Chilet-Rosell et al. BMC Public Health 2010, 10:134 http://www.biomedcentral.com/1471-2458/10/134 Page 7 of 9 Table 2: Compliance with Farmaindustria’s “Code of Good Practice for the Promotion and Use of Medicines” on non- corporate web pages (Information and Forums) promoting the best-selling HRT drugs in Spain. (Continued) http://www.carlaantonelli.com (**): Progyluton No http://www.portalesmedicos.com (**): Progyluton No http://es.answers.yahoo.com (**): Progyluton No (Web pages visited January 2009) Type of web page: (*) Medical information, (**) Forum. Co.: Company No No No Yes Yes Yes Boosts femininity/ Menstrual cycle Regulation Menstrual cycle Regulation Menstrual cycle Regulation No No No No No No Table 3 Characteristics of Pharmacies on line promoting the best-selling HRT drugs in Spain. Portal and HRT drug http://www.goldpharma. No com: Absorlent plus, Duofemme, Estalis Estracomb, Merigest Perifem http://www.rx-med.net: No Duofemme, Merigest Perifem (Web pages visited January 2009). Registered name/Co. address Address of Data Requirement Differentiated company http:// Sheet patient/ www.whois.net professional information Seychelles Islands No United Kingdom No No No No No Sales in Spain Burden of proof on the user to check current legislation for each country and accepted no responsibility Sells worldwide, but accepted no responsibility for compliance with legislation in other countries far as it increases the risk of suffering a fracture [19,20], whilst the menopause, which is a normal part of the life cycle, is often advertised as pathological[21]. In both cases, HRT has been recommended and prescribed, leading to the perception of real diseases in the popula- tion [22]. At present, no specific body exists in Spain with the express remit of monitoring online sales of unauthorised medications. Due to the protection offered by the supra- national structure of the Internet, countries possessing strict pharmaceutical controls have recently been over- whelmed with medications acquired in other countries with more permissive health legislations, and to date have been unable to prevent the phenomenon [9]. HRT drugs are sold in Spain on commercial web sites which exempt themselves from any responsibility regarding the purchase. Their registered headquarters are located in countries where such sales are either not legislated for, as is the case of sales from the Seychelles identified in this study, or illegal, as is the case of sales from the UK. Such uncontrolled sale of HRT drugs without a medical consultation or prescription constitutes a serious threat to public health, in this case more precisely to the women’s population. Since the pharmaceutical companies have a vested interest in the quality and ethical and legal status of the information provided about their products, it was the industry itself which agreed to implement self-regulation regarding promotion. Thus, the pharmaceutical companies committed themselves to compliance with codes of good practices for the promotion of medicines [13,14]. However, it may be that this strategic decision is actually one of the reasons behind the deficiencies observed regarding the identification, information and promotion of HRT medications on the Internet. Farm- aindustria’s Code of Practice Surveillance Unit has a great deal of work ahead of it if the corporate web pages are to be compelled to respect the codes of con- duct. As this study has shown, in general, the companies do not require the user to register as a health care pro- fessional in order to access the information provided on the page, nor do the pages facilitate bibliographic refer- ences which provide objective support for the informa- tion. Furthermore, these companies do not include the necessary information concerning the pharmaceutical characteristics of their HRT drugs on their web pages. Health information sites have proliferated, and in Spain there are now over 6,000 disease-related virtual forums [16]. These websites represent an important source of health information. The infringement of ethi- cal requirements on these non-corporate web sites con- stitutes a danger to Public Health, given that 80% of patients now use the Internet to find information about their disorders [17]. Therefore, independently of official bodies, pharmaceutical companies should take the initia- tive in monitoring the suitability of information pro- vided about their drugs on forum sites, chat rooms and non-corporate web pages. Furthermore, they ought to