The Internet and Health:
Controversies and Opportunities
The Internet and Health:
Controversies and Opportunities
Ignacio Basagoiti
Director de Campusalud www.campusalud.com
Proyecto Webs Médicas de Calidad www.pwmc.org

2
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
Quality g limit the importance of topic
Experience g incite questions
Proposals g promote considerations
g suggest, propose solutions
I am going to exclusively speak of the health information,
leaving aspects like the electronic mail, the communication
between health profesionals and patients, the forums and
spaces of interaction and other important emergent elements
like health blogs, drugs commerce and the children in the
Internet

3
The Internet and Health:
Controversies and Opportunities
Objetives
An educated health care consumer is likely to get
Internet better care.
A “citizen-centered health system” that promotes
Quality health, requires informed patients capables to take
Experience their own decisions about your health.
Proposals
tree of Knowledge
The Internet as theTree of Knowledge

4
The Internet and Health:
Controversies and Opportunities
Objetives Connected users
Internet
Quality
Experience Reino Unido
Nov 2002
Suecia
Proposals Finlandia
Portugal
Austria
Holanda
Luxemburgo
Italia
Irlanda
Francia
España 31
Grecia
Alemania
Dinamarca Nº de individuos
Belgica Fuente:EGM, 2003
UE 43
0 20 40 60 80

5
The Internet and Health:
Controversies and Opportunities
Objetives Algunos datos
ciudadanos conectados
Internet
(América Latina)
Quality Argentina
Bolivia
Experience Brasil 14,3
Chile
Proposals Colombia
Cuba
Rep Dominicana
Ecuador
El Salvador
Guatemala
Honduras
Nicaragua
Mexico
Panama
Paraguay
Peru
Puerto Rico
22,8
Uruguay
Venezuela
Total
0 1 2 3 4 5
Octubre 2003
http://global-reach.biz/globstats/refs.php3

6
The Internet and Health:
Controversies and Opportunities
Objetives Algunos datos
Citizen conected
Internet
Quality
Experience 20,7 17
Proposals
44,1 millones (39,8 spanish speakers)
74,8 millones (60,5 spanish speakers)
22,8 + 14,3 =37,1
Nov 03

7
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Who, What and Why access to
medical information?
Quality
Experience
Proposals “Health seekers” — Internet users who
search online for information on
health topics, whether they are acting as
consumers, caregivers, or e-patients

8
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Who? Who, What and Why access to
medical information?
Quality
Experience
Use of Internet to look
Proposals for health information
Eurobarometro 2003 (58.0)
50
45
40
35
30
25
20
15
10
5
0
UE B DK D GR E FR IR IT LX NL A P FIN S UK

9
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality
Spanish Health-Seekers os all those online, years 2003-2005.
Experience
Proposals
2005 28%
2004 23%
2003 18%
0% 5% 10% 15% 20% 25% 30%
Source: SIBIS 2004, INE 2003 & 2005

10
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
Proposals

11
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality Global use of the Internet vs search health information, last tree
months, by age.
Experience Millares
16000
Proposals 14000
12000
10000
8000
6000
4000
2000
0
Total 15-24 25-34 35-44 45-54 55-64 65-74 >74
Total 15-24 25-34 35-44 45-54 55-64 65-74 >74
Total 15.131.420 4.207.916 4.799.150 3.382.589 1.791.724 780.737 144.617 24.685
Salud 4.255.720 867.193 1.467.377 1.161.245 516841 202288 35286 5489
Source: INE 2005

12
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
g Main number of the Internet users and health- seekers
Proposals
are between 25 and 34 years.

13
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality Percentage of the Internet users that search health information last tree
month of whole poblation and online poblation, by gender.
Experience
30,9
Proposals 35 28,13
25,84
30
25
20
15
10
5
0 Total Hombres Mujeres
% de poblacion total 4,87 9,85 9,45
% de usuarios de Internet 28,13 25,84 30,9

14
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
g Main number of the Internet users and health- seekers
Proposals
are between 25 and 34 years.
gWomen online search health information more than
men (30,9 vs 25,8)

15
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality Percentage users who search health information last tree years
of whole population and online population by age groups.
Experience
35
Proposals
30
25
20
15
10
5
0 Total 15-24 25-34 35-44 45-54 55-64 65-74 >74
% de poblacion total 4,87 16,15 19,07 16,3 9,15 4,36 0,92 0,16
% de usuarios de Internet 28,13 20,61 30,58 34,33 28,85 25,91 24,4 22,24

16
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
g Main number of the Internet users and health- seekers
Proposals
are between 25 and 34 years.
gWomen online search health information more than
men (30,9 vs 25,8)
g 34% of online users betwwen 35-44 years, searched
the web for health information in last tree months.

17
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality
Percentage of use the Internet for search health information last tree
Experience month of all online users, by educational level.
40
Proposals
35
30
25
20
35,18
15
28,13 26,47 27,2
22,47
10
16,65
5
0
0
E.Secundaria E.Secundaria
Todas Analfabetos E.Primaria FP Superior E.Superior
1ª 2ª
% salud 28,13 0 16,65 22,47 26,47 27,2 35,18

18
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
g Main number of the Internet users and health- seekers
Proposals
are between 25 and 34 years.
gWomen online search health information more than
men (30,9 vs 25,8)
g34% of online users betwwen 35-44 years, search the
web for health information in last tree months.
g A higher educational level correlates a higher search for
health information

19
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Spain Who? Who, What and Why access to
medical information?
Quality
Percentage of use the Internet for search health information last
Experience tree month of all online users, by work situation.
40
Proposals 35
30
25
20
34,19 35,23 35,22
15 29,3
28,13 26,3
10 21,8
5
0
Activos Activos Labores
Todas Estudiantes Pensionistas Otras
ocupados parados hogar
% salud 28,13 29,3 26,3 21,8 34,19 35,23 35,22

20
The Internet and Health:
Controversies and Opportunities
Objetives
Spain Who? Who, What and Why access to
medical information?
Internet
g Number of spanish health-seekers has a continuous
Quality increase. 28% of citizens online search the internet for
health information.
Experience
g Main number of the Internet users and health- seekers
Proposals
are between 25 and 34 years.
gWomen online search health information more than
men (30,9 vs 25,8)
g34% of online users betwwen 35-44 years, search the
web for health information in last tree months.
g A higher educational level correlates a higher search for
health information
g Housewife and pensioners online are the two groups
with highest percentages of health-seekers

21
The Internet and Health:
Controversies and Opportunities
Objetives
Internet What? Who, What and Why access to
medical information?
Quality
Experience
Proposals

22
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA What? Who, What and Why access to
medical information?
Quality Health topics searched for by internet users
Topics % of online men % of online women
Experience
Specific disease or medical problem 60 71*
Proposals Certain medical treatment or procedure 46 57*
Diet, nutrition, vitamins, nutritional supplement 43 59*
Exercise or fitness 40 45
Prescription drugs or over-the-counter drugs 36 43
Health insurance 30 31
Alternative treatments or medicines 27 33
A particular doctor or hospital 27 30
Depression, anxiety, stress, mental health issues 19 26*
Experimental treatments or medicines 21 24
Environmental health hazards 18 18
Immunizations or vaccinations 15 17
Sexual health information 11 11
Medicare or Medicaid 9 13
Problems with alcohol or drugs 7 9
How to quit smoking 5 10*
Source: Pew Internet & American Life Project November 2004

The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA What? Who, What and Why access to
medical information?
Quality
Experience
Proposals

24
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA What? Who, What and Why access to
medical information?
Quality
Experience 44% of Internet users have searched online for information about
diet, nutrition, vitamins, or nutritional supplements
Proposals
36% have searched online for information about exercise or
fitness. Internet users between the ages of 18 and 29 are the
most likely to have searched for this type of information – 51%,
compared to 35% of 30-49 year-olds, 28% of 50-64 year-olds,
and just 13% of Internet users age 65 or older.
34% users have ever searched online for information about
prescription or over-the-counter drugs
25% have searched online for information related to health
insurance.

25
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA What? Who, What and Why access to
medical information?
Quality
Experience
80% internet users have looked online for
Proposals information on at least one of 16 health topics, with
increased interest since 2002 in diet, fitness, drugs,
health insurance, experimental treatments, and
particular doctors and hospitals.
Some demographic groups showed notable interest
in specific topics – 59% of online women have read up
on nutrition information online, for example,
compared with 43% of online men. Thirty-eight
percent of online parents have checked online for
health insurance information, compared with 26% of
internet users who do not have children living at
home.
Pew Internet & American Life Project May 2005.

26
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA Why? Who, What and Why access to
medical information?
Quality
Among other things, Internet users:
Experience Research a diagnosis or prescription.
Prepare for surgery or find out how best to recover
Proposals from one.
Get tips from other caregivers and e-patients about
dealing with a particular symptom.
Give and receive emotional support.
Keep family and friends informed of a loved one’s
condition.
Find humor and even joy in a bad situation
More than half of those who recently conducted searches did so on
behalf of someone else — a spouse, child, friend, or other loved
one — not for themselves.

27
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA Why? Who, What and Why access to
medical information?
Quality
57% of those who recently conducted searches did so on behalf
Experience of someone else — a spouse, child, friend, or other loved one —
not for themselves.
Proposals
parents, women, healthy people, and the middle aged
between 30 and 49 years old.
small group of Internet users who are living with a
disability, handicap, or chronic disease.
who take care of someone living in their household

28
The Internet and Health:
Controversies and Opportunities
Objetives
Internet USA Why? Who, What and Why access to
medical information?
Quality
Experience
38% of online parents have checked online for health insurance
Proposals information, compared with 26% of internet users who do not have
children living at home.
Caregivers who live with someone who is chronically ill or disabled, a
group of searchers who make through and frequent use the Internet
for health issues, are particularly likely to have searched for
information about a specific treatment – 62% have done so
44% of Internet users have searched online for information about
diet, nutrition, vitamins, or nutritional supplements. Some of these
searches are certainly for weight management

29
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Advantages Health Care Information
Quality
Accesibility to information: one of the most
Experience important aspects of online health advice is the fact that it
Proposals is available at any hour of the day or night, from wherever
users are able to log on.
Instantaneous
Comfortable
Conectivity (interaction space)
Personalization: allows consumers to customize the
portal interface and information preferences
Anonimity: is important that Internet users can get
health information anonymously

30
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality Accesibility
oConection
Experience oSpecial needs
Proposals All we can = noise
Not only can nearly everyone use the information, but publishing your own
Web site is just as easy. This has resulted in an unprecedent proliferation of
information sources on a global scale
A new religion
Absolutely trues, solution for whole problems, virtual sustitute...User must
accept the considerable discrepancy (‘asymmetry’) in knowledge between
themselves and health professionals.
Credibility
Information sources, scientific references
Information excess–Organization chaos
Where is Wally?
“Plain language” Information must be
comprehensible
Cybercondriacs

31
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality Accesibility
oConection
Experience More than 70% world population have no access to a telephone
line.
Proposals Home Internet conection in Spain by kind and year
Millares
5000
4000
3000
2000
1000
0
Whole homes online Phone line traditional Broadband
2003 3.599.054 2.683.193 1.275.790
2004 4.544.751 2.405.420 2.029.652
2005 4.982.199 2.124.647 2.956.752

32
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality
Accesibility
Experience Special needs
oPhísicals
Proposals oCognitives
oEducacionals
Technical adaptation to ageing changes is necessary for better usability.
Additionally, cognitive, psychological and social factors are just as important for
optimizing access and usage of computers by the elderly population.
Low health literacy limits many users’ ability to understand what is available
online

33
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality
Experience
Proposals
Health .................... 4.220.000.000
Salud ....................... 136.000.000
Medicine................. 1.170.000.000
30 march 2006
Searching for information has become more
difficult, and the quality of search results is often
disappointing

34
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality
Plain language” Information must be
Experience
comprehensible.
Proposals
Consumer health information should be written at a
comprehensible reading level; often patients want
pragmatic information sauch as how long their illsness
will prevent them from working, before scientific details

35
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Cyberchondriacs
Quality FREQUENCY OF ACCESSING HEALTH INFORMATION ONLINE: 1998-2005
"How often do you look for information online about health topics – often, sometimes, hardly ever or never?"
Base: Have access to Internet
Experience 1998 1999 2001 2002 2003 2004 2005
Proposals % % % % % % %
Often 12 13 16 18 17 19 25
Sometimes 30 30 30 35 37 31 33
Hardly ever 29 31 30 27 23 24 14
Never 29 26 25 20 22 26 29
Total who
have
looked for
health or
medical 42 43 46 53 54 50 58
informati
on
sometimes
or often
Total who
have ever
looked for
71 74 75 80 78 74 72
health or
medical
information

35
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Problems Health Care Information
Quality Cyberchondriacs
Experience
Adults who now look for medical data
Proposals or on sanitary cares assiduously do it
more than in previous years.
•Although the total number of adults who have looked
Health information online there are decreased, the
frequency with which the North American users consult
the pages Web that offer health contents increases.
•Thus, 58% of the interviewed people whom they have
access to Internet recognize that it looks for this class of
information "some times" or "often", 50% as opposed to
that it consulted these news year the past.

36
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Solutions Health Care Information
Quality
Experience
accesibility
Proposals
□The European Commission has been active in
establishing quality criteria for Health related
websites and accessibility of web sites. Patients who
seek online health information may have a variety of
physical impairments, and its important to develop
resources that are usable by individuals with
disabilities.
□The Web Accesible initiative (WAI) and the
spanish UNE 139803, provides guidelines for
assuring broad accesibility to Internet Based
Information.

37
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Solutions Health Care Information
Quality
Experience credibility
Proposals
Self- regulaing policies
They are the rules and guiding principles a health site follows with respect to
privacy, security, editorial, and advertising. Their main problema are that
often are posted as footnotes –so consumers may be unaware of their
existence- , are self-proclaimed, and are not standardized.
Source disclosure.
By using high-quality sources, a health site can demonstrate it has the ability
to gather, organize, and present quality health information and add value for
consumers. If consumers trust most of the sources used by a health portal,
they are likely to transfer that trust to the portal itself.

38
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Solutions Health Care Information
Quality
Experience
Acredited Search Engines
Proposals
The search engines, on the heels of the Web, realized
that they have a real stake in making sure the results of
their searches are relevant, reliable and trustworthy.
Rather search engines (not specialized) promoting
trustworthy health and medical sites such as
Kosmix.com, mamashealth.com, Webmd.com and
Healthline.com whith “touts sites that have been
accredited by online Web ethics committees like the
Health on the Net Foundation.”

39
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
g Authority, Transparency and Honesty
Quality
Experience g Contents:
gtrustworthy,
Proposals gupdated,
glegible,
iniciativas
gadapted to the receiver
• eHealth
g Orientación: • Hon Code
g receiver information,
• Discern
g segmentation
(patients vs profesionals) • IHC
g disclaimers,
g contact facilities, • pWMC
g usability • WMA

40
The Internet and Health:
Controversies and Opportunities
Objetives
iniciatives
Internet
HON PRINCIPLES (*)
Quality 1 2 3 4 5 6 7 8
Experience WMA
Proposals PWMC
HON: Authority / Complementarity / Confidentiality /
Attribution / Justifiability / Authorship /
Sponsorship / Editorial policy .
eEUROPE 2002 QUALITY CRITERIA (*)
1 2 3 4 5 6
WMA
PWMC
eEurope: Transparency and Honesty / Authority
/ Privacy / Updating / Accountability /
Accesibility

41
The Internet and Health:
Controversies and Opportunities
Objetives una duda ...
Internet
Quality Who must assume responsability offer health
Experience information online to citizen?
Proposals
g goverment institutions
g medical societies and organizations
g patient associations(asoc. enfermos, autoayuda...)
g profesional staff

42
The Internet and Health:
Controversies and Opportunities
Objetives una duda ...
Internet
...What sources of information trust european citizens?
Quality
Experiences
0 20 40 60 80 100
Proposals
Medical societies 84,4
Org consumidores 67,2
Universities 65,5
Mass Media 39,3
Goverment 23,4
Org religious 22,9
Political org 10,7
Eurobarometro 2003 (58.0)

43
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
Quality En la mejora de calidad ...
Experience
Proposals proyect Webs Médicas de Calidad (pWMC)

44
The Internet and Health:
Controversies and Opportunities
Objetives proyecto Webs Médicas de Calidad (pWMC)
Internet
Is ....
Quality
Experience An inter-institutional iniciative with an important
Presence of scientific organizations (TSB, AEP...)
Proposals
Look for ...
An rigurous acreditation of the Internet
resources, since ethic and usability perspective
Seal

45
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Internet presence
Quality E-journal ?
Educaensalud ? Campusalud vs
Experience TSBsalud
Proposals
web TSB
Accesibility plans
Online education?
Experts group NTS
pWMC
Campusalud Prof

46
The Internet and Health:
Controversies and Opportunities
Objetives
Internet
Quality A Patients Virtual Library
Experience
Proposals Access to credible and comprehensible health information
Evidence based information
Documents offers by prestige organizations
User friendly and accesible tools
Free log in
Pattern standard defined by BIREME-PAHO/WHO
A reference site where obtain
trustworthy health information for
citizens who consume that like for
professionals who must provide it

47
The Internet and Health:
Controversies and Opportunities
Objetives
Internet Finding relevant information
and ascertaining its
Quality trustworthiness are two
Experience inseparable concepts necessary
for the web to flourish as an
Proposals unpredecedent source of
knowledge and continue in
Conclusion helping ill patient or citizen to
stay healthy

The Internet and Health:
Controversies and Opportunities
Thank you!!