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.

Terrorism and emergent challenges in public health.

The authors explore the complexity of challenges facing the public health community in an era increasingly defined by terrorism. The public health and associated political structure in this country has much to do to better coordinate its' efforts in an effective way. Solutions will ultimately come from partnerships between government agencies, community organizations, the business community, and international interests.

Health information literacy and competencies of information age students: results from the interactive online Research Readiness Self-Assessment (RRSA).

BACKGROUND: In an era of easy access to information, university students who will soon enter health professions need to develop their information competencies. The Research Readiness Self-Assessment (RRSA) is based on the Information Literacy Competency Standards for Higher Education, and it measures proficiency in obtaining health information, evaluating the quality of health information, and understanding plagiarism. OBJECTIVE: This study aimed to measure the proficiency of college-age health information consumers in finding and evaluating electronic health information; to assess their ability to discriminate between peer-reviewed scholarly resources and opinion pieces or sales pitches; and to examine the extent to which they are aware of their level of health information competency. METHODS: An interactive 56-item online assessment, the Research Readiness Self-Assessment (RRSA), was used to measure the health information competencies of university students. We invited 400 students to take part in the study, and 308 participated, giving a response rate of 77%. The RRSA included multiple-choice questions and problem-based exercises. Declarative and procedural knowledge were assessed in three domains: finding health information, evaluating health information, and understanding plagiarism. Actual performance was contrasted with self-reported skill level. Upon answering all questions, students received a results page that summarized their numerical results and displayed individually tailored feedback composed by an experienced librarian. RESULTS: Even though most students (89%) understood that a one-keyword search is likely to return too many documents, few students were able to narrow a search by using multiple search categories simultaneously or by employing Boolean operators. In addition, nearly half of the respondents had trouble discriminating between primary and secondary sources of information as well as between references to journal articles and other published documents. When presented with questionable websites on nonexistent nutritional supplements, only 50% of respondents were able to correctly identify the website with the most trustworthy features. Less than a quarter of study participants reached the correct conclusion that none of the websites made a good case for taking the nutritional supplements. Up to 45% of students were unsure if they needed to provide references for ideas expressed in paraphrased sentences or sentences whose structure they modified. Most respondents (84%) believed that their research skills were good, very good, or excellent. Students' self-perceptions of skill tended to increase with increasing level of education. Self-reported skills were weakly correlated with actual skill level, operationalized as the overall RRSA score (Cronbach alpha = .78 for 56 RRSA items). CONCLUSIONS: While the majority of students think that their research skills are good or excellent, many of them are unable to conduct advanced information searches, judge the trustworthiness of health-related websites and articles, and differentiate between various information sources. Students' self-reports may not be an accurate predictor of their actual health information competencies.