The Health on the Net Foundation Code of Conduct (HONcode) for medical and health Web sites addresses one of Internet`s main healthcare issues: the reliability and credibility of information. The Internet has become one of the most widely-used communication media. With the availability of Web server software, anyone can set up a Web site and publish any kind of data which is then accessible to all.
The problem is therefore no longer finding information but assessing the credibility of the publisher as well as the relevance and accuracy of a document retrieved from the Net. In many cases, a given Web site provides no appropriate documentation regarding the scientific design of a medical study, nor are studies made available that support given claims. The Health On the Net Foundation has elaborated the Code of Conduct to help standardize the reliability of medical and health information available on the World-Wide Web. The HONcode is not an award system, nor does it intend to rate the quality of the information provided by a Web site. It only defines a set of rules to:
Even before HON was launched in early 1996, members of the Net community – healthcare professionals as well as ordinary ``surfers`` – were complaining how difficult it was to assess the reliability of information. Of particular concern was the uncertain quality of medical advice provided on growing numbers of Web sites and the lack of scientific evidence behind claims made for commercially-available treatments. HON also noticed that many sites were not providing even basic user orientation, like the source of cited documents, Webmaster contact information, last-update notices on pages or information on their organizational structure and funding.
Then as now, these omissions were in most cases free of malicious intent. But user trust and good business practices go hand in hand: such information is essential if Web sites are to attract and successfully retain customers. HON`s discussions with Webmasters and information providers soon showed they were anxious to improve their services and would happily follow some simple, broadly-accepted rules and guidelines for content presentation. Out of this, in July, 1996, sprang the first version of the HON Code of Conduct for medical and health Web sites (HONcode).
The HONcode aims to raise the quality of healthcare information available on the Net. It is a voluntary certification system based on an ``active seal`` concept. While primarily intended for healthcare site developers and publishers, the blue-and-red HONcode seal on subscribing sites also helps users identify sources of reliable information. It addresses, among other things, the authority of the information provided, data confidentiality and privacy, proper attribution of sources, transparency of financial sponsorship and the importance of clearly separating advertising from editorial content.
Over the first ten months of its existence, the HONcode was slightly modified and also expanded from six to eight principles The current version has remained unchanged since April, 1997. It has been translated and is in use in 26 different language versions: Arabic, Catalan, Chinese, Czech, Danish, Dutch, English, Finnish, French, German, Greek, Hungarian, Icelandic, Italian, Japanese, Korean, Macedonian Malaysian, Norwegian, Polish, Portuguese, Russian, Slovak, Spanish, Swedish, Turkish.
The Internet is an unprecedented medium of free expression. It ignores national and cultural boundaries. Internet technologies are developing with bewildering speed. A single Web site can cover a vast array of unrelated subjects. Conventional print and audio-visual media leave a physical record, while net content is volatile: here today, gone tomorrow. For all these reasons and more,
There is no common legal framework for the provision of healthcare information on the Internet and other on-line services;
The Internet community itself has a record of stiff resistance to attempted government regulation;
Legislative bodies seem unable, if not unwilling, to address the dynamics of this global medium in a timely manner.
Webmasters and information providers can themselves apply the HONcode to set basic good standards for the presentation of healthcare advice and information. Of course, they are free to accept or reject it. But in formally submitting an application 1 for certification, they commit themselves strictly to observe all the HONcode principles. They are held to this commitment by the entire Internet community and through verification by the HON team.
The HONcode proposes benchmarks designed to make sure readers always know the source and purpose of the information they are reading. It does not seek to rate the medical accuracy, validity or appropriateness of the information itself. There is no substitute for the person-to-person practice of medicine. The second HONcode principle clearly states that medical information on the Internet can support, but never replace, the relationship between patients and their care-providers. Users of the medical Internet must themselves develop the knowledge and discernment necessary to avoid dubious Web sites. HON encourages users to practice caution and healthy scepticism. While the HONcode seal on sites should be a handy reference, we also recommend that users study a number of other useful criteria and evaluation tools listed on our website.
The HONcode is dynamic and has evolved from discussions with Webmasters, patient support groups and medical professionals in several countries. HON may incorporate additional principles and/or modifications, based upon constructive feedback from users and after consultation with all subscribing sites and the wider Internet community. If you have a comment to make, please mail it to HONcode@healthonnet.org. We would like to thank the more than 2,800 sites that already adhere to the HONcode. The Health On the Net Foundation wholeheartedly supports the propagation of useful health and medical information on the Internet and greatly appreciates the considerable efforts made in this domain by many individuals and organizations around the world.