The integrity of the "Health Internet" used by millions of people is threatened by commercial interests, a coalition of health policy experts argues.
The Internet Corporation for Assigned Names and Numbers (ICANN) is the steward of internet names such as the traditional top-level domains including .com and .org. ICANN plans to expand the domains to .health, .doctor and .hospital.
Groups such as the World Health Organization, Save the Children, the European Commission and ICANN’s own ombudsperson have objected to the plans. In Friday’s issue of the Globalization and Health, a group led by Tim Mackey of the Global Health Policy Institute of doctors calls for moratorium on the use of .health.
"Do we want information about health, and expressly labelled as being about health, to be governed by the law of the jungle?" asked Amir Attaran, a co-author of the commentary and a professor in the faculties of law and medicine at the University of Ottawa.
Attaran pointed to health fraud that currently exists on the internet, such as online pharmacies that sell unapproved medicines.
"It is self-evidently problematic to propound online scientifically unfounded information, or biased information, in an era where consumers and patients are increasingly using the internet as their primary source for health information," the authors said.
But ICANN has disregarded cautions in favour of applicants such as large corporations, the team said, pointing to its rejection of domains such as .wtf and .sucks that could be bought by disgruntled customers.
The future of the what the World Health Organization calls the "Health Internet" — the range of benefits of risks of the internet to consumers, health professionals and public health systems — could include smoking.health, owned by a tobacco company or cancer.doctor, which could potentially be purchased by unscrupulous vendors catering to vulnerable patients.
ICANN charges between $25,000 US and $185,000 US for an initial application for a top-level domain, not including annual fees. The American Heart Association withdrew its application for a health-related top level domain, the authors say.
"We're simply publishing the paper to implore them [ICANN] at the last minute to do the right thing. If they don't want to do the right thing, people will probably be hurt, people will probably be killed and in a few years we get to tell you, 'told you so,'" Attaran said in an interview.
They suggested an expert working group could discuss governance of the top-level domains to ensure access to trusted health information and to prevent online fraud and abuse.
ICANN has argued that there is no way to determine what constitutes quality health information and that safeguards already exist.
Some domains, such as the aviation community's .aero, require third-party accreditation to restrict their use.
But if ICANN persists in expanding .health without meaningful safeguards, the authors said the action would show a lack of due diligence that the legal system might one day try to penalize.
Two of the authors received travel funding to attend a WHO meeting on maintaining trust on the health internet.