Health On the Net Foundation

Health On the Net Foundation (HON) is a not-for-profit organization founded in 1995 under the auspices of the Geneva Ministry of Health and based in Geneva, Switzerland. This came about following the gathering of 60 of the world's foremost experts on telemedicine to discuss the growing concerns over the unequal quality of online health information. The unanimous conclusion of this gathering was to create a permanent body that would, in the words of the program, "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world." The HON Foundation became one of the first organizations to guide both lay users and medical professionals to reliable sources of health information in cyberspace.

Mission
The mission of the foundation is to guide the growing community of healthcare consumers and providers on the World Wide Web to sound, reliable medical information and expertise. In this way, HON seeks to contribute to improved health care through patient empowerment and better informed health professionals.

Certification


HON Foundation issued a code of conduct (HONcode) for medical and health Web sites to address reliability and usefulness of medical information on the Internet. HONCode is not designed to rate the veracity of the information provided by a Web site. Rather, the code only states that the site holds to the standards, so that readers can know the source and purpose of the medical information presented. The HONcode is voluntary, which means that webmasters and information providers can apply for HONcode certification. Following this, the website is reviewed by a specialized team of health and legal professionals. The HONcode certification is a dynamic state and is extended every year according to site compliance. It is the oldest and the most used ethical and trustworthy code for medical and health related information available on the Internet.

The principles of the HONcode are:
 * 1) Authority - information and advice given only by medical professionals with credentials of author/s, or a clear statement if this is not the case
 * 2) Complementarity - information and help are to support, not replace, patient-healthcare professional relationships which is the desired means of contact
 * 3) Confidentiality - how the site treats personal and non-personal information of readers
 * 4) Attribution - references to source of information (URL if available online)and dates when pages was last updated
 * 5) Justifiability - any treatment, product or service must be supported by balanced, well-referenced scientific information
 * 6) Transparency of authorship - contact information, preferably including email addresses, of authors should be available
 * 7) Transparency of sponsorship - sources of funding for the site
 * 8) Honesty in advertising and editorial policy - details about advertising on the site and clear distinction between advertised and      editorial material

Currently the HONcode is used by over 5,000 certified websites, covering 72 countries and has been translated into 34 languages. It is used to sensitize web publishers to the need for quality information and create awareness in health professionals and so, help guide their patients to trustworthy health information.

HON offers all users the trustworthy web sites and support groups, medical images and terminology, journal articles and news through its search engines MedHunt, HONcodeHunt and HONselect. HON also provides two databases of trustworthy health information, one on eye diseases and the other on general medical conditions. Provisu.ch is a database of reliable health information on all eye diseases and is accessible by those with poor or no vision through its variability of letter size and audio version. Santeromande.ch is an extensive database, mainly directed towards the French speaking public of Switzerland and neighbouring France and provides reliable health information, directory of registered health professionals, medical centers or hospitals, medical associations and federal organizations.

Health On the Net Foundation was granted on 23 July 2002 NGO status by the Economic and Social Council of the United Nations. HON also has a partnership at the French governmental level, when it was accredited in 2007 by the French National Authority (HAS) to be the official certifying body for all French health websites.

Abuse of HONcode
A journal article raised a number of problems with the HONcode logo, indicating that consumers may mistake it as an award or interpret it as an indicator for assessed information. Other issues with the HONcode logo were discussed in the Journal of Medical Internet Research (JMiR), a peer-reviewed eHealth journal. Websites which are not in compliance with HONcode can continue to display the logo, as Health On the Net Foundation (HON) has no means of obligating the offending webmaster to remove the logo. Clicking on that logo (for verification) will not indicate that the site is out of compliance, as HONcode only indicates that sites are "undergoing annual review". Hence, websites which are not in compliance with HONcode may still be displaying the HONcode logo, calling into question the entire principle of HONcode. Other problems with the application of the HONcode principles are that HON does not have a means of verifying many of the principles, such as credentials (medical or otherwise) as stated on websites displaying the logo, or that copyright or confidentiality is not violated by webmasters. HONcode relies on the webmaster for honest representations about compliance with the principles.

In recent times however, HON has developed ways to counteract the abuse of the HONcode. One of these is the use of an active and dynamic logo which shows its validity and reflects the site compliance in real time. In addition, all medical credentials are verified through national databases of registered medical professionals. HON has always encouraged the internet community to demand for quality health information and the general public plays a large role in the policing of the HONcode by HON.

Consumer protection advocate, Stephen Barrett, is a strong supporter of the HONcode and has made efforts to improve compliance with its rules and to expose those who abuse it. In a whole "Special to The Washington Post", extensive coverage of his views on the subject were provided, including suggested improvements and his criticisms of many named abusers.

In cases of suspected fraudulent websites, or of abuse of the HONcode, HON advises internet users to alert Quackwatch or HON itself: "If you come across a healthcare Web site that you believe is either possibly or blatantly fraudulent and does NOT display the HONcode, please alert Quackwatch. Of course, if such a site DOES display the HONcode, alert us immediately."