The World Wide Web and Travel Medicine: An Overview

Alan Spira, MD, DTM&H; Eric L. Weiss, MD, DTM&H

The growth of travel medicine as a medical subspecialty has been paralleled by the growth of travel medicine on the world-wide web (WWW).

The WWW has excited consumer and professional alike with its advantages of increasing ease of access (especially internationally), user-driven navigation and content detail, and potential for being current. But there are disadvantage, too. The user of the web must differentiate fact from editorial opinion, and trust the source.

With ever-increasing numbers of people crossing international borders, the need for information to help travelers manage their health before, during and after traveling has increased. Travelers are frequently turning to the WWW before visiting their travel health practitioner. There are numerous websites offering travel and tropical medicine information for both the lay person and the health professional. Some of these websites are from respected, well-established scientific and governmental organizations, some are from private business enterprises, and others are from individuals hoping to make an impact on the field of travel medicine.

Travel Medicine on the Web

Currently, the prime focus for travel medicine web sites is on preventative health care: immunizations; precautions; medications, self-treatment; and disease outbreaks. Some of the more consumer-oriented sites offer additional educational content on a variety of topics ranging from insect repellents to altitude illness prevention. Among the most respected sites are the CDC, WHO, ISTM, ASTMH (American Society of Travel Medicine and Hygiene), ProMed, MedicinePlanet, Travax/Encompass (Shoreland), and Travelcare (International SOS). The last three are from private business organizations with whom an account must be established in order to utilize their resources.

As a new and growing enterprise in a previously unexplored realm, the web has both benefits and pitfalls. With the recent dot-com crash, it has become painfully apparent that businesses, organizations, and individuals are unregulated and practice as they wish. This raises two important issues: that private organization websites will have to follow sound business practices in addition to offering quality services and accurate information; and that Caveat Emptor still applies for consumers.

The lay person may find it hard to judge quality and accuracy, but by viewing the web site’s sources of information, editorial board, and depth of coverage they should be able to make a fair assessment. Only ethical and high-minded web sites strive for a high quality service. But one finds confusion even in the most well-intended of sites. Often, there is difficulty in separating out an intention to assist the professional versus assisting the layperson. Overlap is common, and as a result neither intended recipient group is adequately satisfied.

It appears that more lay people use the web than professionals. As these consumers turn to the web for obtaining what they believe to be accurate and reliable medical information, they can readily be confused by conflicting information and language. The lay person is then forced to interpret the information without the proper background or resources to do so, and may become discouraged, follow the wrong advice or do nothing. It must be clear from the outset which population the website is serving. An old Japanese proverb warns that the hunter who chases two rabbits at once catches neither. Ideally a website should focus on one type of audience - the professional or the public. Otherwise the professional audience will not be informed or educated and the lay consumer may end up befuddled or overwhelmed.

Another pitfall in this burgeoning electronic realm is that few sites are nimble enough to offer up-to-the minute information that can be essential to travelers’ health. But this is more an issue with the web site organizations, than with technology. The main pillars of the travel medicine web community, the CDC and WHO, are clearly the most reliable and steadfastly accurate sources for confirmation of outbreaks. But being large, political, and as such (and usually appropriately) conservative, they may wait several days or weeks until enough data has been collected to definitively identify an outbreak or other emerging health issues. Clearly, this conservative approach conveys credibility, reliability and consistency, and helps prevent rumors from causing political, medical and social problems.

However, at the same time the conservative approach may lead to delayed diagnoses, treatment, or vaccine recommendations in cases when a new problem arises but laboratory-confirmation has not yet been cemented. There is also a delay until the medical ‘establishment’ is informed. A case in point is the recent reemergence of polio on Hispanolia in the countries of the Dominican Republic and Haiti in the Caribbean and the delay in its announcement. In contrast, smaller, private organizations have the ability to follow and publicize disease changes without the same constraints and responsibilities as the larger organizations. However, one must be sure that such web sites are reputable, with a good track record, and operate with high medical standards. Their sources should be competent and reliable and if subject to scrutiny, stand up well.

Away From Home

What resources are available on the web for those already in the middle of their journey? This is probably the greatest areas of challenge at present for WWW sites. It has become remarkably easy for the international traveler to gain internet access: tourist destinations have seen a proliferation of “internet cafes” and most high-end hotels have a Business Center with internet access at reasonable hourly prices. Some intrepid (and email-addicted) travelers go so far as to travel with their laptop computers and an assortment of phone and power adapters to ensure regular internet and email access. It is one author’s experience (ELW) that using local Internet Service Providers (ISP) at the hotel or at an internet café is considerably more reliable and less expensive than trying to go it on your own. Additionally, newer web-based email sites (mollymail.com, mailstart.com and others) allow you access your home email server from afar.

However, during travel is where too many unreliable and unregulated sites offer conflicting and even harmful information which can do the traveler ill. It can take a long time to search the web adequately for credible information. And if the information is found, even in a remote part of the world, it may turn out to be not very helpful - or harmful. In contrast, if the traveler is armed with the web address (URL) of one of the above reputable TM sites, there is considerable useful information to be found, ranging from disease information to databases of local embassies or consulates (at the present time, mostly limited to U.S.- centric information). There are several companies and/or agencies working on building databases of local medical providers and/or facilities, but this is challenging both in the scope of the project and the ability to provide assurances in quality of care.

After a traveler has returned, which sites can be trusted to offer advice and information that a travel medicine specialist or the traveler can turn to and feel safe? This group is for the most part the same as the pre-travel web site list previously mentioned. The ISTM and ASTMH are excellent resources for the public to find travel and tropical medicine expertise. It is terribly important to make the lay user of the web aware that the WWW is not a substitute for competent clinical medical care and that they should seek out a specialist, such as those certified by the American Society of Tropical Medicine and Hygiene, and hopefully, soon, the International Society of Travel Medicine.

The Future

What does the future hold for the web and travel medicine? This year was a ‘wake-up call’ for many web-based companies after the market crash with the realization that a dot.com business needs to generate realistic revenues just like any other company. As a result, there will likely be a shift and consolidation in the number of companies offering online travel health information. More optimistically, governmental agencies are reaping the benefit of new technologies and easier web publishing and putting more user-friendly and useful information on-line. The web is increasingly available internationally, both to those planning trips as well as those actually underway. The potential ability of the traditional internet to impact the health and safety of the traveler as well as the very field of Travel Medicine is very great indeed.

Even more exciting is the emergence of new technologies which will allow internet surfers to access web-based content without the need for phone lines. “Wireless” technology is becoming pervasive. In the next few years web access via wireless devices will surpass web access via traditional “wired” desktop and/or laptop computers. This is particularly true in Europe and Asia, where the mobile phone infrastructure is well-established, consistent and popular among the public.

In many parts of the world, “wired” technology will be completely skipped in favor of wireless web access. Most of the world remains without the benefit of being wired for phone service: wireless communication will most likely arrive in the more poor and remote portions of the globe long before traditional wired services. This again has important implications for the traveler. No matter where the traveler is, he or she will be able to get the same information as do as home, although it may not be as graphically attractive as on a large-screen monitor. Several companies are racing to take advantage of this new technology, excited by the prospects of providing the mobile user with services such as hospital and/or provider databases, electronic medical records, health news and alerts, interactive health tools, and even access to live medical personnel in case of emergency. These changes are not far away; some of them already exist and are being put into use even as you read this. The future for travel medicine on the WWW is bright, and when backed by a reliable, established organizations, will become part of our routine medical practice.

The Authors: Eric is the Chief Medical Officer for MedicinePlanet.com and Assistant Professor of Emergency Medicine at the Stanford University School of Medicine in Palo Alto, California. Alan is the Medical Editor for Medicine Planet.com, the assistant editor for reviews for the Journal of Travel Medicine, and the Medical Director of The Travel Medicine Center in Beverly Hills, California. Both are long-time and loyal members of the ISTM.