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As e-commerce and online pharmacies (OPs) arose, the potential impact of the Internet on the world of health shifted from merely the spread of information to a real opportunity to acquire health services directly. Aim of the study was to investigate the offer of prescription drugs in OPs, analysing their characteristics, using the content analysis method. The research performed using the Google search engine led to an analysis of 118 online pharmacies. Only 51 (43.2%) of them stated their precise location. Ninety-six (81.4%) online pharmacies did not require a medical prescription from the customer's physician. Online pharmacies rise complex issues in terms of patient-doctor relationship, consumer empowerment, drug quality, regulation and public health implications.

Although scientific evidence concerning harms and benefits of direct-to-consumer advertising (DTCA) is constantly growing, there is a paucity of published research focusing on gaining a better understanding of the perceptions and experiences of involved parties. This gap in the literature becomes even more salient when it comes to the indirect target audiences of DTCA, such as healthcare providers. This study explores American physician perceptions of prescription drug advertising, while elucidating the perceived impact of DTCA in a US context. Our results suggest that 15 years after the introduction of DTCA, physician concerns about its impact on the doctor–patient relationship persist. Negative effects of DTCA include patient acquiring a false sense of autonomy; requests for unnecessary or more expensive drugs; exaggerated perception of advertised drugs’ side effects; as well as additional workload and time commitment. Nevertheless, DTCA is also viewed as a stimulus for ‘opening communication opportunities’ with the patient. Results of this study can be used to inform the dialogue not only in the United States, but also in other countries where efforts are being made to reduce restrictions on DTCA.

Introduction A chemical factory located in Brescia, an industrialized town in North Italy, produced polychlorinated biphenyls since the 1930s to the 1980s, determining a relevant pollution of soil,...

Introduction: Polychlorinated biphenyls (PCBs) are persistent pollutants classified among endocrine disruptors and human carcinogens. In an urban area in Northern Italy (Brescia), a chemical factory producing PCBs from 1938 to 1984 caused soil and food pollution. Since the discovering of the environmental pollution in the area in 2001, various public health interventions have been implemented to avoid human contamination. Methods: Two independent surveys were carried out in 2003 and 2013 using the same study design and methods. A random sample of the adult general population living in four areas of the town with different soil contamination level was enrolled in both surveys. Investigation included serum levels of 24 PCB congeners and of other common clinical-chemical parameters and questions about residential and occupational history as well as current and past diet and consumption of locally produced food. 537 subjects were tested in the 2003 and 488 in the 2013 survey. Results: Total PCB serum levels showed a strong correlation with age (Spearman r = 0.71 in 2003 and r = 0.80 in 2013), but not with gender. Consumers of food produced in the most polluted area had higher total PCB serum levels (median 15.6 and 4.7 ng/ml in 2003 and 2013, respectively) than non-consumers (4.1 and 2.3 ng/ml) and consumers of food produced in non-polluted areas (6.5 and 1.9 ng/ml), with increasing trend of PCB serum levels with cumulative local food intake. PCB serum levels from 2003 to 2013 survey declined by around half in all age groups, especially among the youngest people. The total PCB reduction was found to be due to a combination of a birth cohort effect (−41% every 10 years) and survey period effect (−18% in 2013 versus 2003), with medium chlorinated CB congeners showing the most relevant reduction (−30%) between the two surveys. High chlorinated CBs were more strongly associated with birth cohort (−46% every 10 years): in the 2013 survey they represented 58% of total PCBs in 60–79 years old while they were 37% among the under 40s with a median value 20 times higher in the oldest than in the youngest (3.1 versus 0.16 ng/ml). Conclusions: PCBs serum levels declined from the 2003 to 2013 survey though they are still high in the elderly mainly because of past intake of locally produced contaminated food. Present findings suggest that PCBs food chain contamination and human absorption have been interrupted successfully in the area since discovery of the pollution in 2001. Keywords: Polychlorinated biphenyls, PCB, Environmental pollution, Food contamination, Human exposure

SUMMARY Purpose Online pharmacies (OPs) are recognized as a potential threat to public health. The growth of an unregulated global drugs market risks increasing the spread of counterfeit medicines which are often delivered to consumers without a medical prescription. The aim of the study was to assess the strategies of argumentation that OPs adopt in their marketing. Methods A sample of 175 OPs was analyzed using the content-analysis method, and evaluated by relying on the Elaboration Likelihood Model (ELM) of persuasion. Results Almost 80% of the sample of OPs did not ask for a medical prescription by the consumer’s physician. The selling arguments used included privacy policy, economic, quality, and service issues. About one-third of the OPs did not declare any side-effects regarding the drugs offered. Conclusion Our results show that OPs advertise their products in an argumentative fashion that enhances consumers’ peripheral reflection: by analogically playing with the selling of other commodities, they magnify aspects of the online trade that consumers might find convenient, but overshadow the nature and risks of the actual products they sell. Copyright # 2010 John Wiley & Sons, Ltd.

Using the field of direct-to-consumer genetic tests as a case in point, this paper argues against the misuse of the term empowerment, and calls for a regulation of its usage. The misleading assumption under certain current usages of the concept of empowerment is that it is enhanced by the provision of health information. While the information-empowerment correlation is misleading, if not wrong, the feeling of being empowered imposes an increasing burden of critical thinking on those people (patients and consumers) who have to evaluate that information and act for the benefit of their health.

Background The increasing phenomenon of online pharmacies has potential for serious public health problems. This study aimed to evaluate the possibility of accessing a prescription drug in the absence of a prescription for an Italian purchaser. Methods Fluoxetine pills were ordered from several online pharmacies. The study included website analysis, and the quality of the received product including packaging, chemical and microbiological analyses. Results Orders could be placed correctly on 61 of the 98 selected websites, and a sales transaction was concluded successfully on 17 websites. Thirteen drug samples were eventually received. In one case it was necessary to fill in a questionnaire before ordering the drugs. All websites displayed aggressive marketing strategies. There was wide variation in terms of domain registration, company base (when declared) and manufacturer's location (mostly India). All pills were delivered in sealed blister packs showing the lot number and manufacturer's details. A leaflet was enclosed in one case only. In three cases we received more pills than ordered, and in one case Viagra pills as a free gift. Pharmacopoeia microbiological requirements were satisfied. Chemical analysis revealed that the active principle was always present, although many samples did not meet the Pharmacopoeia “other impurities” or “total impurities” criteria. Heavy metals and solvents regulated by the Pharmacopoeia did not exceed the set limits; some of the non-regulated ones were also assessed, in some cases with a positive result (e.g. styrene). Conclusion About 20% of purchase attempts resulted in delivery of the drugs, even in the absence of a medical prescription. Traceability was poor and drug quality was generally worse compared to conventional pharmacy-purchased products. Based on all these broad-spectrum results, user safety appears not to be globally guaranteed.

Internet and e-commerce have profoundly changed society, the economy, and the world of health care. The web offers opportunities to improve health, but it may also represent a big health hazard since it is a basically unregulated market with very low consumer protection. In this paper we analyze marketing and pricing strategies of online pharmacies (OPs). Our analysis shows that OPs use strategies that would be more suitable for a commodity market than for drugs. These strategies differentiate according to variety (brand or generic), quality, quantity, and target group. OPs are well aware that the vacuum in the legislation allows them to reach a target of consumers that pharmacies cannot normally reach, such as those who would like to use the drug without consulting a physician (or, even worse, against the physician's advice). In this case, they usually charge a higher price, reassure the users by minimizing on the side effects, and induce them to bulk purchase through sensible price discounts. This analysis suggests that the selling of drugs via the Internet can turn into a “public health risk”, as has been pointed out by the US Food and Drug Administration.

In the field of health communication, a particularly critical issue is communication to the public of environmental risks, especially on topics for which there is still a high degree of scientific uncertainty regarding risk estimates. One such topic is undoubtedly the impact of waste on people's health. The aim of this study was to evaluate the presence and characteristics of Italian websites dealing with the topic of waste and health. The keywords 'waste' and 'health' were entered in 2010 in the three most commonly used search engines, and the first five pages were analysed. The selected websites were coded according to the content analysis method. For websites of interest we evaluated the 'page rank'. Out of the 150 occurrences analysed, the number of websites found to deal with this subject was only 19, four of which were of an institutional nature. The majority of websites gave a message of increased health risk associated with the three kinds of waste disposal tackled. As regards visibility, only one of the four institutional websites maintained its position on the first page of the three search engines. We found that institutional health websites have low visibility, despite extensive media coverage of waste and health issues in Italy as a result of the Naples case, which was debated globally. This indicates that public health institutions' web strategies are basically unable to meet people's health information requirements, which could strengthen rival health information providers.

Background/aims The aims were to estimate among patients with hepatitis C virus (HCV) infection the prevalence of alcohol and coffee intake and smoking habit, the reliability of these self-reported data and the possible change of patients’ habit after their first contact with a Viral Hepatitis Service. Methods 229 patients were initially interviewed personally at the Viral Hepatitis Service and after 6 months they were re-interviewed by phone in regard to their alcohol, coffee drinking and smoking habits. Results Alcohol drinkers were 55.5% of males and 35.3% of females. Most subjects drank coffee daily, both men (90.0%) and women (84.9%). The proportion of current smokers was higher in males (43.6%) than females (26.9%). We found a fair to good reliability of self-reported data regarding patients’ habits, alcohol and coffee intake, and number of cigarettes smoked daily. We observed a statistically significant decrease in alcohol and coffee intake and cigarettes smoked between baseline and follow-up interviews. Conclusion We found a fairly high proportion of HCV-infected patients who regularly drink alcohol and coffee beverages and smoke cigarettes, especially among males. The reliability of self-reported data on these habits seems satisfactory. More decisive action to modify these habits, especially alcohol intake, is required in these patients.

Internet and e-commerce have deeply changed society, the economy, and the world of health care. The web offers opportunities to improve health, but it may also represent a big health hazard given its nature of a basically unregulated market with very low consumer protection. In this paper we analyse marketing and pricing strategies of online pharmacies (OP). Our analysis shows that OPs uses strategies that would be more suitable for a commodity market than for drugs. These strategies differentiate for variety (brand or generic), quality, quantity, and by target group. OPs are well aware that the vacuum in the legislation allows them to reach a target of consumers that normally pharmacies cannot reach, as those who would like to use the drug without consulting a physician (or, even worse, against physicians advice). In this case, they usually charge a higher price, reassure the users by minimizing on the side effects, and induce them to bulk purchase through sensible price discounts. This analysis suggests that the selling of drugs via the internet can turn into a "public health risk", as it has been pointed out by the U.S. Food and Drug Administration.