Web-based medical facilitators in medical tourism: the third party in decision-making.

The emergence of web-based medical tourism facilitators (MTFs) has added a new dimension to the phenomenon of cross-border travel. These facilitators are crucial connectors between foreign patients and host countries. They help patients navigate countries, doctors and specialties. However, little attention has been paid to the authenticity of information displayed on the facilitators' web portals, and whether they follow ethical guidelines and standards. This paper analyses the available information on MTF portals from an ethics perspective. It compares 208 facilitators across 47 countries for the services offered. Data were collected from the databases of the Medical Tourism Association and World Medical Resources. India was the most common destination country linked to 81 facilitators. The five countries with the maximum number of facilitators were the USA, the UK, India, Canada and Poland. This paper identifies concerns regarding the information displayed about patients' safety, and the maintenance of confidentiality. There is a need to develop ethical standards for this field.

Safeguarding donors' personal rights and biobank autonomy in biobank networks: the CRIP privacy regime.

Governance, underlying general ICT (Information and Communication Technology) architecture, and workflow of the Central Research Infrastructure for molecular Pathology (CRIP) are discussed as a model enabling biobank networks to form operational "meta biobanks" whilst respecting the donors' privacy, biobank autonomy and confidentiality, and the researchers' needs for appropriate biospecimens and information, as well as confidentiality. Tailored to these needs, CRIP efficiently accelerates and facilitates research with human biospecimens and data.

Research ethics in the MySpace era.

Social networking web sites are popular among adolescents and may represent a new venue for conducting adolescent health research. Conducting research by using social networking web sites raises several concerns, including the social value of this research, fair subject selection, confidentiality, privacy, and informed consent. Addressing each of these concerns, we offer an ethical framework to promote informed and appropriate decisions.

Health on the Net Foundation: assessing the quality of health web pages all over the world.

The Internet provides a great amount of information and has become one of the communication media which is most widely used [1]. However, the problem is no longer finding information but assessing the credibility of the publishers as well as the relevance and accuracy of the documents retrieved from the web. This problem is particularly relevant in the medical area which has a direct impact on the well-being of citizens. In this paper, we assume that the quality of web pages can be controlled, even when a huge amount of documents has to be reviewed. But this must be supported by both specific automatic tools and human expertise. In this context, we present various initiatives of the Health on the Net Foundation informing the citizens about the reliability of the medical content on the web.

You might as well smoke; the misleading and harmful public message about smokeless tobacco.

BACKGROUND: Compared to smoking cigarettes, use of Western smokeless tobacco (ST) products is associated with a very small risk of life-threatening disease (with estimates in the range of a few percent of the risk from smoking, or even less). This means that smokers can realize substantial health benefits by switching to ST, an obvious substitute. But consumers and policy makers have little chance of learning that ST is much less dangerous than smoking because popular information provided by experts and advocates overstates the health risks from ST relative to cigarettes. METHODS: To examine the extent of this overstatement in one medium, we conducted a systematic review of websites containing information about ST and health risks. We examined the content of 316 relevant websites identified by a Google search. RESULTS: We found that when any substantive information about the risk from ST is given, the risk is almost universally conflated with the risk from cigarettes. Accurate comparative risk information was quite rare, provided by only a handful of websites, all appearing low in our search results (i.e., of low popularity and thus unlikely to be found by someone searching for information). About 1/3 of the websites, including various authoritative entities, explicitly claimed that ST is as bad as or worse than cigarettes. Most of the other sites made statements that imply the risks are comparable. CONCLUSION: Through these websites, and presumably other information provided by the same government, advocacy, and educational organizations, ST users are told, in effect, that they might as well switch to smoking if they like it a bit more. Smokers and policy makers are told there is no potential for harm reduction. These messages are clearly false and likely harmful, representing violations of ethical standards.

Evaluation of Brazilian web site information on allergic rhinitis.

UNLABELLED: Nowadays, the World Wide Web (Internet) is an information source for non-experts and physicians. AIM: To evaluate, based on ethical principles, Brazilian web sites information about "allergic rhinitis". Allergic rhinitis is a very common disease, effecting more than 10% of the general population, leading to decrease in quality of life. STUDY DESIGN: Review. MATERIAL AND METHOD: We performed the evaluation of 173 Brazilian web sites, which were obtained from four search engines (Google, Yahoo, AltaVista and Radar Uol). The web sites were evaluated according to the Manual of Ethical Principles, Regional Council of Medicine of the state of Sao Paulo (CREMESP), regarding transparency, honesty, quality, privacy, medical ethics, informed consent, responsibility and origin. RESULTS: Among the analyzed web sites, 149 (86.1%) were not in accordance with the Manual of Ethical Principles of Regional Council of Medicine of the state of Sao Paulo (CREMESP). According to the analyzed items, the irregularities that were found were quality (84.4%), privacy (46.2%), honesty (18.5%), informed consent (15.6%), responsibility and origin (13.9%), transparency (12.1%), medical ethics (2.3%). There was inaccurate information in 24.3% of the analyzed sites. CONCLUSIONS: The majority of the websites regarding allergic rhinitis are not in accordance with the ethical principles of CREMESP. In general, the quality of a great part of the Brazilian web sites that address "allergic rhinitis", and the quality of the information disseminated by them, are insufficient to satisfy doctors and patients.

Using the Internet to conduct research.

The internet has become an everyday communication tool for countless people throughout the world. It has a variety of potential uses in education, practice and research, but only in the last decade have nurse researchers begun to take advantage of the multiple uses the internet has to offer. The author reviews the uses of the internet to conduct research and addresses challenges and issues that currently influence web-based research.

Internet health resources: from quality to trust.

OBJECTIVES: Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users' trust is also required, we examine the relation of quality aspects to trust building online. METHODS: We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality. RESULTS: Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust. CONCLUSIONS: Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.

Health web site accreditation: opportunities and challenges.

The development of the health Internet creates opportunities and challenges for health care organizations. One challenge is building trust among users of online health resources. Research suggests that consumers do not fully trust health Web sites, with privacy and content quality among their concerns. Accreditation may offer a mechanism for health Web sites to demonstrate quality and trustworthiness to patients. URAC has created such an accreditation program, which was fully implemented in December 2001.