The search for reliable health advice is, famously, second only to pornography as a reason for using the internet. Nobody seriously argues that the net isn't shaping up to be a powerful tool for raising levels of public health, especially since its relative anonymity eliminates much of the embarrassment involved in seeking help. But there's a problem: a significant minority of healthcare sites seem to be operated by characters every bit as unscrupulous as the purveyors of online porn whom they rival in popularity.
Type the words "cancer treatment" into any search engine and you'll be presented with a seemingly infinite list of pages - a fair number of which, according to studies of the reliability of internet health advice, won't be all they're cracked up to be. Surveys of every sector of medicine yield similar results: a recent investigation by American gastroenterologists, for example, concluded that one in 10 sites in the field contained treatment information that was "unproven or outright quackery"; a study last year from Ursinus College in Pennsylvania, meanwhile, warned that the quality of mental health advice online was "not very impressive. Many of the sites targeting the 'worried well' [contained] biased, misleading information about specific treatment options without including an objective examination of equally efficacious alternatives." For almost every health problem the situation seems to be the same. "The problem [of unreliable information] is increasing because it's getting more and more easy to purchase a domain name and set up a site," says Celia Boyer, of the Health on the Net Foundation, a Geneva-based organisation established to monitor and improve the quality of medical information on the net. "The fact that the internet is so much better-known than it was two or three years ago makes the problem of quality urgent."
In offering a platform to every variety of mountebank and snake-oil salesman the web may not be fundamentally different to junk mail, or classified advertisements in lifestyle magazines - but the scale, of course, is massive, and the relative newness of the medium means it's still easier to fool more of the people more of the time. A private surgery in a prestigious city-centre requires plenty of capital; a website that smacks of long-established trustworthiness, on the other hand, need only have required a beginner's guide to web design and a few days' work. And there are plenty of them, hawking vitamin supplements, Viagra, human growth hormone, beef tallow to treat arthritis, fish cartilage for cancer, and much more.
It isn't just a matter of small-scale charlatans out for a fast buck. Former US surgeon-general C Everett Koop - the name behind DrKoop.com, a leading health site - had his knuckles rapped by the American Medical Association last year for failing to disclose that he was taking a cut from products sold on the site. Malicious intent isn't necessarily required, either: frequently, information is just old, even if it was originally posted on the web out of nothing but a desire to help.
One area in which the web offers some of the greatest potential benefits - one-to-one online consultations - is also one of the most hazard-prone. Different countries require different levels of qualification before somebody can call themselves a doctor: if you're paying around £50 for a consultation over the web there will not necessarily be a straightforward way to tell that your doctor has a decade's medical training rather than a few weeks' experience in colonic irrigation. At the moment, according to the Health on the Net Foundation, they're usually best avoided; if you must consult online, research your doctor first - for example by searching the public access Medline database to find out if they have recently had any articles published in reputable medical journals.
If you already know what treatments you need, there are plenty of drugs suppliers eager to relieve you of your money. Some, like Drugstore.com, are recognised as reputable and law-abiding, but in the UK it's perfectly possible, though legally questionable, to order prescription drugs such as Viagra from overseas firms charging around £60 for a packet of 10 50mg tablets. Most require an online consultation, but in many cases it's a formality; a 1999 study of 46 such pharmacy sites by doctors at the University of Pennsylvania failed to turn up a single one who refused to prescribe and supply. Nine didn't even require a consultation.
But those most vulnerable to quackery online are those for whom conventional medicine has already failed. "The most fragile people are those with chronic illnesses, leukemia, cancer - they've already tried all other kinds of medicine already, and now they'll try anything else," says Celia Boyer.
Nowhere do claims of miracle cures abound more plentifully than in cancer treatment: magnets, shark cartilage and derivative of absinthe are among the unproven "remedies" offered by numerous sites. Last year, having decided that deceptive health claims on the net had reached "epidemic" proportions, the US Federal Trade Commission launched Operation Cure.All, and charged three companies - Body Systems Technology, Magnetic Therapeutic Technologies and Pain Stops Here! Inc - with making unsubstantiable claims for cancer treatments.
There are probably many more. "We wish we would get more complaints," said Richard Cleland, a senior attorney with the FTC. "If you're suffering from cancer, you may have other concerns than filing a complaint."
Conscious of the dangers of unreliable products - but also aware of the hugely lucrative commercial advantages of making the web a trustworthy place to find healthcare advice - governments worldwide are formulating guidelines for quality control. Last year the US federal health department set up Healthfinder, a website devoted to helping users navigate medical sites; the UK followed suit with Health In Focus, backed by leading health charities and the Patients Association to sift the wheat from the chaff. Meanwhile, the Health on the Net Foundation is campaigning for the adoption of site guidelines to ensure that information is accurate, up-to-date and honestly presented.
In the meantime, the foundation and others offer several rules of thumb for sorting reliable information from commercially motivated sales pitches: watch out for overzealous testimonials from "satisfied customers" and check that sites contain postal addresses or telephone numbers as well as email contact details; be suspicious of products that purport to be available from one source only; use "portal" sites - such as Healthscout.com as a starting point, since they do some filtering for you. And above all: if a remedy sounds too good to be true, it almost certainly is.
