Internet sites are offering physicians free discussion forums, medical journal articles and even e-mail. But doctors don't get a free lunch.
In exchange for free online services, sites like Medscape, Physicians Online and WebMD require physicians to turn over personal data. The sites promise this information won't go to advertisers but say they do use it for general demographic data, such as how many internists or Californians use the site. This allows advertisers to choose who sees their advertisements based on the demographics of individual users and the pages they view.
While sites are expanding into subscription sponsorships and other means of raising revenues, most rely heavily on advertising, especially from the pharmaceutical industry.
"What's going to happen is they're going to use the information for specific marketing," says Daren Marhula, healthcare information technology analyst for Minneapolis-based U.S. Bancorp Piper Jaffray. "If you're looking for diabetes information, you'll get (an advertisement for) a diabetes drug."
The concept is new to physician sites only because the sites themselves are young; most have popped up in the past year. Nonmedical Web sites commonly collect such information to present to advertisers and marketers.
A book released this year designates the concept "permission marketing," meaning site users understand that to get what they want they must exchange some information about themselves. If a person refuses, access to the site is limited or terminated.
In its Feb. 26 initial public offering filing, Atlanta-based WebMD spelled out why it considers permission marketing important.
"Our Web site will be more attractive to healthcare advertisers if we have a large audience of subscribers and consumers with demographic characteristics advertisers perceive as favorable," WebMD wrote in its filing with the Securities and Exchange Commission.
Fellow Internet healthcare company Healtheon Corp. of Santa Clara, Calif., certainly saw WebMD's potential audience of physicians and consumers as valuable. Healtheon's multibillion-dollar stock offering for WebMD was viewed as a sign of the vast moneymaking potential of bringing physicians online. Without the deal, Healtheon is largely a site based on transactions between physicians, hospitals and insurers.
Internet privacy advocates say most corporate sites (not just those in the medical field) don't go out of their way to let people know what happens to the information they provide.
In its analysis of the Healtheon-WebMD deal, the "NouveauGeek" column on the CBS Marketwatch Internet financial site criticized WebMD for not being clear about its "true business . . . collecting demographic information."
"WebMD's Web site seems almost purposely designed to mislead its true purpose," wrote the author, Rebecca Lynn Eisenberg.
WebMD executives did not return Modern Physician phone calls seeking comment.
Also, critics say, a site's promise not to turn over an individual's name, address and other information to an advertiser rings hollow because no legislation exists to stop it from doing so.
Marc Rotenberg, director of the Washington-based Electronic Privacy Information Center, is among the leading advocates for legislation that would require sites to reveal what they're doing with the personal information. How that would be done, and who would enforce such legislation, has not been spelled out.
Rotenberg testified May 27 to a U.S. House subcommittee looking at online privacy disclosures that the current industry self-regulation won't "adequately address the public concerns about privacy and the Internet."
"I've been generally unimpressed by what these (privacy) statements say," Rotenberg says, talking about Web sites in general. "They're more like disclaimers."
Site operators say those who register are not objecting to disclosing information. Executive Vice President Jeffrey Drezner, M.D., says despite pressure from advertisers, Medscape won't turn over individual information because that might harm the trust between a user and the site.
"It was important to us to understand who our readership audience really is," Drezner says. "Secondarily, we have found that people do not object to registering because of the high quality of content they find freely available on our site."
After an individual registers, many medical sites use technology called "cookies" to recall personal information. Each time a user logs on, he or she is presented with specially geared editorial information and advertisements.
Print publications also tailor content and advertising to readers based on demographic information. But printing an issue for each individual would be cost-prohibitive and impractical.
Physician-centered sites say another reason they ask for personal information is to verify that registrants are doctors. Medscape, for example, says about 10% of users who register as physicians turn out to be lying. Drezner says users feel as if they'll be shut out of the site if they don't say they're doctors.
Beth Nash, M.D., medical director for Tarrytown, N.Y.-based Physicians Online, says doctors on her all-physician site want to feel confident that when they're discussing specific cases in a chat room, they're talking only to other doctors.
Nash also says that's the only way to tailor information individually for each doctor.
"We do ask (physicians) to tell us their specialty, (so) we can push to them information we think will be most useful to them. We believe physicians are incredibly busy and don't want to have to do a whole lot of searching," Nash says. "They want to be spoon-fed, to an extent."
However, sites have another reason to verify the identities of their doctor members. "Pharmaceutical sponsors want to know who your readership is by specialty so they feel comfortable sponsoring the site," Drezner says. "We have to be able to demonstrate that we reach their target audience."