Letters

The Internet

EDITOR,--Two recent articles have described the use of electronic mail and the worldwide web.^{1 2} In his editorial on the Internet Enrico Coiera raises the problem of the disclosure of personal information³; we support what he wrote and offer the following additional comments, which are based on abuses of these facilities that we have witnessed that give rise to serious concerns.

* Patients may join discussion groups on, and seek information by using, the worldwide web. They obtain advice that sometimes seems to be given on the basis of little information or on questionable clinical grounds

* Bogus professionals and worldwide web sites with information of unknown validity have inappropriately advised members of the public, who may believe that such advice has sound scientific and clinical substance to it

* In email groups people may give detailed personal and medical information about themselves, relatives, or friends or (in the case of medical professionals) about patients that clearly breaches confidentiality. This information allows people to recognise acquaintances or to seek patients out if they do not already know them. Parents have also openly discussed their child's psychiatric condition on lists such as the open but professional child and adolescent psychiatry list, described elsewhere⁴

* Advice may be inappropriate because the person giving the advice, or the worldwide web site, is in a different country and subject to different jurisdictions

* One mailing list specifically announces forthcoming clinical trials to people interested in participating as patients in clinical research. This potentially biases the designs used in these trials (for example, through failure to obtain representative samples)

* Virtual support groups exist on the Internet for discussion of specific symptoms or disabilities. Some are dedicated to the discussion of suicidal ideation, and one of these has a high frequency of expression of suicidal ideation and regular discussion of the most efficient techniques for completing a suicidal act. This has legal implications in Britain.

We are concerned about the possible abuse of this facility. We propose that the relevant regulatory bodies of countries on the Internet discuss this issue together to arrive at a universal set of guidelines that should safeguard all those concerned. The Internet is clearly a powerful tool, and thus extra care should be taken in its use.

Wellcome research fellow in child psychiatry ap23@leicester.ac.uk Lecturer in mathematical psychology dds@leicester.ac.uk Greenwood Institute of Child Health, Leicester LE3 0QU

Andrew Parkin, David D Stretch 

1. Pallen M. Guide to the Internet: electronic mail. BMJ 1995;311:1487-90. (2 December.) [Free Full Text]
2. Pallen M. Guide to the Internet: the world wide web. BMJ 1995;311:1552-6. (9 December.) [Free Full Text]
3. Coiera E. The Internet's challenge to health care provision. BMJ 1996;312:3-4. (6 January.) [Free Full Text]
4. Parkin A, Stoker A. Surfing the net: a guide to the Internet for professionals in child mental health. Child Psychology and Psychiatric Review (in press).