There's a New .Health Domain and It Could Save You From Fake Medicine

Looking for health information online usually feels like casting your line in a swamp of "alternative" treatments and snake oil. But the folks behind a new domain—.health—want to help people identify legitimate sources of medical information.

The domain head honcho—the Internet Corporation for Assigned Names and Numbers (ICANN) —gave the responsibility for new .health websites to a Miami-based company, dotHealth, which will oversee who gets to purchase the shiny new suffix. This week, dotHealth CEO Jose Rasco announced that they will begin selling registrations to trademarked health companies in May, and open it to the public in December.

The goal is to have .health addresses become an identifier for qualified medical companies and websites providing important, reliable information. "With more information online, it has become more difficult to distinguish the credible information, particularly when it comes to health," Rasco said in an email interview. "The .health TLD will provide a home for health information online that is focused, credible and meaningful."

According to Rasco, the company will take specific steps to ensure that those who get .health addresses will be dependable. An advisory board will review all applicants, and fake pharmacies, for example, will not be allowed to purchase the new domain. A security protocol administered by Neustar, the largest provider of core registry and digital naming services, will also help deter misuse.

Some experts worry that the .health approval process won't be stringent enough to prevent internet users from being sold fake cures. Consumers have come to recognize that certain domain extensions, like .gov or .edu, lead to bona fide websites, but there's no clear indication that .health websites will be audited the same way.

"I don't think this will improve the quality of health information online. And I don't think it will be a service to consumers unless additional safeguards are put in place," said Timothy Mackey, director of the Global Health Policy Institute at the University of California, San Diego School of Medicine.

"If you're relying on doctor Google to diagnose your disease — which a lot of people do — or if you're relying on it to self-determine what your treatment options are, or if you're just worried about your kid and it's 5 a.m. and their leg is hurting or something like that — which I'm guilty of myself — then you really should be looking at reputable websites that are associated with evidence-based information, sites like Mayo Clinic, or PubMed."

Mackey argued that dotHealth's evaluation process isn't transparent and that the company hasn't responded to public health officials' concerns. "When you talk about .health sites, ideally they would have evidence-based information that is non-biased, that is objective and has been vetted and verified by a third party or perhaps by people that have a public health background," he said. Otherwise, websites could provide inaccurate information about vaccines, for example. Or anyone with the highest bid could easily get a coveted address like diet.health.

Moreover, if ICANN decides to release a slew of other health-related domains — like .med, .doctor, or .clinic — as it suggested in 2011, people may have the same difficulty in differentiating among all the options that they face now.

Some groups of domain owners have started collaborating in an effort to set standards for verifying which websites are allowed to register for which addresses. But according to Mackey, if internet users really want good health information, they need to look to academic institutions and be more critical of commercial websites for now.

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How iPhone Health Tracking Data Can Help Us Understand Asthma

Health data collected entirely from smartphones could help researchers study an unprecedented amount of evidence-based information about the nature of chronic diseases. And a new study of asthma patients shows that the data isn't just scalable, it's pretty reliable too.

Traditionally, finding and recruiting enough people to participate in clinical studies has been a challenge for medical researchers. But by using the Apple ResearchKit, launched in 2015, scientists at the Icahn School of Medicine at Mount Sinai in New York were able to develop an app for asthma that overcame those barriers. It allowed researchers to gain easier access to patients, without regard to their location.

The Asthma Health app measured patients' symptoms, triggers and medication adherence accurately. It also collected other useful data such as geolocation and air quality, helping researchers to correlate daily asthma symptoms to environmental factors. For example, the scientists were able to relate wildfires in Washington state to increased symptoms in some participants. Other triggers such as pollen and heat were also corroborated as expected.

The results rivaled the size and quality of existing asthma studies, such as the National Health Interview Survey conducted by the CDC, according to Pei Wang, a genomics professor at Mt. Sinai who co-authored the study.

Nearly 50,000 people downloaded the app, though researchers capped the study at 7,593 people who completed the consent process to enroll in the study. Once participants granted permission, the Asthma Health app could monitor their asthma inhaler use and connect to their electronic health records.

"We now have the ability to capture rich research data from thousands of individuals to better characterize 'real world' patterns of disease, wellness, and behavior," Eric Schadt, senior author on the paper, said in a statement. "This approach provides a more comprehensive and accurate view of our patients that was not feasible in the past."

However, the smartphone-based study has its limitations. The researchers admitted that people who voluntarily downloaded the app may not represent the those who suffer from asthma in the general population. There might be a bias toward those who have more severe forms of asthma, as well as higher-earning, college-educated iPhone users. For example, 87 percent of people earning more than $75,000 own smartphones compared to just 52 percent of people earning less than $30,000, according to a Pew Research survey. 

And though the researchers assured participants that their personal health information was encrypted and compliant with the Health Insurance Portability and Accountability Act (HIPAA), data privacy is still a concern.

Despite these weaknesses, the findings point to a positive direction in thinking about how to use smartphone-generated health data, especially at a time when there are an estimated 3 billion users around the world.

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