   We urge physicians to fill in the questionnaire on the DAERI website if they think they have seen a patient who has been concretely "harmed" by Internet information or services.     Gunther Eysenbach Project Initiator   Christian Köhler Project Officer   Research Unit for Cybermedicine and eHealth Dept. Of Clinical Social Medicine, University of Heidelberg Bergheimer Str. 58 Heidelberg, 69115 Germany     [1] Smith R. Almost no evidence exists that the internet harms health [News] BMJ 2001;323:651
Cybersuicide: Technology being misused? 16 October 2001
Kallur Suresh, Specialist Registrar in Psychiatry Royal London Hospital (Mile End) London E1 4DG Send response to journal: Re: Cybersuicide: Technology being misused?	Smith's article about internet and its effects on health makes interesting reading. I wish to highlight another rather worrying dimension of this new technology. We reported a case in 1998 where a depressed patient from the UK left a 'suicide note' on the internet. This e-suicide note was fortunately picked up by someone in America, who had the presence of mind to alert British police who could prevent the death of the patient through timely action (Suresh and Lynch, 1998). It is unclear at present as to how common such e-suicide notes are, but it raises concerns as to whether such notes will be left lying in someone's 'inbox' until it is too late. They may not be taken seriously or acted upon by the recipient. Concerns have been expressed about the range and quality of information available on the world wide web on various health related issues, not least sites that give practical guidance and tips on the various ways of committing suicide. Such uncensored, freely available information can be dangerous in the hands of vulnerable, suggestible individuals with mental health problems. Suresh K & Lynch S (1998) Psychiatry and the WWW: some implications. Psychiatric Bulletin 22: 256-257.