Chilet-Rosell et al. BMC Public Health 2010, 10:134 http://www.biomedcentral.com/1471-2458/10/134 2. Obligatory inclusion of the drug’s Summary of Pro- duct Characteristics. 3. Conformity of the indications with the Patient Information Leaflet (for this, the Patient Information Leaflet approved by the Spanish Agency of Medicine and Health Care Products for each drug was consulted). 4. Inclusion of the registered company name and address. 5. Inclusion of complete bibliographic references, including references to the original source. Additionally, compliance with these same recommen- dations on non-corporate web pages referring to the same drugs was studied. If this information was not already explicitly stated on the page, the registered com- pany name and address, and possible sponsorship, was identified using the website http://www.whois.net (this website offers domain-based research services). The following information was also collected on non- corporate web pages: - Whether the page offered links to sites selling medicines. - Erroneous or inadequate information concerning drug indications. The legal status of the online pharmacies was deter- mined on the basis of the inclusion of the registered company name and address. In these cases, the availabil- ity of the drug’s Summary of Product Characteristics, the stipulation of the need for a prescription and the presence of restrictions on access to the information, as well as the possibility of purchasing prescription-only medication from Spain was studied. Results Out of a total of 70 web pages (see Additional File 1), corresponding to the eight HRT drugs studied were retrieved from Google. After the exclusion of the repeated web pages, 34 were analysed (Figure 1). Of these 34 web pages, five were corporate web sites (Table 1), 27 were non-corporate (23 web pages provid- ing medical information and four forums) (Table 2), and two were online pharmacies (Table 3). Table 1 includes the characteristics of the web pages provided by pharmaceutical companies marketing the HRT drugs analysed. Inclusion of the registered com- pany name and address was the only issue fulfilled by them all. The application of measures to ensure that medication advertising was restricted to health profes- sionals was apparent only in the case of one company (Organon Española SA.). Three other web pages required the user to register, but did not require a pro- fessional body membership number, whilst Bayer applied no control over access to information. Only two web pages complied with the precept of including the Summary of Product Characteristics, and three others Page 3 of 9 presented the medication indications as given in the Spanish Drug Formulary. None of them included biblio- graphic references or cross-references to the original studies. Table 2 presents the characteristics of non-corporate web pages offering medical information or forums where some of the medications studied were mentioned. Of the 27 non-corporate web pages, 11 (41%) provided no information concerning the registered company name and address. As for the obligation to include the Summary of Product Characteristics, 22 (81.5%) did not comply and a further five (18.5%) did not include the indications as provided in their corresponding Patient Information Leaflet. Several inappropriate HRT therapeutic indications were recorded for 11 web pages: seven (26%) indicated HRT treatment for osteoporosis without mentioning a note of caution or the restrictions imposed by the Min- istry for Health and Consumer Affairs due to the unfa- vourable risk-benefit profile [6,7]. Five (19%) indicated HRT as a means of regulating the menstrual cycle (four of these pages were forums), and one (4%) forum com- mented on the use of two HRT medications for “boost- ing femininity”. Two web pages (7%) providing medical information fulfilled the requirement of including bibliographic references and references to the original source. Results for providing different levels of information to patients and health professionals were mixed: 16 web pages made no distinction, five pages made no distinction but did insist on the need to consult a professional, five dif- ferentiated between patients and health professionals but did not restrict access to the information, and only one required the user to register in order to access the information, but did not require the user to prove their health professional status. Among the non-corporate web pages providing medical information, three included links to the sale of medications, although these did not include HRT drugs. None of the two online pharmacies (http://www.gold- pharma.com and http://www.rx-med.net) included had its base in Spain, although one was based in the Eur- opean Union, specifically, the United Kingdom. None of them complied with the requirements analysed (inclu- sion of registered company name and address, Summary of Product Characteristics, prescription only status and differentiation between information aimed at the patient and that aimed at the health professional). In the case of these online pharmacies, medications could be pur- chased from Spain. Regarding legal status, Goldpharma (registered in the Seychelles, according to http://www. whois.net) placed the onus probandi (burden of proof) on the user to check current legislation for each country and accepted no responsibility. Likewise, Rx-med