GUIDELINES FOR MEDICAL AND HEALTH INFORMATION
SITES ON THE INTERNET
Principles governing AMA Web sites
Margaret A. Winker, MD; Annette Flanagin, RN, MA; Bonnie
Chi-Lum, MD, MPH; John White, MS; Karen Andrews; Robert L. Kennett;
Catherine D. DeAngelis, MD, MPH; Robert A. Musacchio, PhD
The Internet has permitted physicians,
other health care professionals, patients, and other consumers
to quickly access medical information in unprecedented volume.
Such access has the potential to speed the transformation of
the patient-physician relationship from that of physician authority
ministering advice and treatment (with sometimes questionable
patient understanding and adherence to recommendations) to that
of shared decision making between patient and physician. However,
several substantial barriers remain before this relationship
can be realized. These barriers include equitable access to
information, imbalance between patient health literacy and the
information provided, extreme variability in the quality of
the content, potential for commercial interests to influence
content, and uncertain preservation of personal privacy.1-4
Web users have been warned regarding the incomplete, misleading,
or inaccurate medical information available on the Web.3 For
those seeking easy ways to identify high-quality, reliable information,
some Web sites and organizations have provided rating systems
to evaluate quality of information on the Internet. However,
these systems often do not provide the criteria used to assess
quality, nor do they provide the reliability and validity of
their measures.2,4,5 Ultimately, assessing the quality of content
depends on the same factors that readers of print publications
depend on: authorship of the content, attribution to the sources
of content, disclosure of funding and competing interests, and
timeliness of the information presented.3
Among Internet users who seek medical information, personal
privacy was ranked as their most important concern.6 A recent
study found that while many Internet health information sites
provide privacy policies, most do not follow them.7 More than
nearly any other type of information provided via the Web, medical
Web sites must adhere to strict personal privacy codes to prevent
individuals' personal medical information, including patterns
of use and interests, from involuntarily entering the hands
of marketers, employers, and insurers.
Information from the American Medical Association (AMA), including
the tables of contents and abstracts of JAMA and the Archives Journals, has been available on the Web since 1995. Physician
Select, a database of physicians that is intended for the public
and is searchable by name, specialty, and location, has been
online since July 1996. Health Insight, a health information
site for consumers, was launched in spring 1997. JAMA and the
Archives Journals have been available in full text and fully
searchable online since September 30, 1999.
The AMA has developed and followed a number of guidelines to
govern aspects of its Web offerings. For example, in 1995, the
Principles Governing Advertising in Publications of the American
Medical Associations were revised from guidelines that addressed
only print publications to guidelines addressing advertising
on the Web sites of JAMA and the Archives Journals.
In 1997, an editorial in JAMA proposed a set of quality
standards for medical information on the Internet.3 These standards
include proper identification of authors and contributors; attribution
for all sources of information; disclosures of site ownership,
financing, advertising, and conflicts of interest; and indication
of the dates content is posted and updated. In October 1999,
the AMA Board of Trustees approved Web Site Linking Guidelines.
Now, in addition to the AMA Publications site and the AMA Web
site, the AMA and 6 other founding societies are preparing to
launch Medem, a health information Web site for the public.
To provide guidance for all these sites, the Guidelines for
the AMA Web Sites, provided herein (see below), address
the creation and updating of content, acquisition and posting
of advertising, the preservation of privacy and confidentiality,
and the provision of reliable and efficient e-commerce.
The development of these guidelines began in 1999. An AMA staff
committee, composed of the listed authors, was organized to
review the existing individual guidelines and draft a single
document that would provide principles to govern the presentation
and functionality of the 4 major areas for which quality standards
were needed: content, advertising and sponsorship, privacy and
confidentiality, and e-commerce. Initial drafts were reviewed
by committee members and consensus was reached on the content
of each of the 4 principles. The document was then reviewed
internally and externally by experts in ethics, publishing,
government regulations, law, and medical informatics and by
the AMA Online Oversight Panel. After subsequent revision, the
document was reviewed by the Executive Committee of the AMA
Board of Trustees and was approved on February 28, 2000.
The dissemination of medical and health information via the
AMA Web sites has been evolving since 1995. During the last
5 years, the AMA has had substantial experience providing online
content, some experience with online advertising and sponsorship,
and limited experience with e-commerce. The Guidelines for AMA
Web Sites were created to facilitate the maturation and implementation
of these and other Web-based functions, while simultaneously
assuring site visitors' rights to privacy and confidentiality.
Many of the principles outlined in these guidelines have served
the AMA Web sites during their 5-year evolution. However, the
guidelines will be fully operational on the AMA Web sites in
conjunction with the implementation of registration and access
control in the near future. The primary goal in creating these
guidelines was to guide the development and maintenance of the
AMA Web sites. However, these guidelines may be helpful to others
providing medical information on the Web, as well as to viewers
who want to know what to look for as they search for reliable
high-quality medical information.
These guidelines are not static; the constant evolution of the
Web ensures that guidelines will need ongoing reevaluation and
frequent revision. We encourage readers, viewers, others interested
in the provision of online medical information, and policymakers
to review and comment on these guidelines. Future revisions
will consider these comments while retaining the guidelines'
fundamental principles: authorship, attribution, and disclosure
must always be clearly provided; editorial content must be current
and the way in which quality is ensured explicitly stated; advertising
and commercial sponsorship must not influence any editorial
content and advertising must be easily discernible from editorial
content; privacy and confidentiality policies must be explicit
and adhered to, ensuring that individuals' rights to privacy
and confidentiality are preserved; and e-commerce must function
efficiently and securely. Adherence to these fundamental principles
will facilitate acquisition and application of medical information
by patients, the public, physicians, and other health care professionals.
The following guidelines apply to all American Medical Association
(AMA) Web sites, including any Web sites with which the AMA's
name is associated in any way other than a simple link to any
of the AMA Web sites. These guidelines are the AMA's policy
for its Web sites but also are intended to provide guidance
for creators of Web sites that provide medical and health information
for professionals and consumers. These guidelines are established
with the understanding that the World Wide Web is a constantly
evolving technology, and the guidelines must be reviewed and
revised frequently to ensure that they reflect the current state
of technology and practice on the Web.
A standing committee composed of AMA staff members from the
Scientific Publications and Multimedia, Publishing and Business
Development, Ethical Standards, and Internet and Database Services
areas will review the guidelines regularly and revise as necessary.
The committee will seek review and comment from an advisory
panel of individuals outside the AMA with expertise in Web-based
content, advertising, privacy and confidentiality, and e-commerce.
The AMA is committed to providing medical and health information
of high quality via its Web sites. Visitors to AMA Web sites
will be given information, navigational direction, and tools
needed to judge the quality, reliability, objectivity, sources,
and funding of content and to make effective use of content.
Definition of Content
Content is defined as all material (including text, graphics,
tables, equations, audio, and video) and menu/directional icons,
bars, indicators, listings, and indexes. These principles also
address functions that support content (eg, links, navigation,
searches, calculations).
Site Ownership
Web site ownership, including affiliations, strategic alliances,
and significant investors, should be clearly indicated on the
home screen or directly accessible from a link on the home screen.
Copyright ownership of specific content should be clearly indicated
on screen and on items printed from the site.
Site Viewing
The site should provide information about the platform(s) and
browser(s) that permit optimal viewing in a location that is
easy to find.
Viewer Access, Payment, and Privacy
Information about restrictions on access to content, required
registration, and password protection (if applicable) should
be provided and easy to find.
Information about payment (ie, subscriptions, document delivery,
pay per view, etc) should be provided and easy to find. See
"Principles for E-commerce" herein.
Information about privacy should be provided and easy to find.
See "Principles for Privacy and Confidentiality" herein.
Funding And Sponsorship
Funding or other sponsorship for any specific content should
be clearly indicated and should comply with the "Principles
for Advertising and Sponsorship" herein.
Content should be easily distinguished from advertising as described
in "Principles for Advertising and Sponsorship."
Quality of Editorial Content
Guidelines for editorial content review, posting dates, and
sources were developed based on experience with the AMA Scientific
Publications' sites. All scientific publications and consumer
site information adhere to these guidelines. As of publication
of these guidelines, content posted on the AMA corporate site
will adhere to these guidelines as well.
Review
Content should be reviewed for quality (including originality,
accuracy, and reliability) before posting. Clinical editorial
content should be reviewed by content experts not involved in
creation of the content, and the content should be revised appropriately
in response to such review. The method of review will be determined
by individual sites. (For example, Scientific Publications sites
include peer review. Other sites rely on review by editorial
boards.)
The language complexity of the content should be appropriate
for the site's audience. Content should be reviewed for grammar,
spelling, and composition before posting.
A description of the editorial process and method of content
review should be posted on the site.
A list of staff members and other individuals (eg, editorial
board) responsible for content quality, other than anonymous
peer reviewers, should be posted on the site.
Date Of Posting, Revising, And Updating And Timeliness Of
Editorial Content
The dates that content is posted, revised, and updated should
be clearly indicated. Procedures for updating and removing time-sensitive
content should be developed, implemented, and periodically reviewed
to ensure that the updating and review schedule is appropriate.
(For example, content can be sorted by date posted and all content
older than 6 months reviewed for timeliness and accuracy.) An
indication of significant revisions to any specific content
should be posted and may include instructions to discard copies
of versions previously printed or downloaded.
Sources Of Editorial Content
Source for specific content should be clearly identified (ie,
author byline or names of individual, organizational, departmental,
institutional, agency, or commercial provider/producer).
Affiliations and relevant financial disclosures for authors
and content producers should be clearly indicated.
Individuals who post content in online discussions, chat rooms,
and e-lists should be instructed to disclose financial interests
and commercial funding or affiliations related to the subject
of the posted content discussion, chat, or list.
Reference material used to develop content should be cited in
a manner appropriate for the site's audience.
Linking
Intrasite content links should be reviewed before posting
and maintained and monitored. If links are not functional, links
should be repaired in a timely manner.
External site links should be reviewed before posting and maintained
and monitored. If links are not functional, these links should
be repaired in a timely manner.
External links to commercial sites must comply with the "Principles
for Advertising and Sponsorship."
Intersite Navigation
Sites should not prevent viewers from returning to a
previous site.
Sites should not redirect the viewer to a site the viewer did
not intend to visit.
Sites should not frame other sites without permission.
Downloading Files
If content can be downloaded in a portable document file
(PDF) format, instructions regarding how to download the PDF
file and how to obtain the necessary software should be provided
and easy to find. A link to such software should be provided.
Navigation of Content
Features that facilitate use of the site should be provided
and easy to find, and should include a site map or other site
organizational guide, a help function or frequently-asked-questions
page, a feedback mechanism, and customer service information
(if available).
Each distinct site should provide a search engine or appropriate
navigation tool to facilitate use. If the site provides a search
engine, instructions specifying how to use the search function
and how to conduct different types of searches may be provided.
Graphics files should include a "mouse over" indication
of the graphical content. For large files, the space where the
file resides should include the size of the file. As a courtesy
to the viewer, when possible, when a large file can be downloaded
by clicking, the viewer may be informed of the size of the file
before the file begins downloading and should have the opportunity
to cancel the download.
These principles are revised from the Principles Governing
Advertising in Publications of the American Medical Association,
previously revised in May 1999.
These principles are applied by the AMA to ensure adherence
to the highest ethical standards of advertising and to determine
the eligibility of products and services for advertising on
the AMA Web sites.
The appearance of advertising on the AMA Web sites is neither
a guarantee nor an endorsement by the AMA of the product, service,
or company or the claims made for the product in such advertising.
The fact that an advertisement for a product, service, or company
has appeared on the AMA Web sites shall not be referred to in
collateral advertising.
As a matter of policy, the AMA will sell advertising space on
its Web sites when the inclusion of advertising does not interfere
with the mission or objectives of the AMA or its publications.
To maintain the integrity of the AMA Web sites, advertising
(ie, promotional material, advertising representatives, companies,
or manufacturers) cannot influence editorial decisions or editorial
content (as defined in "Principles for Content").
Decisions to sell advertising space are made independently of
and without information pertinent to specific editorial content.
The AMA Web sites' advertising sales representatives have no
prior knowledge of specific editorial content before it is published.
Placement of advertising adjacent to (ie, next to or within)
editorial content on the same topic is prohibited (for the table
of contents, a banner advertisement must not appear next to
the title of a related article). Just as a print advertisement
should not be placed next to an editorial page on the same topic,
a digital advertisement should not be adjacent to editorial
content on the same topic, either by linking or appearing adjacent
in the content section of the same screen. Similarly, just as
a print reader can choose to read an advertisement or skip over
it, a computer user should have the option to click or not click
on an advertisement. Viewers will not be sent to a commercial
site unless they choose to do so by clicking on an advertisement.
The AMA, in its sole discretion, retains the right to decline
any submitted advertisement or to discontinue posting of any
advertisement previously accepted.
Advertising
Digital advertising may be placed on the AMA Web site.
Digital advertisements must be readily distinguishable
from editorial content. If the distinction is unclear, the
word "advertisement" should be added.
Digital advertisements may appear as fixed banners or
as rotating advertisements.
Digital advertisements may not be juxtaposed with, appear
in line with, or appear adjacent to editorial content on
the same topic, or be linked with editorial content on the
same topic.
Digital advertisements that are fixed in relation to
the viewer's screen or that rotate should be placed to ensure
that juxtaposition (as defined in item 4 above) will not
occur as screen content changes.
Digital banner advertisements should be limited to 1
advertisement per screen view.
AMA, JAMA, and Archives Journals logos may not appear
on commercial Web sites as a logo or in any other form without
prior written approval by the individuals responsible for
the respective areas within AMA.
Advertisements may link to additional promotional content
that resides on the AMA Web site.
Advertisements may link off-site to a commercial Web
site, provided that the viewer is clearly informed with
a buffer page that to proceed by clicking would mean the
viewer would leave the AMA Web site and that the AMA Web
site does not vouch for or assume any responsibility for
any material contained on the Web site to which it links.
The buffer page will display the following statement:
You are leaving the AMA Web site. If you wish to link to
a Web site maintained by [company name], please click below.
If you do not wish to leave the AMA Web site, please click
on the "back" button of your browser to return
to the site. The AMA does not assume responsibility for
content of other Web sites.
The AMA will not link to Web sites that frame the AMA Web
site content without express permission of the AMA; prevent
the viewer from returning to the AMA Web site or other previously
viewed screens, such as by disabling the viewer's "back"
button; or redirect the viewer to a Web site the viewer
did not intend to visit.
The AMA reserves the right to not link to or to remove links
to other Web sites.
Methods of corporate funding should be described in the
Web site's information about advertising or the digital
rate card.
Sponsorship
All financial or material support for electronic collections
of articles, Web site content, and other types of online
products (such as condition-specific Web sites, online databases,
or material on CD-ROM) will be acknowledged and clearly
indicated on the home screen or via a link from the home
screen.
Acknowledgment of support will appear on the home page,
on the running foot of all pages, on any packaging and collateral
material included (eg, CD-ROM jewel case and companion print
insert), and on any materials used to publicize the online
product. Content accessed through the site that does not
reside on the site (eg, abstracts or articles from another
site) will not include sponsorship information.
These acknowledgments will not make any claim for any
supporting company product(s). The final wording and positioning
of the acknowledgment will be determined by the AMA. The
wording will be similar to "Produced by [AMA publication]
with support from [Company]."
The home page acknowledgment of digital products may
be linked to an on-site "About [Company]" page
or may link to the company's Web site through the intervening
buffer page referred to in "Advertising," item
10.
The "About [Company]" page may be linked to
other on-site pages provided by the supporting company.
These pages must be readily distinguishable from editorial
content, must be clearly labeled as provided by the supporting
company, and must not be linked to related AMA editorial
content.
The running foot acknowledgment will not be linked to
any other materials.
Other acknowledgments and disclosures may be required,
as deemed necessary by the AMA.
AMA, JAMA, and Archives Journals logos may not appear
on the sponsoring company Web site as a logo or in any other
form without prior written approval by the individuals responsible
for the respective areas within the AMA.
III. PRINCIPLES FOR
WEBSITE PRIVACY AND CONFIDENTIALITY
The following principles reflect the AMA's commitment to maintain
the Web site visitor's rights to privacy and the confidentiality
of personal information. In this context, privacy refers
to the right of the individual site visitor to choose whether
to allow personal information to be collected, by the host site
(in this case, the AMA) or by third parties, and to know what
type of information is collected and how that information is
used. Confidentiality is the right of an individual to
not have personally identifiable medical or other information
disclosed to others without that individual's express informed
consent.
The Internet has the potential to allow information about Web
site use to be tracked in aggregate (which can help site developers
understand site use and improve the experience of the viewer)
and at the individual user level. Individual user information
can improve the visitor's experience of the site by permitting
personalization of the site related to the individual's particular
interests or concerns. However, tracking of personal medical
and health information (ie, medical conditions, health-seeking
behaviors and questions, and requests about drug therapies or
medical devices or information pertaining to them) could breach
an individual's personal privacy and reveal an individual's
health data.
Thus, health and medical Web sites have a particular obligation
to protect the privacy and confidentiality of individuals. Patients
and individuals with interest in particular medical conditions
should feel confident in obtaining information and using resources
on the site, without concern that such use will be identified
with them without their permission. The AMA believes that all
site visitors should have the opportunity to opt in or out of
allowing personal information to be tracked. In addition, the
AMA takes extensive measures to ensure the safety and security
of its Web site servers and to guard against divulging private
information. The AMA believes that Web site visitors should
know who (eg, the site organization or third party) is tracking
personal information and the types of personal information that
are tracked and should have the right to opt out of such information
being collected at any time.
Protection of patients' rights to confidentiality is fundamental
to medical publishing. Health care professionals must adhere
to privacy and confidentiality principles to legally and ethically
share important information about medical conditions of individual
patients. The sharing of such information may improve clinical
care for the individual or improve the general state of knowledge
about medical and health care through medical research. Medical
publications, whether in print or online, must not reveal identifiable
information about an individual without that person's express
informed consent. These principles apply to information in medical
publications (eg, JAMA) as well as less formal venues used by
health care professionals, such as online discussion groups,
chat rooms, and e-lists.
Privacy
A link to the privacy policy of the Web site should be
provided on the home page or the site navigational bar and
should be easily accessible to the user. The Web site should
adhere to the privacy principles posted.
Individuals responsible for Web sites that post advertising
should be aware of current technology and access possessed
by third parties that post or link to advertisements. Web
sites should ensure that the technology and access used
by third parties adheres to the Web site's privacy policies.
The site should not collect name, e-mail address, or
any other personal information unless voluntarily provided
by the visitor after the visitor is informed about the potential
use of such information.
The process of opting in to any functionality that includes
collection of personal information should include an explicit
notice that personal information will be saved, with explanation
of how the information will be used and by whom. The opt-in
statement should not be embedded in a lengthy document and
should be explicit and clear to the viewer.
Collection, retention, and use of nonmedical personal
information about site visitors may be offered to viewers
when the AMA believes that such information would be useful
in providing site visitors with products, services, and
other opportunities, provided such use adheres to these
principles and is within bounds of current regalations and
law (http://www.ftc.gov/privacy/index.html).
Individuals may agree to have such nonmedical personal information
collected or may choose not to, with the understanding that
opting out of having such information collected prevents
the site from being tailored to their particular needs and
interests. Such information will not include personal health
information, such as any information about medical conditions
or medications purchased.
Names and e-mail addresses of site visitors should not
be provided or released to a third party without the site
visitor's express permission.
E-mail information, personal information about specific
visitor's access and navigation, and information volunteered
by site visitors, such as survey information and site registration
information, may be used by the site owner to improve the
site but should not be shared with or sold to other organizations
for commercial purposes without the site visitor's express
permission.
The AMA will use e-mail addresses voluntarily provided
by site visitors to notify them about updates, products,
services, activities, or upcoming events. Site visitors
who do not wish to receive such notifications via e-mail
should be able to opt out of receiving such information
at any time.
The AMA has licensed its physician and medical student
list to third parties for more than 50 years. This information
is licensed to database licensees under strict guidelines.
The names and addresses of physicians in the AMA Physician
Masterfile are made available only for communications that
are germane to the practice of medicine or of interest to
physicians or medical students as consumers. E-mail addresses
are excluded from such licensing agreements.
Nonidentifiable Web site visitor data may be collected
and used in aggregate to help shape and direct the creation
and maintenance of content and to determine the type of
advertisement to be seen by site visitors while on the AMA
site.
The AMA will not collect and will not allow third parties
to collect personal medical information (medical conditions,
health-seeking behaviors and questions, and use of or requests
for information about drugs, therapies, or medical devices)
without the express consent of the site visitor after explanation
of the potential uses of such information.
A cookie is a small file stored on the site user's
computer or Web server and is used to aid Web page navigation.
Two types of cookies are commonly used. A session cookie
is a temporary file created whenever a Web site is accessed
and is self-terminated based either on an expiration date
(eg, 3 hours from creation of the cookie) or by closing
the Web browser. A persistent cookie is a permanent
file and must be deleted manually. Cookies referred to in
the context of these Guidelines are persistent cookies.
A cookie function may be used on the site to track visitor
practices to help determine which site features and services
are most important and guide editorial direction. The cookie
makes it possible for the user to access the site without
requiring entry of a user name or password, allows the user
to view different restricted areas of the site without reregistering,
allows the user to personalize the site for future use,
and permits the user to make subsequent purchases without
reentering credit card information. Users who do not desire
the functionality created by the cookie should have the
option to disable the cookie function, either by indicating
when asked that they do not wish to have a cookie created
or by disabling the cookie function on their browser. Individuals
should be able to opt out of cookie functions that permit
tracking of personal information at any time.
E-mail messages sent to a Web site may not be secure.
Site visitors should be discouraged from sending confidential
information by e-mail. Site visitors sending e-mail accept
the risk that a third party may intercept e-mail messages.
Market research conducted by the site or its agent to
enhance the site should be clearly identified as such.
E-mail alerts and newsletters should contain an "unsubscribe"
option.
Credit Card
Privacy Statement
Posted: May 2001
The AMA abides by the privacy statement that is published
on its Web site. In addition, all credit card transactions
are conducted over a secure socket layer connection. Credit
card information is not stored or re-used in any manner.
Only authorized personnel with specific IDs and passwords
can access credit card information solely for the purpose
of performing adjustments or refunds at the customer’s
request.
Confidentiality
Content published within the AMA Web sites that includes patient
information should adhere to the patient privacy and anonymity
principles followed by JAMA and the Archives Journals, which
are based on the recommendations of the International Committee
of Medical Journal Editors (http://JAMA.ama-assn.org/info/auinst_req.html).
These principles apply equally to formal medical publications
and the informal interactive communication permitted by the
Web, including online discussion groups, chat rooms, or e-lists.
- Patients should be aware when they provide information about
their individual medical conditions in the context of such discussions
that information may be linked with a personal identifier. However,
AMA Web sites will not collect information about individual
medical conditions without the express permission of the site
visitor. Physicians and other health care professionals should
be aware that any patient information reported in the context
of such venues must adhere to the confidentiality principles
listed herein. Moderators of such sessions should make every
effort to ensure that listed material adheres to the principles
stated herein and, when in doubt, should query the individual
providing the information. If the individual is a patient providing
such information, the moderator should query the patient as
to whether the patient intends for the sensitive medical information
to be revealed. If the individual providing the information
is a health care professional, the moderator should query the
professional as to whether the patient reported has provided
informed consent and state so.
Patients have a right to privacy that should not be infringed
without express informed consent. Identifying patient information
should not be published in print or online descriptions, photographs,
or pedigrees (illustrations of how a disease is expressed within
an extended family for purposes of determining possible inheritance)
unless the information is essential for scientific purposes
and the patient (or parent or guardian) gives express informed
consent for publication.
Identifying details should be omitted if they are not essential,
but patient data should never be altered or falsified in an
attempt to attain anonymity. Complete anonymity is difficult
to achieve, and informed consent should be obtained if there
is any possibility as to whether identifiable information may
be disclosed.
When express informed consent has been obtained, it should be
indicated in the posted Web content.
The AMA e-commerce principles are intended to ensure that users
and purchasers of information, products, and services on the
site will have access to secure, efficient transactions for
online and remote customer fulfillment. All such transactions
should adhere to the AMA "Principles for Privacy and Confidentiality."
A link or reference to the site's policies on privacy
should be clearly visible.
The security software and encryption protocol used on
the site for financial transactions should be described.
Users should be able to select whether or not the Web
host will retain the user name and password (ie, disable
cookie function, as described in "Principles for Privacy
and Confidentiality"). Users should be able to opt
in or opt out of functions that track personal information
at any time.
A link or reference to customer service contact information
(e-mail, telephone, fax, mail), including hours of operation
and time zone, should be clearly visible.
The terms of use for e-commerce should require a deliberate
selection (accept/not accept).
Users should be able to review transaction information
prior to execution (information, products, and services
listed; prices; totals; shipping and handling expenses).
As a courtesy, following execution of the transaction,
users should be provided, on a page or by e-mail, purchase
information (see item 6 above) as well as shipping tracking
number, if appropriate.
Users will be notified on-screen when entering or leaving
a secure site and will have the option to proceed or remain
on the current site.
If a user's browser does not support a secure connection,
no financial transactions will be permitted over the Internet.
Response times for feedback and fulfillment should be
clearly stated.
Products and services will not be endorsed or cobranded
by the AMA or AMA publications. Any product promotions must
adhere to the "Principles for Advertising and Sponsorship."
Author Affiliations: American Medical Association, Chicago,
Ill.
Corresponding Author and Reprints: Margaret A. Winker, MD, JAMA,
515 N State St, Chicago, IL 60610
(e-mail: margaret_winker@ama-assn.org).
Acknowledgment: We thank Linda Emanuel, MD, PhD, Sophia Drivalas,
Todd Allen, Marty Suter, and the AMA Online Oversight Panel
and Corporate Review Team for their critical review and comments.
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Jadad AR.
Promoting partnerships: challenges for the Internet age.
BMJ.
1999;319:761-764. MEDLINE
Eysenbach G, Diepgen TL.
Towards quality management of medical information on the
Internet: evaluation, labelling, and filtering of information.
BMJ.
1998;317:1496-1500. MEDLINE
Silberg WM, Lundberg GD, Musacchio RA.
Assessing, controlling, and assuring the quality of medical
information on the Internet: caveant lector et viewor—let
the reader and viewer beware. JAMA.
1997;277:1244-1245. MEDLINE
