Many Germans no longer take the standard piece of advice on medicines: "Ask your doctor or pharmacist about risks and side effects."

When they have health problems or questions about medical treatment, they consult internet portals like Netdoktor.de and Lifeline.de. Not all online medical practices are advisable, however.

"The choice of medical portals on the web is getting longer and more confusing," notes Dagmar Villarroel Gonzales of the Berlin-based Agency for Quality in Medicine (Aqumed), a non-profit organization owned by the German Medical Association (BAEK) and National Association of Statutory Health Insurance Physicians (KBV).

Acqumed has compiled a list of more than 1,000 vetted medical portals, which can be accessed at Patienten-information.de. "The first thing you've always got to do is ask who's behind such health guides," Villarroel Gonzales said, pointing out that many articles proved to be advertisements.

False reports
Internet surfers must also be careful not to fall for false reports. Seals of approval can now help them orient themselves: Switzerland's Health on the Net Foundation (HON) and Germany's Action Forum Health Information System (AFGIS) distinguish up-to-date and independent medical sites. Patients should be especially wary of "miracle healers" on the web.

"It's necessary to warn strongly against remote diagnoses - they can be life-threatening," said Klaus Greppmaier of the Berlin-based NAV-Virchow-Bund, the national association of doctors in private practice.
"Doctors in Germany aren't allowed to give personal advice via the internet anyway. Their professional code bans it," Greppmaier says.

Health portals are therefore restricted to general explanations of illnesses and treatments. Site operators carry no responsibility for consequences of their advice because officially they make no diagnoses. But Villarroel Gonzales criticised what she sees as their sometimes too vaguely-worded distinction between specialized information and personal advice.

"Some of them only point to the distinction in the small print," she said.

The other side of the story
Site operators take a different view. "We don't seek to replace treatment by a doctor, but to make it more understandable to the patient," remarked Christoph Hausel of Netdoktor.de. "Patients often find prescriptions incomprehensible, and a lot of medical jargon is used in doctors' offices." Hausel's site has a glossary explaining medical terms and abbreviations.

"We merely act as guides by directing patients to the right specialist, saving them a visit to the family doctor," said Ralf Fischbach of Qualimedic.de. About 80 medical specialists answer patients' questions on his site.

"Another advantage of the internet is that people can remain anonymous," Fischbach said, adding that patients could chat with fellow sufferers in "Web waiting rooms."

"This exchange is very important to many patients," Hausel said. He noted that patients' reports of their experiences were very popular as well. "There's no patent remedy for migraines, for example, so tips from others on how best to deal with them are often helpful," he remarked.

Web portals are hardly going to make local doctors superfluous anytime soon, though. "We see that patients today are better informed than in the past, but the need for medical advice has become even greater as as result," Greppmaier said. DPA