Chilet-Rosell et al. BMC Public Health 2010, 10:134 http://www.biomedcentral.com/1471-2458/10/134 C O R R E S P O N D E N C E Open Access Hormone Replacement Therapy advertising: sense and nonsense on the web pages of the best-selling pharmaceuticals in Spain Elisa Chilet-Rosell1,2*, Marta Martín Llaguno3, María Teresa Ruiz Cantero1,2, Pablo Alonso-Coello2,4 Abstract Background: The balance of the benefits and risks of long term use of hormone replacement therapy (HRT) have been a matter of debate for decades. In Europe, HRT requires medical prescription and its advertising is only permitted when aimed at health professionals (direct to consumer advertising is allowed in some non European countries). The objective of this study is to analyse the appropriateness and quality of Internet advertising about HRT in Spain. Methods: A search was carried out on the Internet (January 2009) using the eight best-selling HRT drugs in Spain. The brand name of each drug was entered into Google’s search engine. The web sites appearing on the first page of results and the corresponding companies were analysed using the European Code of Good Practice as the reference point. Results: Five corporate web pages: none of them included bibliographic references or measures to ensure that the advertising was only accessible by health professionals. Regarding non-corporate web pages (n = 27): 41% did not include the company name or address, 44% made no distinction between patient and health professional information, 7% contained bibliographic references, 26% provided unspecific information for the use of HRT for osteoporosis and 19% included menstrual cycle regulation or boosting feminity as an indication. Two online pharmacies sold HRT drugs which could be bought online in Spain, did not include the name or contact details of the registered company, nor did they stipulate the need for a medical prescription or differentiate between patient and health professional information. Conclusions: Even though pharmaceutical companies have committed themselves to compliance with codes of good practice, deficiencies were observed regarding the identification, information and promotion of HRT medications on their web pages. Unaffected by legislation, non-corporate web pages are an ideal place for indirect HRT advertising, but they often contain misleading information. HRT can be bought online from Spain, without a medical consultation or prescription constituting a serious issue for public health. In our information society, it is the right and obligation of public health bodies to ensure that such information is not misleading. Background The balance between the benefits and risks of long term use of hormone replacement therapy (HRT) has been a matter of debate for decades. As early as 1939 the review published by Nancy Krieger in 2005 on the his- tory and epidemiology of hormone replacement therapy (HRT) highlighted a potential association between HRT * Correspondence: elisa.chilet@ua.es 1Preventive Medicine and Public Health Department, Universidad de Alicante, Alicante, Spain and breast cancer [1]. It was not until the 70s that the concern about endometrial cancer started [1]. Since the publication of the Women’s Health Initiative (WHI) in 2002, detailing the higher incidence of cancer and cardi- ovascular disorders in women on HRT, the benefits of its long term use have been strongly questioned [2]. New clinical trials have confirmed these findings, con- cluding that the risk-benefit profile for the prevention of chronic conditions is generally unfavourable [3,4]. HRT is no longer recommended routinely as a preventative measure or as a first line treatment in the case of © 2010 Chilet-Rosell et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.