The online health care industry got a reality checkup last September when the New York Times published a front-page story questioning the ethics of former Surgeon General C. Everett Koop's medical information site, Drkoop.com. The company had failed to disclose to site visitors that its eponymous chairman was paid commissions on medical products and services sold through Drkoop.com, and that hospitals paid for placement on the site's list of health care resources.
Six days after the story broke, George Lundberg, editor in chief at Drkoop rival Medscape, unveiled a new policy that separated health information from advertising on his site. The timing was coincidental, and propitious for Medscape. But if Koop - a self-described national icon - wasn't above reproach, what did that say about the trustworthiness of health sites in general?
"The urgency with which we should deal with the issue was clear," says Lundberg, a 66-year-old pathologist and the former editor of the prestigious Journal of the American Medical Association. Lundberg is no stranger to controversy; he joined Medscape last February after he was fired from JAMA for publishing an article on teenagers' sexual attitudes.
Since September, Lundberg has spearheaded a campaign with his friend Koop and other competitors to establish industry ethics guidelines. If 1999 was the year of fresh-faced Internet medical entrepreneurs like Healtheon/WebMD's Jeff Arnold, the year 2000 will likely see graybeards such as Lundberg taking a lead role in establishing the legitimacy of health sites as they begin to provide actual medical services.
"Internet medicine is simply an extension of medicine," says Lundberg, who looks like central casting's idea of the stern but reassuring family physician.
"But a large number of people have no idea what medical ethics are all about - and these are the people who provide health information on the Internet."
The conflict that got Koop in hot water might not raise eyebrows elsewhere on the Web. But health care is different. Imagine the outcry, for instance, if doctors secretly took commissions from pharmaceutical firms whenever they recommended particular drugs to patients.
"There is a need for some sites that reflect the best scientific and medical judgment available, and [a need for] some ethical standards for all health sites to minimize the possibility of doing harm," wrote Barry Bloom, the dean of Harvard's School of Public Health, in an e-mail to The Standard. Lundberg is a visiting professor at the school.
Getting hypercompetitive Internet health companies to agree on guidelines that could limit revenues won't be easy. Lundberg, who has spent most of his career in the upper echelons of the medical establishment, already has rankled some Internet health execs - many of whom come from marketing, not medical, backgrounds - with his remarks about online medicine's ethical lapses.
But if the industry can't cooperate, the government may get involved, warns Lundberg. He says congressional staffers have approached him with concerns about online medicine. "If we don't get progress," he says, "there will probably be Senate hearings to try to move [health sites] along to self-policing, which is what we all want to do."