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BMJ. Jan 26, 2002; 324(7331): 238.
PMCID: PMC1122149

Does the internet harm health?

Some evidence exists that the internet does harm health
Robert Kiley, head of systems strategy

Editor—I would take issue with the statement that there is almost no evidence to support the claim that the internet harms health.1 A search of Medline, for example, identifies a report in the Annals of Internal Medicine (www.annalsw.org/issues/v133n11/nts/200012050-00006.html) that describes the case of a patient who died of kidney and liver failure after using hydrazine sulphate (as recommended by the Kathy Keeton website, www.kathykeeton-cancer.com) as an alternative treatment for cancer.2

On another occasion a nurse in the United States was charged with manslaughter after giving MICON—a non-toxic treatment given over 24 hours (www.edensinstitute.com/micom.html)—to a patient with cancer (see www.ncahf.org/digest/01-18.html).

In addition to these examples there are other cases when people find a “cure” on the web and use this, possibly at the expense of conventional treatment. A newspaper article in England (www.thisiswiltshire.co.uk/wiltshire/archive/2000/11/23/devizes_news_county2ZM.html) told of a local patient with cancer who raised money to go to a private clinic in Mexico to receive treatment with Laetrile (laevo-mandelonitrile-beta-glucuronoside). The article quoted local (Mexican) doctors as being “confident” that this would cure the cancer. In contrast, the National Cancer Institute reports that “Laetrile has shown little anticancer activity in animal studies and no anticancer activity in human clinical trials” (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 unproved treatments at the expense of proved conventional ones.


1. Smith R. Almost no evidence exists that the internet harms health. BMJ. 2001;323:651. . (22 September.) [PMC free article] [PubMed]
2. Black M, Hussain H. Fatal hepatorenal failure associated with hydrazine sulfate. Ann Intern Med. 2000;133:877–880. [PubMed]
Jan 26, 2002; 324(7331): 238.

Database of adverse events related to the internet has been set up

Gunther Eysenbach, project initiator
Christian Köhler, project officer

Editor—Crocco et al's systematic review, mentioned by Smith,1-1 is probably biased by the fact that cases of harm are rarely reported in the peer reviewed literature. Recognising this fact, since January 2001 our research unit has collected, on a database, published and unpublished cases of adverse events related to the internet (www.medcertain.org/daeri). We solicit and collect cases submitted by doctors 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 misdiagnosis or wrong treatments due to online prescription of drugs or medical consulting over the internet; the discontinuation of lifesaving treatments because patients have misinterpreted internet information; the addictive potential of the internet; and the potential of the internet to encourage suicide. As an incentive to submit cases we pay a small honorarium to the submitting doctor.

Although the positive effects on consumer health may well outweigh the negative effects, the medical profession should collect and assess evidence of possible harm much as it collects details of rare but severe side effects of drugs. The eventual aim of the database is to allow qualitative analysis of these stories and to suggest measures to minimise the risks for consumers of health information using the internet.

Discussion about the quality of health information on the internet is hampered by our lack of understanding of how consumers digest information and how the mechanism of potential harm operates. We also need such data to conduct further observational and experimental studies investigating possible problems related to the internet and to establish the prevalence of possible problems.

We urge doctors to fill in the questionnaire on the DAERI website if they think they have seen a patient who has been harmed by information or services obtained on the internet.


1-1. Smith R. Almost no evidence exists that the internet harms health. BMJ. 2001;323:651. . (22 September.) [PMC free article] [PubMed]

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