Education And Debate Education and debate

Regulating health information: a US perspectiveCommentary: Legal aspects of health on the internet: a European perspective

BMJ 2002; 324 doi: (Published 09 March 2002) Cite this as: BMJ 2002;324:602

Regulating health information: a US perspective

  1. Nicolas Terry (, professor
  1. Center for Health Law Studies, Saint Louis University School of Law, 3700 Lindell Blvd, St Louis, MO 63108, USA
  2. Avienda Limited, PO Box 2327, Cardiff CF23 9YW
  • Accepted 21 January 2002

Technologically mediated health care raises problems of quality of information, cross border practice, and patient confidentiality. Nicolas Terry probes the legal aspects of these complexities, and Benedict Stanberry adds a European perspective

Identifying the regulatory agenda for health information is not difficult. The quality of publicly available health information, cross border medical and pharmacy practice, and the privacy of medical records appear on the radar screens of most public health and consumer protection organisations. Left unregulated, any of these issues can cause considerable harm. Each issue also embodies difficult tensions: state versus federal rights, increased access to care versus quality assurance, and confidentiality versus professional discourse.

US state and federal legal systems have not achieved a coherent approach to regulating the dissemination of health information. Furthermore, the American experience will not always transfer directly to publicly funded medicine and government initiatives. Nevertheless the American experience with private sector ehealth is an instructive model, even if some areas have been neglected and others over-regulated.

Summary points

Quality of publicly available health information, cross border medical and pharmacy practice, and privacy of records will be key issues for European regulators

Concerns about medical advice sites may be exaggerated

US regulators have yet to find the appropriate balance between risk and benefits of cross border practice

New US federal laws on health privacy appear cumbersome but may be instructive for other legal systems

Regulating the quality of online health information

Concerns about widespread inaccuracies in online health information are speculative and intuitive rather than based on robust research. Berland's quality assessments, at least for English language sites and well educated users, suggest the picture is not so gloomy as critics expected.1

Public law regulation of health information may conflict with US guarantees of free speech, and differences of opinion among medical professionals make the broad regulation of health advice difficult. Consequently, …

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