Browsing medical journals: Is Big Brother watching?

I would like to know how and why my data is being collected.

Reading journals is a mainstream activity for all registered doctors who are looking to fulfil their continuing professional development (CPD) requirements. Most of our reading is now done online. I suspect few enough of us subscribe to the paper edition of our favourite journals anymore. But what came as a shock (I know, I am an innocent abroad) was to read recently that each time you visit a medical journal homepage, it’s likely that a third-party firm is tracking your browsing behaviour – potentially to send you targeted advertising in the future.

My eureka (!) moment came when I was reading a paper in JAMA Health Forum from health economists in the University of Pennsylvania. They found that more than 99 per cent of medical journal sites use third-party tracking.

“For physicians, accessing articles on medical journal websites – like a study on a new hypertension drug – could lead to profiling, including based on medical specialties and medical areas of interest,” lead author Dr Ravi Gupta told Medscape Medical News.

It’s all down to the ubiquitous ‘cookies’ we are asked to approve every single time we open any website. However, opting out of ‘cookies’ on journal websites may limit our ability to access specific articles. “Prior work from my co-authors has shown that this can limit the ability to access journal content,” Gupta said. “The responsibility rests largely on medical journals and journal publishers to allow for greater user privacy.”

Gupta and his co-authors identified all medical journals with an impact factor of 2.0 or more that also had clinically relevant subcategories of the Web of Science’s life sciences and biomedical category. They then searched for third-party cookies on the journals’ websites.

They found that 1,239 sites (77 per cent) included a third-party cookie. The investigators also visited each journal’s home page using technology called webXray to detect third-party tracking. Overall, they report that 1,599 of 1,605 (99 per cent) of medical journal home pages included a third-party data request.

Third-party firms owned by Alphabet, Google’s parent company, had data requests on 99 per cent of journal home pages studied. In addition, they found that 40 per cent of journal home pages had data requests from companies owned by Twitter, Facebook, Oracle, and Adobe.

This sounds to me like a recipe for us being exposed to unasked-for advertising from pharmaceutical and health companies. Which of course leads to the old chestnut of whether such advertising might direct our prescribing habits towards therapies with limited evidence of efficacy.

It must be acknowledged that this research took place in the US where there is a far more permissive regime when it comes to direct-to-consumer advertising. The researchers looked for the advertising policies for the five most prevalent tracking firms to see whether they allow pharmaceutical ads or ads specifically targeted toward medical professionals. All five allow pharmaceutical advertising. However, they only found marketing disclosures for Oracle and Adobe, both of which permit ads specifically targeting medical professionals. The situation may be less permissive in the EU.

The JAMA paper only assessed the presence of tracking, not the implications. So we are still in the dark as to what this means in practice. The worry is that some of the tracking is used to target prescribers and researchers. Further research is needed before we can determine exactly how invasive this tracking is. It may be that the pharmaceutical industry does not have access to tracking information such as this or it does have access, but does not use it here in the EU.

We are all used to being tracked online and seeing new types of advertisements appear after we have searched for a particular product or service. I find this mildly annoying and it makes me wonder where my personal data might end up in the internet of things. So I would like to know how and why my data is being collected.

I am a relative Luddite when it comes to technology, but I do know that internet tracking isn’t entirely about user experience. Other reasons websites track us include: To create revenue streams; to measure business performance; and to measure a website’s usability.

What I don’t have a clue about is how I might limit, at least in part, the use of my information for commercial reasons. Perhaps an enlightened reader could tell us how we might go about reducing our exposure when carrying out innocent activities, such as keeping up to date with the medical literature?