Growing pains of the Internet age

The Internet is the new medium of business, communication, education, services, and entertainment. Most people had never heard of the World Wide Web 5 years ago, but business, schools and universities, governments, and individuals have since begun to provide a wide range of services to previously unreachable audiences. This exciting phenomenon is generating enormous economic growth and creating more personal wealth than anyone could have anticipated. This gold rush has certainly led to lapses in judgment and ethical behavior. The financial opportunities for Internet pioneers are unprecedented, and Mildred Cho suggests that we need new Internet “e-thics” guidelines that will address potential conflicts, primarily by placing additional restrictions on advertising. That perspective is, perhaps, myopic. Untruthful, harmful, or misleading content is of concern to any responsible Internet developer, but so are privacy, data security, and illegitimate business practices. In addition, we all need to be aware of the widening gap that is developing between the segments of the population that have access to online information and those—mostly elderly or poor persons and people in developing countries—who do not. The Internet is a different medium for traditional business, not a new business itself. As such, it does not need completely new legislation or regulation. Existing regulations should guide the development of Internet policy. The challenge must be to expand the electronic marketplace while recognizing the unique nature of the medium and the differing needs of the global online community. The Association of Medical Publications has long had a code of ethics that prohibits the exchange of editorial material for any monetary compensation or advertising consideration. A member publication will not publish advertisements that might be mistaken for its own editorial material without labeling such material clearly as an advertisement. Leading medical journals also subscribe to advertising placement guidelines developed by the Vancouver Group that restrict the placement of advertisements next to related editorial material. The Accreditation Council for Continuing Medical Education restricts the placement of advertising within an experience of continuing medical education. Publications directed to consumers have similar standards developed by the American Society of Magazine Editors that prohibit editors from working on advertising inserts or “noneditorial” material that appears in their publications. Most major publishers prohibit their own editors from having any equity stake in companies that they cover. It is generally accepted that these standards, prepared years ago for print products, are to be applied equally to all online activities. Many of the stories detailing potential conflicts have involved new information companies and groups that have, in some cases, not been around long enough or were being run by people without sufficient editorial experience to be aware of the existing standards. Many of these Internet start-ups are establishing ties with established media channels (CBS/Medscape, CNN/WebMD) and are beginning to realize the need for strong standards of editorial integrity and control. The Internet Content Coalition, a nonprofit trade association of advertising-driven consumer sites, posted guidelines on ad placement in 1998. An alliance of 16 electronic health companies called HiEthics is working on a self-regulation code of conduct for advertising, sponsorship, and content, with a consensus document hoped for in March 2000. They are focusing on at least three minimum standards: financial disclosure, clear separation of content and commerce, and science-based labeling. They agree that health sites should fully disclose any financial incentives for the site developer that are related to editorial content. They also agree that information developed to promote a product or device in exchange for compensation should be easily distinguishable from editorial content. The third leg calls for the referencing of sources of content along scientific lines, including the last dates that the information was modified, to help readers decide if the information presented is from a credible scientific source. Because the accuracy of advertising information is crucial, the scientific validity of the product messages, who receives them, and how they are delivered take on heightened significance. Dozens of legitimate advertising agencies that specialize in preparing commercial messages for pharmaceutical and medical device companies have been in business since the 1920s, and they communicate complicated information in a form that is clear and understandable. Their clients, the manufacturers, are ultimately responsible for the content of the messages, so I can find no justification for excluding them from the process. Because we are dealing with issues of expression, government involvement should be considered only as a last resort. Except in rare cases, existing law and government regulation is sufficient to guide the conduct of online pharmaceutical advertising, and the US Food and Drug Administration has wisely indicated that they will not be publishing any new Internet guidance at this time. I applaud Cho for attempting to address the “e-thical” issues of the Internet. I suggest that all of us involved in the issue use the tools currently available to ensure the quality of electronic information and not try to reinvent the wheel.

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