Does the internet really ‘empower’ patients?

Picture credit: Namakkalshowroom (Own work), via Wikimedia Commons

There is a prevailing view that the internet helps to reduce information asymmetry present in healthcare markets when patients search for medical information online. But what about when it is misused by commercially motivated healthcare organisations? Here KCL graduate Kaidi Ru uses the death of ‘Wei Zexi’ in China to argue that new forms of online advertisements radically alter healthcare decision-making processes, to the tragic detriment of health.

Online advertising and Wei Zexi

Wei Zexi was a 22-year-old who suffered from a rare form of cancer and died after receiving ineffective treatment at the Second Hospital of the Beijing Armed Police Corps. Before his death, Wei reflected about his experiences in an online post. He explained that he had searched for information about his illness on Baidu.com and found the top link was an advertisement for ‘highly effective DC-CIK immunotherapy’ at the Second Hospital. The treatment was claimed by the hospital to have a success rate of more than 80%. Rather than seeking chemotherapy, and out of trust for Baidu’s reputation and the Second Hospital’s status as a Class III Grade-A military hospital, Wei’s parents brought him there for the immunotherapy treatment.

The treatment was unsuccessful and, having delayed the best timing for more appropriate treatment, Wei passed away on 12th April 2016. His death sparked a wave of debate about the role of ICTs in healthcare in China. Subsequent press reports showed this treatment – advertised as a paid-placement on Baidu – had never been approved by the Ministry of Health for commercial clinical use in China.

On 3rd May 2016, amidst growing online criticism, the People’s Daily newspaper published a commentary entitled ‘Wei Zexi’s death questions business ethics and responsibility’ in which it criticised Baidu’s paid-placement scheme and urged for further investigations. Government investigations showed Wei was placed in private hands – the biomedical centre only nominally belonged to the Second Hospital and was in fact leased to two private for-profit Putian group entities: Kang Xin Hospital Investment Company and Shanghai Claison Biotech Company. Baidu and the Putian network of hospitals had an extensive commercial partnership until news of the ‘Wei Zexi Incident’ broke, and Baidu’s earnings from Putian paid-placement services in 2013 contributed nearly half of its total 26 billion yuan ($3.78 billion) advertising income.

Risks for patients

Health policy-making too often assumes that providing greater information to prospective healthcare users will reduce information asymmetries and empower users. Yet substantial resources are required to understand and assess the range of available information and choices. As the ‘Wei Zexi Incident’ clearly illustrates, inexperience with companies’ online paid-placement schemes mean that information-seeking can in fact be riskier for individual patients. And individuals’ lack of recognition of such schemes not only lead to financial losses but also cost lives.

These risks are particularly acute in settings where providers are commercially motivated and poorly regulated. Interviews with doctors from Putian hospitals revealed that they received intensive training in persuasion skills to make patients believe their treatments would be effective. Commissions and bonuses are used to incentivise provision of unnecessary or even ineffective treatments. When the hospitals are involved in medical disputes they often opt to pay settlements to the families of patients, while maintaining high spending on advertising to restore damaged ‘brand images’ and to attract new patients.

Regulation of paid-placements

For a long time, paid-placement has had ambiguous classifications in China. Internet companies present such schemes as advertisements with commercial clients, but once disputes occur, they argue paid-placements are information services and therefore not subject to advertising legislation. Commercial promotion is disguised as scientific articles describing an illness, but with rhetorical questions that introduce the hospital’s name and method of treatment.

Before Wei’s case, there was no specific law addressing the issue of paid-placement advertising in China. The amended Advertisement Law that had come into effect on 1st September 2015 did establish some ground regarding online advertising by prohibiting pop-up windows and banners. But did not clarify the necessary qualifications needed for issuing online advertisements. In this sense, Baidu can only be thought of playing in the grey zone with its paid-placement scheme.

The ‘Wei Zexi Incident’ points to weaknesses in the governance of healthcare and the internet. Government regulation must adapt to the challenges when healthcare providers move into previously unknown territories such as cyberspace. But companies like Baidu are responsible for the material they publish and prioritise online. Without closer scrutiny of online healthcare markets, we are likely to see further tragic cases like Wei Zexi.

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