Google and the dot-health bubble

Doctors seek a solution to combat online pseudoscience

Google screen grab

It’s flu season. You want to learn more about the annual flu shot. Your first stop? Dr. Google. Over 78 million results pop up, all potential sources about the flu shot. Wikipedia, Purdue Pharma, WebMD: Who to trust?

A group of researchers, health associations, and consumer advocates think Googlers need help. We need a safe “top-level domain name” (the part of the web address to the right of the dot) that would separate evidence-based sites from pseudoscience trash.

Just as .gov suggests a governmental page, this group want to see .health on sites that have been vetted by a body, such as the World Health Organization, which would bestow the suffix only to those that have met some minimum quality requirements, limiting the fraud and abuse that are so common online. “A domain is associated with a site’s brand, origin content or quality,” explained Dr. Joan Helen Dzenowagis, who is responsible for the WHO’s eHealth governance unit. “The sites that fall under .health are likely to be considered the ultimate online source of information and advice on health.”

While the quiet quest for .health has been going on in the medical literature for more than a decade, according to a new commentary published in the Lancet, November could mark the loss of this battle against evil Dr. Google.

That’s because .health and other new medical top-level domains like .doctor and .hospital are poised for sale to private companies that have little or no health expertise, or plans for restrictions on who they sell related web addresses to. This is just the health angle on the Internet Corporation for Assigned Names and Numbers (or ICANN, the body that oversees the Internet naming system) project to expand the number of Internet domains. Soon, web addresses will be more varied and descriptive when the number of suffixes goes from a restricted 22 (.org, .com, etc.) to over 1,000 (.blog, .book, etc.). Imagine the possibilities: cure4cancer.health or worldsbest.doctor.

The researchers behind the Lancet article aren’t going to let this sale happen without a fight. They’re asking ICANN to reconsider and hand the .health domain over to an entity that would oversee its use in the public interest. As one of the authors, Amir Attaran of the University of Ottawa, told Science-ish, “I don’t want highly sensitive health information being vetted by private companies with zero expertise in health such as Donuts.com, and which are engaged in a mad rush for domains like .wtf at the same time as .health. None of that inspires confidence.”

Attaran has a point, but the campaign to secure .health also has its critics. Wendy Seltzer, a fellow with the Berkman Center for Internet and Society at Harvard Law School, said that imposing quality controls at the level of domain name registries isn’t quite right. “ICANN is not equipped to be a regulator,” she said. Plus, even when there are sanctions on who can have a domain name, they don’t necessarily work in practice. There are all sorts of non-accredited institutions that get .edu addresses, for example, and sifting good health sources from dubious ones could be even more difficult.

Susan Crawford, a professor at the Cardozo School of Law, said many people don’t find information through domain names any more: they use intermediaries like apps and social networks. “I wouldn’t put too much weight in, or worry about, the domain-name system. It’s becoming less important as a way for people to find info online than it has historically been.”

Still, almost 2,000 people paid nearly $200,000 to apply for ownership of one of these new domains. That must mean something. And the fight against Dr. Google is about a lot more than the internet naming system.

“The Internet has become a global asset for health,” said Dr. Dzenowagis. “It is critical to health security, health and medical education, connecting health research communities, and empowering people by giving them access to information, where ever they live.”

Through whatever means, we need more people to think about how to re-engineer the Internet for health. We need health professionals working alongside developers to figure out how to get high-quality information to people at the right time in a way that makes sense to them. Whether that’s with a special domain name, search-engine optimization, or an app doesn’t really matter. If this century’s health revolution is about getting people access to clean information, then the Internet is the most important delivery tool.

Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. She is currently on a Knight Science Journalism Fellowship at the Massachusetts Institute of Technology. Check back for periodic updates here and here, and reach her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto




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Google and the dot-health bubble

  1. Quis custodiet ipsos custodes?

    Scientists who are quacks deserve a special area on the web to peddle their nonsense? How do we even tell between science and pseudoscience now, exactly?

    The Economist Oct 2013:

    A SIMPLE idea underpins science: “trust, but verify”. Results should always be subject to challenge from experiment. That simple but powerful idea has generated a vast body of knowledge. Since its birth in the 17th century, modern science has changed the world beyond recognition, and overwhelmingly for the better.

    But success can breed complacency. Modern scientists are doing too much trusting and not enough verifying—to the detriment of the whole of science, and of humanity.

    Too many of the findings that fill the academic ether are the result of shoddy experiments or poor analysis. A rule of thumb among biotechnology venture-capitalists is that half of published research cannot be replicated. Even that may be optimistic. Last year researchers at one biotech firm, Amgen, found they could reproduce just six of 53 “landmark” studies in cancer research. Earlier, a group at Bayer, a drug company, managed to repeat just a quarter of 67 similarly important papers. A leading computer scientist frets that three-quarters of papers in his subfield are bunk. In 2000-10 roughly 80,000 patients took part in clinical trials based on research that was later retracted because of mistakes or improprieties.

    http://www.economist.com/news/leaders/21588069-scientific-research-has-changed-world-now-it-needs-change-itself-how-science-goes-wrong

    • Scientists respond to incentives. The funding is not abundant for scientists looking to reproduce results. Maybe that would be a good job for PhD students and post docs rather than clutching at straws to find something novel to study.

    • Welcome to healthcare.

    • Obviously one of those guys who envisions himself as one of the “enlightened gate-keepers” of information. The same sort of person who does not want any opinion ameliorating the severity of climate change to see the light of day. I’m guessing he uses the word ‘denier’ a lot.

  2. Sure, Internet has fraud. But so do Canadians access to good doctors. Note, I said good doctors as many are either licensed drug pushers or not very good with patient care.

    Best part of the Internet on health issues is you can get 2^32 opinions and evaluate them for yourself. Lots of money for quackery, but there is a lot of real good information too. Mayo clinic has a good site, so does Hopkins….just know like doctors, not all information is accurate. Learn which sites are legit and which ones want your money for quackery.

    Keeps doctors on their toes too, as patients walking in that are realistic, analytical, capable of rational though can get right to the ailments cause with less guess work.

    Learn how to identify fraud for any reasons, not just health, and be aware there are a lot of unscrupulous fraudsters that will harass you at the mall, at your door and in the Internet. Seek to check them out and understand what your are doing is priceless.

  3. With the exception of those perspectives contributed by Wendy Seltzer, many of the statements or assertions about .health and the applicants to ICANN for .health contained in the article in the Lancet and in this article are inaccurate, misleading or unsupported, and serve to mischaracterize the role of a top level domain registry operator.

    Fact is that TLD registry operators can play an important role in support of the public interest in preventing or disabling web sites that are used for the illicit sale or promotion of harmful or dangerous substances which are have been validated by regulatory authorities as safety concerns. In the case of the .health TLD, a review of the applicants and their respective applications, policies and proposed models of governance would prove the statement that the applicants have “zero expertise in health” as blatantly inaccurate.

    Attempting to censor the Internet on the basis of “quality” represents a dangerous precedent and for which both articles have failed to acknowledge as nothing more than a violation of the principles of international laws. Over the past several decades, there have been several diversified attempts made by government agencies, public health organizations, health industry regulators, non-governmental organizations (NGOs) and others throughout the global public health community to establish a series of standards, best practices and codes of ethics to encourage the dissemination of quality health information for patients and professionals and the general public.
    Although each of these standards and recommended best practices share common goals and objectives for ensuring health information quality, there is no agreement on what criteria should be used to define what “quality” health information actually means.

    There are, and will always be, different viewpoints coming from different geographies, cultures, religions, areas of specialization, schools of thought etc. This is why the
    rule of law must prevail jurisdictionally and internationally to ultimately
    regulate individual operations. A review of the WHO’s 2011 Report as cited in the Lancet Article would reinforce the level of diversity in regulations: http://whqlibdoc.who.int/publications/2011/9789241564397_eng.pdf.

    Even in the context of professional medical journals, where quality is already codified to great extent, quality is still a highly subjective and contentious issue. It only gets more challenging in other areas of health that have little or no codification and lack the same degree of scientific rigor. Not all health information is free of bias – and just because it might come from a biased source doesn’t mean that it isn’t “quality” information.

    Where the “line” should be drawn to ensure the public’s legitimate interests for a safe, secure and trusted .health top level domain is indeed a real question. However, with respect to “quality” the proper line to draw – and the only possible approach
    from a pragmatic perspective understanding the role and function of a registry
    operator – is the elimination of anything harmful and/or illegal. There is
    otherwise a basic conflict of laws point as between freedom of information and
    protection of divergent interest groups within the umbrella of “health.”

    So the public has a clear view and understanding of the applicants and applications for .health and the ICANN New gTLD Program Rules:

    Applications to ICANN for the .health TLD:

    DotHealth, LLC: https://gtldresult.icann.org/application-result/applicationstatus/applicationdetails/495 or http://www.dothealthgtld.com
    Goosefest, LLC (“Donuts”): https://gtldresult.icann.org/application-result/applicationstatus/applicationdetails/734
    Afilias: https://gtldresult.icann.org/application-result/applicationstatus/applicationdetails/1852

    ICANN New gTLD Program Web site: http://newgtlds.icann.org
    ICANN New gTLD Applicant Guidebook: http://newgtlds.icann.org/en/applicants/agb
    NGPC Resolution of Government Advisory Committee Safeguard Advice: http://www.icann.org/en/news/correspondence/crocker-to-dryden-3-29oct13-en.pdf

    • Regulatory authorities = the cabal.

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