Intended for healthcare professionals

Rapid response to:

Information In Practice

Conducting clinical trials over the internet: feasibility study

BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:484

Rapid Response:


McAlindon et al deserve to be congratulated for using the power of
the internet in such an imaginative way and showing just how much can be
done in cyberspace. However, I was deeply disturbed by one aspect of their
trial, namely their statement that they 'used a commercial service to
email their advertisement to approximately 2 million recipients'. This
sounds to me like spam.

Spam, for those who are not familiar with it, is bulk unsolicited
email, and the many reasons why it is deplorable have been well described
[1]. Regrettably, it is not yet illegal in most countries, but it is
certainly deeply immoral. Sending an email to 2 million recipients can
only be justified if the sender is sure that every single one of those 2
million recipients had given express permission to receive the email. If
not, the email is spam.

I hope that McAlindon et al can clarify exactly what steps they used
to ensure that permission had been obtained from all 2 million of the
recipients of their email. I also hope that they were not so naive as to
assume that a commercial mass emailing service took those precautions for
themselves. I have often been spammed by such services, despite never
giving permission to be on their mailing lists. As spam is not illegal,
there is little incentive for commercial services to be scrupulous.

If there is not a cast iron guarantee that the mass mailing was not
spam, then I am disappointed that this method of advertising was approved
by the ethics committee. I am sure that it would not have been approved by
the ethics committee of which I am a member.



Competing interests:  
I receive several dozen spam emails every day.

Competing interests: No competing interests

14 September 2003
Adam Jacobs
Dianthus Medical Limited, London SW19 3TZ