Navigation

Medline Plus Drug Information

Abstract

Information about medications appropriate for dermatologists and patients with skin diseases is readily available on the Internet. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Although it is easy to find excellent dermatological drug information, the World Wide Web is dynamic and unmoderated, and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers and evaluate the quality of health-related information.

**********

Introduction

A survey by Nielsen/NetRating estimated that in June 2004 there were more than 300 million active Internet users in 13 countries surveyed. (1) More than 20,000 medical/health sites are visited and described by HON (Health on the Net). (2) Research from Harris Interactive published in February 2004 indicates that in 2003 roughly three quarters of the American Internet population used the web for health information. Fifty-one percent of online health information seekers first went to a portal or search engine that allowed them to search for health information across many different sites, while 23% went directly to health-related sites. (3)

Hitwise found in March 2004 that the word "herpes" was among the top search terms that led to visits to health and medical information websites, (3) confirming that many users have skin problems.

There are many authoritative sites for dermatology patients that include online drug information, interaction tools, news about novel treatments and clinical trials, personalized advice, friendship, and support. Consumers with skin diseases can conveniently purchase over-the-counter medications and skin care products from numerous discount stores.

Drug information is supplied by academic institutions and associations, commercial health portals, individual physicians, drug companies, patients and others (Table 1).

Dermatological Sites

Several colleges and institutions claim to have peer-reviewed, authoritative, unbiased, and reliable information for patients about skin diseases and their management. In July 2004, more than 2 million page views were recorded for the New Zealand Dermatological Society's website DermNet NZ including 76,793 pages on drug treatments. The page on topical steroids is consistently the most popular of these.

The American Academy of Dermatology's consumer site, SkinCarePhysicians.com, also has informative sections on the most common conditions and their treatment. Other useful resources include the British Association of Dermatologists, the Australasian College of Dermatologists, and Singapore's National Skin Centre.

Some sites were primarily created for the student or physician and added consumer sections later. The online medical textbook Emedicine has a consumer section on skin conditions as part of the American Academy of Emergency Medicine's Emergency Medicine and Family Health Guide. However, the main Emedicine Dermatology textbook is a more comprehensive and impressive international collaboration. Limited drug information is included within disease-specific titles.

There are numerous dermatological consumer/self-help organizations with a presence on the Internet. These often include specific, comprehensive information about the skin disease and its treatment (Table 3).

Increasing numbers of practice websites include useful information for their own patients and others. Pharmaceutical companies and laboratories have purchased numerous disease- and treatment-specific domain names. Experience with their own, or a relative's, skin problem or its treatment has also resulted in a plethora of websites created by individual patients. Unfortunately, even those sites apparently created and maintained by specialist dermatologists may lack credibility. The author(s) may be unnamed; the information may be incomplete, anecdotal or unreferenced; and navigation, formatting and spelling may be poor. Specific products are often promoted to boost online sales or in-office procedures.

Drug Databases

The U.S. Food and Drug Administration (FDA) Center for Drug Evaluation and Research (CDER) website is vast. Consumer drug information is available for new drugs approved since 1998 and links to the drug's complete package insert. Drugs@FDA offers searches of official information about all brand name and generic drugs approved by the FDA, and is derived from the generic therapeutic equivalence Orange Book.

The USP DI[R] Advice for the Patient[R] is a product of the United States Pharmacopeia (USP) and used under license to Micromedex, Inc. (4) It includes in-depth patient-friendly details about several hundred of the 11,000 drugs listed in the related USP DI[R] Drug Information for the HealthCare Professional.

MedMaster[TM] is a product of the American Society of Health-System Pharmacists (ASHP). The database includes about 900 detailed monographs and listings for more than 7,000 brand name and generic medicines. (5) About 10% are dermatological (personal communication). The ASHP consumer health site is www.SafeMedication.com. Several organizations license the MedMaster database to use within their own system or purchase the software application MedTeach, a Client/Server application that allows viewing, printing, and editing.

First Data Bank (The Hearst Corporation San Bruno, California) also provides electronic drug information. Its National Drug Data File[R] Plus knowledge base combines drug information with clinical decision-support modules for every drug approved by the FDA. (6)

PDRHealth is written in lay terms (12th grade reading level) and is based on the FDA-approved drug information found in the Physicians' Desk Reference (PDR[R]). It gives consumers plain-English explanations for the safe and effective use of prescription and nonprescription drugs, herbal medicines, and nutritional supplements. (7)

Multum Information Services, Inc., a Cerner company, offers various Web Solutions, including SubscribeRx with Patient Education Leaflets, (6th grade reading level) drug and allergy interactions, an Online Medicine Cabinet and comprehensive, patient-specific drug summary called MediReview. Patient Education Leaflets flag important comments with Med-I-cons,[TM] a unique system for graphical drug alerts. (8)

Rxlist.com, owned by RxList LLC, was founded and is maintained by Neil Sandow, PharmD. It includes about 5,000 product names, including about 1,300 professional monographs and 1,500 patient-oriented monographs derived from FDA-approved labelling, as well as original pages about herbal and homeopathic medications. Rxlist also offers drug-specific discussion forums. Twelve million pages are served each month (personal communication, August 2004).

In the United Kingdom, the British National Formulary (British Medical Association and Royal Pharmaceutical Society of Great Britain) includes extensive information about drugs and preparations for the skin. Issue number 47 was published in March 2004.

In New Zealand, Medsafe includes online data sheets and, where available, consumer information sheets supplied by the manufacturer. Similar databases are available in other jurisdictions.

The National Center for Complementary and Alternative Medicine (NCCAM) does not specifically consider skin diseases. However, it includes a special complementary and alternative medicine (CAM) subset of PubMed,[R] fact sheets about CAMs, warnings, and alerts. (9)

Toxinz focuses on toxic compounds and the management of poisoned patients. Under construction to meet Australasian requirements, the database contains some 60,000 listed chemical products, pharmaceuticals, plants, and hazardous creatures. (10)

Health Portals

Recognizing that online literature searches using Medline are too complex for patients, the National Library of Medicine has created a consumer site, MEDLINEplus[R]. It includes extensive information on prescription and nonprescription drugs provided by MedMaster[TM] and Micromedex. (11)

Drugs.com[TM] provides up-to-date information on over 24,000 prescription drugs and medications available in the US. You can also search for drug interactions, identify pills, find drug images, and condition treatment guides. It sources information from Micromedex Inc., PDR[R] and Multum. (12) Drugs.com provides the Drug Search facility for mdchoice's consumer site, HealthCentral. (13)

According to Hitwise, WebMD[R] was the most popular health site in March 2004 with 10% of the market share of health and medical information sites in the US. (3) The health portal reports 20 million visitors per month. (14) WebMD has a specific section on drugs and herbs, including news from the FDA. It obtains its comprehensive drug reference from Multum and from Healthwise, Inc. Its sister site, Medscape,[R] aimed at health professionals, sources its referenced drug information from First Data Bank and from the ASHP. (15)

Yahoo![R] is the most trafficked Internet destination worldwide with an average of 2.4 billion page views per day in March 2004. (16) Micromedex provides drug information for Yahoo! Health, (17) the most popular health information site after WebMD. (3)

Harvard Medical School's InteliHealth,[R] funded by Aetna, uses the MedMaster[TM] database and links directly to www.SafeMedication.com. (18)

The Discovery Health Channel offers online health news and a drug reference center powered by Multum. Dermatologists are on the medical review panel. According to Nielsen NetRatings, About.com (a Primedia company, New York) is a top 15 Web property, used by one out of every 5 people on the Internet. (19) The About[TM] network of health sites is visited by 20 million people each month. About Dermatology provides disease information, general articles, a bulletin board forum, and online chat sessions, but its "Medications" section is small.

Trading companies (drug stores) frequently include paragraphs or pages about commonly used medications on their websites. The information is sometimes excellent, but at times may be quite misleading. Those trained in evidence-based medicine and scientific method may find extraordinary claims made by so-called "natural health" practitioners.

Information about clinical trials of new dermatological drugs can be gleaned from CenterWatch Clinical Trials Listing Service[TM] (The Thomson Corporation), ClinicalTrials.com[TM] (Pharmaceutical Research Plus, Inc.), Veritas Medicine and the National Library of Medicine (Table 2).

Personalized Advice

Jupiter Research found that only 3% of adult Internet users held online clinical consultations with their doctors in 2003. (3) It might be convenient and appropriate to provide a limited advice service to one's own patients. This may include answering queries about prescribed and over-the-counter medicines, drug interactions and side effects. Depending on the local jurisdiction, it may not be legal to provide advice or treatment to patients not personally known to the doctor.

Few web sites offer a personalized drug information service. Drug Information Technologies Inc. (Scholz Healthcare) provides a free "Drug Risk Navigator.[TM]" The patient types in the names of their drugs, selects any relevant health condition (eg, diabetes) and lists known drug allergies. The drug risk check reveals possible interactions, contraindications, precautions, important side effects, allergies, or duplicate therapies. The patient can send further questions to "DrugSafetyWorldWide." The site offers an enhanced "DRN Patient Plus" for a fee. (20)

Multum's tool (accessed at Drugs.com) is a handy way to search for and select multiple medications and check for interactions. The results include foods to avoid (eg, grapefruit juice with ciclosporin), what to monitor (eg, blood pressure, ankle swelling), how to adjust doses, and which interactions are serious.

Some health portals, individual dermatologists and pharmacy sites provide open chat sessions with an expert at prearranged times and/or bulletin board responses to dermatological queries. These often refer to specific treatments or medications.

Shopping for Skin Care Products

Although patients with skin conditions may wish to obtain prescription products over the Internet, national and state legislation requires consultation and examination. The FDA warns consumers, "getting a prescription drug by filling out a questionnaire without seeing a doctor poses serious health risks." (21)

The benefits of online drug sales include access for the disabled or geographically disadvantaged, the convenience of 24-hour shopping, a wide selection of products and privacy. Many reputable Internet pharmacies provide consumers with excellent product information, drug interaction advice, and substantial price discounts. Legitimate online pharmacies based in the US may be recognized by displaying a voluntary seal of approval by the National Association of Boards of Pharmacy (NABP) VIPPS[TM] (Verified Internet Pharmacy Practice Sites) system. (22)

Medco (Franklin Lakes, New Jersey) is one of the US's largest VIPPS-approved Internet pharmacies, handling 13.8 million new and refill prescriptions, representing nearly $2 billion in drug spending during 2003. (23)

The Internet has also created a marketplace for the sale of unapproved, illegal, or counterfeit drugs and prescription drugs sold without a valid prescription or products marketed with fraudulent health claims. One can readily obtain prescription dermatologicals from online pharmacies, which claim that board-certified physicians review the online history forms. Several prosecutions of unregistered businesses have resulted from illegal and potentially dangerous sales of prescription medicines. (22)

There are numerous online opportunities for patients to obtain non-prescription skin care products from cosmetic companies, pharmacies, and physicians' practices (Table 4). Amazon lists more than 30,000 skin care products in health and personal care sections listed by category and brand. (24) The Clinical Skin Solutions section of Drugstore.com offers thousands of products to its 5.1 million customers. Net revenue in 2003 was US $245.7 million. (25) SkinStore.com offers 1,500 skin care products to 500,000 apparently satisfied customers. (26)

Books

Despite the innumerable advantages of the Internet, people still generally prefer to read a printed book over a computer screen. Books about health remain popular and online stores can supply obscure, out-of-print or sensitive titles. In August 2004, the key phrase "dermatological drugs" listed more than 1,200 titles held by Amazon and "adverse drug reactions" resulted in 30,000 titles.

Finding Information

Most of those seeking drug information use search engines, hierarchical directories or hybrid metasearch engines. In May 2004, comScore Media Metrix qSearch[TM] service estimated that 54% of US searches were provided by Google[TM] (Google.com, AOL,[R] and the Excite[R] network), and 41% were provided by Yahoo! (Yahoo and MSN). (27) In February 2003, Google claimed to run 250 million searches every day. (28)

The website Search Engine Watch explains how they function and provides tips for effective searching. Search engines "crawl" or "spider" the web and create their listings automatically. Directories depend on humans for their listings. The description of a site depends on direct submissions (often pay-for-placement) or a review by an editor. A search looks for matches only in the descriptions submitted. (29) Metasearch engines such as Dogpile[R] combine optimized results from multiple resources. (30) Medical search pages do not appear to be better than generic systems for dermatological drug information.

Assessing Quality of Information

There are online guidelines to assessing the quality and reliability of health websites. (31) At minimum, sites should adhere to the eight ethical management principles of the Health-On-the-Net Code of Conduct and may then display a certificated seal. (32) The Internet Healthcare Coalition's code of ethics (33) and the recommendations of the American Medical Association are more extensive. (34)

Health Web Site Accreditation, achieved by about 50 websites by April 2004, is created by the American Accreditation HealthCare Commission, URAC. Sites displaying the URAC seal have been measured against 50 rigorous URAC standards for quality and accountability, based in part on a 14-point set of principles by Hi-Ethics. These relate to privacy, security, quality of information, fairness of transactions, and professional conduct. (35)

Besides offering easy to read, accurate, unbiased and comprehensive information, high quality sites should also provide:

1. Name and contact details of the organization providing the information.

2. Name, qualifications and allegiance of the author.

3. Date of latest update.

4. Site sponsors and advertisers.

5. E-mail link to web master.

Watch out for excessive claims of product efficacy, lack of discussion about side effects, risks and complications of a treatment and absence of references to source data.

For further advice about fraudulent and erroneous material on the Internet, refer to Quackwatch (36) and the US Federal Trade Commission. (37)

Table 1. Websites with Useful Dermatological Drug Information.

Name of site              Internet address

American Academy of       http://www.aad.org
Dermatology
British National          http://bnf.org
Formulary
DermNet NZ                http://www.dermnetnz.org
Discovery Health          http://health.discovery.com/centers/
Channel[R]                skincare.html
Drugs.com[TM]             http://www.drugs.com
Emedicine textbooks       http://emedicine.com
InteliHealth[R]           http://intelihealth.com
Medsafe                   http://www.medsafe.govt.nz
National Center for       http://nccam.nih.gov
Complementary and
Alternative Medicine
National Skin Centre,     http://nsc.gov.sg
Singapore's Skin Web
NLM's                     http://www.nlm.nih.gov/medlineplus
MEDLINEplus[R]
RXlist.com                http://www.rxlist.com
SkinCarePhysicians.com    http://www.skincarephysicians.com
The Skin Site[TM]         http://www.skinsite.com
Toxinz                    http://www.toxinz.com
US Food and Drug          http://www.fda.gov/cder/consumerinfo/
Administration            default.htm
WebMD[R]                  http://www.webmd.com
Yahoo![R] Health          http://health.yahoo.com/health

Table 2. Clinical Trials.

Name of site            Internet address

CenterWatch[TM]         http://www.centerwatch.com
ClinicalTrials.com[TM]  http://clinicaltrials.com
National Institutes     http://clinicaltrials.gov
of Health and
National Library of
Medicine
Veritas Medicine        http://www.veritasmedicine.com

Table 3. Links to Patient Support Organizations.

Name of site    Internet address

American        http://www.aadassociation.org/patientadvocacy.html
Academy of
Dermatology
Association
British         http://www.bad.org.uk/patients/support
Association of
Dermatology
Healthfinder    http://www.healthfinder.gov

Table 4. Online Shopping for Skin Products.

Name of site   Internet address

Amazon         http://www.amazon.com
Drugstore.com  http://www.drugstore.com
Skin Store     http://www.skinstore.com

Disclosure: The author is website manager of DermNet NZ, the website of the New Zealand Dermatological Society, which is sponsored by various pharmaceutical companies (http://www.dermnetnz.org/).

Note: Website addresses were correct in August 2004, or as otherwise indicated. The content and location may have changed. The text refers to websites that are useful to patients with skin diseases whose content is written in English.

References

1. ClickZ Stats. Active Internet Users by Country. Available at: http://www.clickz.com/stats/big_picture/geographics/article.php/3386051. Accessed November 2004.

2. Health on the Net. Available at: http://www.hon.net.ch/Accessed November 2004.

3. ClickZ Stats. Net Attracts Health-Seeking Surfers. Available at: http://www.clickz.com/stats/markets/healthcare/article.php/3339561. Accessed November 2004.

4. Thomson Micromedex. USP DI[R] Volume II: Advice for the Patient[R]. Available at:http://www.micromedex.com/products/uspdi/v2/.Accessed August 2004.

5. SafeMedication.com. About MedMaster[TM]. Available at: http://www.safemedication.com/About/medMaster.cfm. Accessed August 2004.

6. FirstDataBank. Knowledge Bases. Available at: http://www.firstdatabank.com/knowledge_bases/nddf_plus/Accessed November 2004.

7. PDRHealth. Drug Information. Available at: http://www.pdrhealth.com/drug_info/index.html. Accessed August 2004.

8. Multum. WebSolutions. Available at: http://www.multum.com/WebSol.htm. Accessed August 2004.

9. The National Center for Complementary and Alternative Medicine. Home page. At http://nccam.nih.gov/Accessed August 2004.

10. Toxinz. Home page. Available at: http://www.toxinz.com/. Accessed August 2004.

11. MedlinePlus. Drug Information. Available at: http://www.nlm.nih.gov/medlineplus/druginformation.html. Accessed August 2004.

12. Drugs.com. About Drugs.com. Available at: http://www.drugs.com/xq/cfm/pageID_1235/qx/index.htm. Accessed November 2004.

13. HealthCentral.com. Available at:http://www.healthcentral.com/. Accessed November 2004.

14. WebMD. About WebMD: Our products and services. Available at: http://www.webmd.com/corporate/index.html. Accessed November 2004.

15. Medscape. Available at: http://www.medscape.com/. Accessed November 2004.

16. Yahoo! Media Relations. Available at: http://docs.yahoo.com/info/pr/faq.html. Accessed August 2004.

17. Yahoo!Health Drug Index. Available at: http://health.yahoo.com/health/drug/. Accessed August 2004.

18. InteliHealth. Available at: http://www.intelihealth.com/. Accessed November 2004.

19. About com. Our story. Available at: http://ourstory.about.com/. Accessed August 2004.

20. DIT Drug Information Technologies, Inc. DIT Drug Risk Navigator Patient Edition. Available at: http://www.dispace.com/ditonline/start_neu.html. Accessed November 2004.

21. US Food and Drug Administration. Buying medicines and medical products online. Available at: http://www.fda.gov/oc/buyonline/default.htm. Accessed August 2004.

22. US Food and Drug Administration. Hearing on Internet Drug Sales, March 18, 2004. Available at: http://www.fda.gov/ola/2004/internetdrugs0318.html. Accessed August 2004.

23. Medco. About us. Available at: http://www.medcohealth.com/medco/consumer/aboutus/main.jsp. Accessed August 2004.

24. Amazon.com. Personal & Healthcare Store. Available at: http://www.amazon.com/. Accessed August 2004.

25. Drugstore.com. Facts sheet. Available at: http://www.shareholder.com/drugstore/factsheet.cfm. Accessed August 2004.

26. SkinStore.com. About Us. Available at: http://www.skinstore.com/aboutUs/aboutUs.asp. Accessed August 2004.

27. Search Engine Watch. comScore Media Metrix Search Engine Ratings. Available at: http://searchenginewatch.com/reports/article.php/2156431. Accessed August 2004.

28. Search Engine Watch. Searches per Day. Available at: http://searchenginewatch.com/reports/article.php/2156461. Accessed August 2004.

29. Search Engine Watch. Major Search Engines and Directories. Available at: http://searchenginewatch.com/links/article.php/2156221. Accessed August 2004.

30. Search Engine Watch. Metacrawlers and Metasearch Engines. At http://searchenginewatch.com/links/article.php/2156241. Accessed August 2004.

31. Purcell G, Wilson P. Evaluating the quality of health information on the Internet. BMJ 324;557-558, 2002.

32. Health on the Net Code of Conduct for medical and health Web sites. Principles. Available at: http://www.hon.ch/HONcode/Conduct.html. Accessed August 2004.

33. Internet Healthcare Coalition. eHealth code of Ethics. Available at: http://ihealthcoalition.org/ethics/ehcode.html. Accessed November 2004.

34. American Medical Association. Guidelines for medical and health information sites on the Internet, May 2001. Available at: http://www.ama-assn.org/ama/pub/category/1905.html. Accessed August 2004.

35. URAC Health Web Site Accreditation. Quality Online Communities you can trust. Available at: http://webapps.urac.org/websiteaccreditation/portal/consumer/Review.asp. Accessed August 2004.

36. Barrett S. Quackwatch. Available at: http://www.quackwatch.com. Accessed August 2004.

37. U.S. Federal Trade Commission. Operation Cure All. Available at: http://www.ftc.gov/bcp/conline/edcams/cureall/index.html. Accessed November 2004.

Amanda Oakley FRACP

Clinical Associate Professor, Waikato Clinical School, Clinical Director, Department of Dermatology, Health Waikato, Hamilton, New Zealand

COPYRIGHT 2005 Journal of Drugs in Dermatology
COPYRIGHT 2005 Gale Group