Using Health-related Websites

Using Health-Related Websites

The popular acceptance of the Internet is provided tremendous opportunities for consumers. These opportunities are readily identifiable because they exists at every point of the process: preventive healthcare information, regularly scheduled wellness screenings, searching for physicians based upon different criteria (e.g. credentials, specialty, experience, location, affiliation, etc), setting up appointments, filling out patient histories, learning about ailments, diseases and conditions, post-treatment follow-up, completing survey questionnaires about healthcare quality, inquiring about payment matters, obtaining insurance re-imbursements, filling out prescriptions, purchasing prescription and non-prescription drugs, sharing experiences with other patients, and so on.

We will now cite some survey data from the MARS OTC/DTC Pharmaceutical Study. This is a mail survey of 23,705 adults in the USA conducted during January-March 2001. In this survey, 60% of the survey respondents said that they had accessed the internet at home, at work or some place else in the last 3 months. The next table shows the internet access incidence by different demographic characteristics. The results here are consistent with commonly known facts about internet users --- younger, better educated and affluent. There are no surprises here.

Demographic Characteristics	% Accessed Internet in Last 3 Months (Base: Total US Adults)
Sex Male Female	62% 59%
Age 18-24 25-34 35-49 50-54 55-64 65+	75% 78% 68% 59% 45% 24%
Hispanic	58%
Race White American Indian/Alaskan Native Black Asian Pacific Islander Other race	62% 65% 44% 80% 61%
Marital Status Single Married Divorced Widowed Separated	68% 64% 50% 21% 50%
Employment Status Full-time (30 hours per week or more) Part-time (less than 30 hours) Full-time student Not employed Retired	71% 63% 96% 53% 27%
Education Less than high school Completed high school Some college College graduate Post-graduate study/degree	30% 50% 72% 85% 84%
Employed Personal Income Less than $20,000 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 - $249,999 $250,000 or more	54% 66% 67% 80% 80% 92% 90% 90% 93% 95%
TOTAL	60%

The purpose of this article is to examine the incidence of visiting health-related websites. Within the MARS study, those people who said that they accessed to the internet in the last 3 months were shown a list of health-related websites with their color logos and asked if they had visited them in the last 30 days. We reproduce this list of websites below as a matter of historical interest, because quite a few of them are out of business by the time that this article was composed (October 2001).

About.com/health
adam.com
AOL.com/webcenters/health
CBSHealthWatch.com
CVS.com
theDailyApple.com
DiscoveryHealth.com
drkoop.com
drugstore.com
eDiets.com
HealthAnswers.com
Healthcentral.com
HealthGate.com
HealthScout.com
IntelliHealth.com
iVillage.com
MayoClinic.com
MDchoice.com
Mediconsult.com
MedicineNet.com
MediZine.com
MSNBC.com
nytimes.com/pages/health
onhealth.com
planetRx.com
RDhealth.com
RealAge.com
ThirdAge.com
WebMD.com
women.com
Yahoo.com/Health

According to the MARS study, 35% of the internet users have visited one or more of these health-related websites in the last 30 days. In the next table, we show the incidence by different demographic characteristics. We do not observe any strong patterns, so the need for health-related information appears to cut equally across demographic groups. A different perspective on the same fact may be that ill health (or the fear of it) is a great equalizer that pursues us from birth till death, even though the specifics change (see previous article).

Demographic Characteristics	% Visited Health-Related Websites (Base: Accessed Internet Last 3 Months)
Sex Male Female	33% 38%
Age 18-24 25-34 35-49 50-54 55-64 65+	36% 40% 35% 32% 28% 34%
Hispanic	38%
Race White American Indian/Alaskan Native Black Asian Pacific Islander Other race	34% 37% 41% 37% 44%
Marital Status Single Married Divorced Widowed Separated	37% 35% 35% 28% 34%
Employment Status Full-time (30 hours per week or more) Part-time (less than 30 hours) Full-time student Not employed Retired	35% 38% 35% 38% 33%
Education Less than high school Completed high school Some college College graduate Post-graduate study/degree	39% 34% 35% 35% 38%
Employed Personal Income Less than $20,000 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 - $249,999 $250,000 or more	35% 37% 40% 29% 40% 36% 31% 27% 36% 34%
TOTAL	35%

The health-related websites can be very different from each other. Some are online pharmacies, some are women's health specialists, some are specialized sections within portals/news sites, some contain chat rooms and forums, and so on. These distinctions occur because health is not a monolithic subject (as, say, major league baseball might be).

In the MARS survey, those survey respondents who have accessed health-related websites in the last 30 days were asked to identify their reasons. The chart below shows that the response rates to the pre-listed answers (note: multiple responses are allowed). By far, the single most common reason is that they need to obtain information about a specific ailment, disease or condition.

The information above forms a suitable basis for a segmentation of the health-related field on the internet. However, as history has revealed so far, going after the largest segment is not necessarily the winning business plan. For example, an online pharmacy does not need millions and millions of visitors, because all they need is a core collection of frequent buyers.

Idealists proclaim that the Internet has empowered healthcare consumers through the democratization of medical and health-related information. In an article by Joanne Kaufman in New York Magazine, NYU Medical Center neurosurgeon Patrick Kelly said, "We talk doctor talk and we've had power because we controlled information. But the Internet removes the monopoly on information. It's going to change medicine in much the same way the printing press changed the Catholic Church in the Middle Ages. Because of the Internet, medicine is going to become consumer-based like anything else, like buying a television set. Doctors aren't going to be happy and hospitals aren't going to be happy, but they're going to have to learn to march to this different drummer."

But things are never that easy. While Internet-enabled consumers can go to the Google.com and look up symptoms and treatments for any number of ailments, diseases and conditions, they do not always have the background and training to interpret the facts properly and/or grasp the totality of their situations. The Kaufman article reported these tragicomic anecdotes:

Neurologist Arthur Weiss is knowledgeable in his field, up-to-date on the literature, respected by colleagues, esteemed by his patients. Fun at a party, too. So perhaps he can be forgiven for sounding a bit testy about the people who, after a few clicks of the mouse, seem to view themselves as his partners in making a diagnosis and, in some instances, offering a treatment plan.
I checked all my symptoms on the Internet, they'll tell him. I've had a stroke. I have a brain tumor. "And they'll want to know why I'm giving them aspirin when Plavix is the latest drug," he says, referring to a medication that reduces the risk of blood clots. "They confront you, and it's not always easy to parry their questions. The information may be good, but it's not relevant to their situation or they're taking it out of context."

Larry Newman, director of the Headache Institute at Roosevelt Hospital, feels Dr. Weiss's pain. He recounts the story of a patient with daily headaches who, after surfing the Web, came up with a diagnosis of mad-cow disease. Then there was the patient Newman diagnosed with hemicrania continua, a rare type of headache. "She called the next day saying she had done a search on the Web and couldn't find any mention of her headache," Newman recalls. "She called me a quack, accused me of making the whole thing up to get her out of my office, and told me not to cash her check."

"People are prepared to say their grandmother is talking rubbish, but the Internet looks more reliable -- especially if there are a lot of graphics and ads for Pampers," says Daniel Cammerman, an Upper East Side pediatrician who recently treated a teenager who, after two days of surfing the Net, was convinced that his mononucleosis would result in a ruptured spleen and hepatitis. "That's all the more reason you need to sit down with someone and spend more time than you otherwise might and try to educate them."

Anne Moscona, chief of pediatric infectious diseases at Mount Sinai, recently dealt with a family whose 4-year-old was preparing for a liver transplant. "We wanted to make sure the child was fully vaccinated, because one of the main thing kids die of after transplantation is infection. The parents said they would get one or two but that they had been reading stuff on the Internet about a supposed link between vaccines and autism. Here were these parents willing to deal with the risk of a liver transplant to save their child, but they weren't able to correctly weigh the benefit risk of vaccines."

(posted by Roland Soong, 10/17/2001)

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