• decision making
• patient involvement

Consumers are increasingly being encouraged to adopt a philosophy of self-care; the internet allows people to obtain advice about treatment and medicines at their own convenience. Studies indicate that there are many inaccuracies in health information on the internet, and a widely varying quality of information with patients in essence taking a “lucky dip” as to which site they choose to view and how good the quality of information is. There may be even greater problems if the sites offer to supply medicines as in the case of many e-pharmacies. It appears that very few e-pharmacies provide the facility for customers to have a meaningful consultation with a pharmacist. A number of national pharmaceutical organisations have developed ethical guidance regarding the operation of e-pharmacies, but this, it appears, is rarely adhered to.

In this issue of QSHC Bessell et al¹ report a study which evaluated the quality of information published on global websites selling medicines using the DISCERN tool and examined what happened when a “pseudo customer” ordered a non-prescription medicine (pseudoephedrine) and a complementary medicine (St John’s wort) online; the customer was also taking fluoxetine (Prozac).

The methodology used is a very useful one for evaluating e-pharmacies. Internet pharmacies—like community pharmacies in general—are open to scrutiny by pseudo customers or mystery shoppers as people can ask for advice and purchase over the counter medicines with no need for registration with the pharmacy. It was good practice to send the results to the e-pharmacies for comment.

In the study by Bessell et al 63 out of 104 websites investigated provided some health information but, overall, the quality of that information as judged by the DISCERN tool was poor. What is particularly sobering is that only three websites provided adequate advice to consumers to avoid a potential drug interaction. Only 27 of the sites actually sold medicines and, of those, only three asked the customer for further information about a potential drug interaction by contacting the customer by telephone and advising them to seek medical advice. One pharmacy sent out of date stock and another sent a substitute brand without checking if it was all right to do so.

“. . . it is probably not safe to surf and self-medicate”

Interaction via a computer terminal allows customers to be completely anonymous and, as such, there can be no proper checks on the customer’s state of health, other medications, or even age. However, people may be more willing to describe their symptoms over a computer terminal than face-to-face with their doctor or pharmacist, particularly if they find the complaint embarrassing. Any advice provided, particularly concerning drugs, could subsequently prove damaging to the patient if all relevant information is not elicited, so this presents a danger—both to the public and to the reputation of the pharmacy profession for providing high quality impartial advice.

The main attribute of the internet is also its main problem—namely, its global nature. No one body controls the whole of the internet so no one body can oversee and ensure the quality and accuracy of its information. It may ultimately come down to the individual user to choose which health based website to trust and use. There is much debate about evaluating websites containing health information and about who should perform that evaluation.^2,3 The New Zealand Pharmaceutical Society (www.psnz.org.nz) has set up an accreditation scheme for internet pharmacies. Accreditation provides reassurance that the internet pharmacy is fully licensed, observes quality pharmacy practices, complies with patient rights to privacy and confidentiality, complies with ethical codes and legislative requirements for the advertising of medicines, provides factual and understandable information about all medicines advertised, and provides opportunity for meaningful consultation between patient and pharmacist.

As Bessell et al conclude, it is probably not safe to surf and self-medicate. Consumers who self-select medicines from websites have insufficient access to information and advice to make informed decisions about the safe and appropriate use of medicines. There is a need to develop more customer focused services. Internet pharmacies need to consider the quality of their services and to start to comply with the standards set for them by national pharmaceutical associations.