Friday, November 6, 1998 Published at 12:25 GMT
Cyberdocs could be deadly
Web consultations "could kill"
Patients who seek medical treatment on the Web could be putting their lives at risk, doctors have warned.
They said that so-called cyberdocs, who may not be medically trained, are dispensing information and treatments that could be dangerous.
The doctors requested advice on symptoms indicating a form of herpes from 17 different US-based medical websites.
Although the information they provided was identical, the advice they received varied considerably from practitioner to practitioner.
In two cases it was completely wrong and could have killed a genuine patient.
The correct response to the doctors' query was that the patiient should seek medical treatment immediately. Failure to do so could result in the death of a genuine patient.
One cyberdoc recommended "two bowel movements" or "two apples a day", and "Red Clover and Dandelion", which they offered to sell the patient.
Another recommended homeopathic medicine and vitamin C and charged $25 for the advice.
Dr Gunther Eysenbach and Dr Thomas Diepgen, from the department of public health, cybermedicine and dermatoepidmiology at Heidleberg University in Germany presented the findings in a letter to The Lancet medical journal.
Dr Eysenbach said: "Procedures should be considered to protect consumers from quacks and non-medically trained healers offering dubious health advice on the Internet."
The doctors proposed an international, independent body to assess the qualifications of cyberdocs and issue licences for doctors who practise on the Internet.
He said remote medicine could not replace an in-the-flesh consultation.
Not even telemedicine, where the doctor sees the patient over a real-time video link and can ask questions, is satisfactory, he said, even though it has won the support of the government.
Dr Buckman was one of the first cyberdocs, offering medical advice on the teletext-style Prestel service.
He said he learnt from his days on Prestel that the only useful advice he could give without seeing the patient was "see your GP".
The German doctors posed as a 55-year old patient for their study when they contacted the cyberdocs.
They complained of red blisters on their skin and said they were taking a drug following a kidney transplant some time ago.
The e-mail they sent was: "I am 55 years old and have a minor skin problem.
"Yesterday multiple fluid filled painful red blisters appeared on a broad streak of reddened skin on the chest (but only there).
"I did not intend to do anything about it, as I think it will go away, but my son suggested to ask you.
"I am on Sandimmune since I had a kidney-transplant some time ago.
"Any idea what this could be? Any suggestions regarding therapy? Most important question: Do I have to see a doctor (I live in a rural area), or can I wait some days to see whether it goes away?"
They added credit card details and signed the email "Gunther, Germany".
Of 10 cyberdocs who responded, three refused to give advice because dermatology was not their area of expertise.
Five of the seven who did reply correctly diagnosed the herpes zoster infection which needed immediate attention with a drug called acyclovir.
But the two who got it wrong caused great concern, Dr Buckman said.
He said their advice was "rubbish".
"It's extremely dangerous - it could kill somebody," he said.
Without acyclovir the patient could develop herpes septacaemia, he said, and die.
"This isn't proper telemedicine, this isn't proper communication, this is just silly.
"These people should not be allowed to do this but of course the Net is not regulated so there's no reason why they can't," he said.