12 December 1999 Rev. 15 February 2000
PROJ99\MEDIAMET.MS
2,000 words

Top 10 health-related web sites,
and structure of the industry
from Media Metrix and Jupiter

Update (December 2001): For a current list, see the Medical Library Association's Top Ten Most Useful Websites. If you know of other good lists, let me know.

Jupiter and Media Metrix have now merged. For the latest from Jupiter Media Metrix see their web site or see if they have anything health-related in their press release list.

NEW YORK--Here's some marketing data on medical web sites that should be useful to medical writers who want to write for the Internet.

2 prominent marketing firms that cover the Internet are Jupiter Communications (whose editors we met at the Editorial Freelancers Association) and Media Metrix , which Charlene Laino mentioned at SWINY ). I called the 2 companies to see what useful information I could get out of them.

My quick evaluation of on-line medical information, after a mind-numbing surf of dozens of health web sites, reading the same news stories over and over again, and testing the sites with a few standard queries, is as follows:

Some sites provide good medical news. The best news reporting for doctors by journalists is WebMD, which uses freelancers on long-term contracts (rumored at $350 a story), with a news staff of 60. Reuters is close behind for news coverage. Medscape provides the best meeting coverage, written for doctors by doctors, not by journalists. The TV- and cable-affiliated sites like MSNBC and CNN are surprisingly good, though they're limited by the interests of their audience and the important subtleties of experimental design sometimes get truncated. The video sites also have good organization and search capabilities; other sites may have more detailed clinical information but it's hard to find what you need. Most major sites subscribe to Reuters, which usually supplies a good 1-source story (which however doesn't go to a searchable archive, so it's gone after a week). The university web sites are usually limited to their own experts. Many web sites are devoted to health, wellness, lifestyle, and alternative medicine; some are web sites that link to vendors, some are vendors that link to health content, and the boundaries are muddled. Alternative medicine coverage ranges from science-based and balanced to fraudulent promotion. Financial disclosure is muddled. Ethics is muddled. For example, DrKoop.com uses "news" stories on controversial subjects from the American Council on Science and Health with no disclosure that ACSH's research is often funded by one of the parties to the controversy.

Healtheon/WebMD Corp. deserves special mention, as a paradigm of a medical web site. On 14 February 2000, the company acquired Medical Manager Corp., which I know from my reporting for Medical Tribune as the company that wrote the leading practice-management software, now used by 185,000 doctors to manage patient billing, scheduling, clinical records and other information. Healtheon has an alliance with Rupert Murdoch's News Corp., and a partnership with CVS Corp. under which CVS.com is the featured drugstore. WebMD and Medical Manager's CareInsite claim "relationships" with 400,000 doctors, and 3.8 million consumers visit WebMD. On WebMD, consumers can get health information, use chat rooms, use interactive tools like ovulation predictors, and find a physician. Doctors can get medical information, order books and supplies, and order lab results. They expect to be able to schedule appointments, check lab results, and deal with insurance companies. The new medical web sites will be complete integrated services for doctors and patients, and news will be one of those services--the free lunch, as the New Yorker's press critic A.J. Liebling used to call it, and hopefully independent. (See: "Creating an Internet Health Colossus; Healtheon Agrees to Acquire Rival to Get a Bigger Slice of Medical Transactions," Ann Carrns, Wall Street Journal, 15 February 2000, p. B1.)

If anyone has worked with these sites, or looks into them, please let me know whether they currently take freelance work, what kind of work they're looking for, and how much they pay (and whether I can disclose that information).

There are other lists: Yahoo's health page has links to thousands of pages, organized into about 50 categories, without too much selectiveness. The most comprehensive list of responsible health sites is probably the Health on the Net home page , which links to about 7,000 sites that subscribe to the HON code of ethics . If anyone knows of a good evaluation of medical web sites, please let me know.

For background on medical web sites, search The Standard for "health" or "medicine."

The new iHealthcareWeekly.com , a free online newsletter, is quite good. They are also sponsoring a conference in New York, Internet Healthcare 2000, 25-26 April .

For a reasonably good review of medical sites for consumers, including a comparative table, see "Is the Web Bad for Your Health?" by Brad Grimes with Peter J. Stuart, MD, PC World, February 2000. They recommend AllHealth.com and Mayo Clinic Health Oasis .

For good brief reviews of 5 major medical consumer web sites, see "Web Health Checkup," Jane Manners, Brill's Content, February 2000, p. 114-166 (which is unfortunately in hard copy only.) Manners concentrated on the qualifications of the editorial staff, and the potential conficts of interest with sponsors.

For a further discussion on the influence of sponsors on web sites, see "Do Sponsors Sway Health Web Sites? Corporate pressure denied, but U.S. watches closely," Marilyn Chase, Wall Street Journal, 8 February 2000. The Food and Drug Administration, and Federal Trade Commission, have been monitoring web sites, and applying the standards of continuing medical education programs.

--Norman Bauman

A. Media Metrix Top 10

The Media Metrix web site lists the top web sites in several areas, but not in health or medicine. They did however prepare a recent report on health-related sites for a client, and Anthony Adorno kindly gave me the top ten.

Unique Visitor Numbers for Health Sites October 1999 Source: Media Metrix, October 1999

AOL Health channel
3,590,000 unique visitors.
drkoop.com
2,495,000.
onhealth.com
1,444,000
nih.gov
1,416,000
healthshop.com
1,332,000
webmd.com
1,395,000
mothernature.com
1,322,000
drugstore.com
1,161,000
planetrx.com
1,110,000
thriveonline.com
1,095,000

Media Metrix (which does for the Internet what the Nielson does for TV) uses a panel of 52,000 Internet users who install special software on their computer that tracks every online move they make. These are unduplicated, unique visitors who visited the site once in a given month.

B. Jupiter Communications

On its web site, Jupiter announced the publication of a new report, "The Online Consumer Health Industry: Revenue Forecast and Competitive Landscape, November 1999 . I called Jupiter to try to talk to the author, analyst David Restrepo. I couldn't get him, but after persistent calls a Jupiter corporate communications specialist kindly emailed me a few chapters of an earlier (July) report. Feel free to send me questions you would like me to ask a Jupiter analyst if I ever get through to one. (And I will.)

Jupiter apparently did a diligent job of sorting it all out and collecting at least the business and financial details of the major web sites that supply health information to consumers (some of which also supply .information to doctors).

Jupiter organized the market into 9 categories:

Health information sites, which is the magazine model. I have abstracted their list of the largest sites with urls below. Most of these sites have "Content providers," such as Reuters , AP, government sources (like FDA Watch and Donna Shalala speeches), medical information vendors like American Institute for Preventive Medicine and Nidus Information Services, Inc. , and on-line versions of published reference books like the Rush-Presbyterian-St. Luke's Medical Center Encyclopedia . Many of the information sites use the same content providers, and many of the web sites are also content providers to other web sites (which is why so many of the health web sites look alike). The traditional market for many of these suppliers has been managed care companies and employee assistance plans, so (in my opinion) they tend to avoid controversy, or anything that could encourage a patient to second-guess his or her doctor. Their loss is our gain--useful patient information is often controversial, so independent medical journalists can run circles around the canned content providers. For a British analysis, see "Sharing decisions with patients: is the information good enough?" BMJ 30 January 1999;318:318-322 .
As noted below, some sites are publicly-traded on the stock market, and so are required by law to file detailed and uncharacteristically candid business plans, usually including extensive market analysis, with the Securities and Exchange Commission. These documents are available on-line at the SEC's Edgar database . Form S-1 and Form 10-K are usually the most useful.
"Aggregators and Portals," namely AOL, Excite, Go Network, Lycos, MSN.com, Snap, and Yahoo. Their opening pages offer news and links to other services, including medical information. More than 50% of users start their health-related searches with general search sites, and only 21% start with health-specific sites. That makes portals particularly important to advertisers. As portals develop closer links (literally) with the health sites, the distinction between the portal and the sites blurs--for example, MSN.COM's relationship with WebMD and MSNBC. (However, the WebMD page you reach from the MSNBC link is not the same page you reach from WebMD directly.)
"Content and Tool Syndicators," who supply medical information and "tools" like medical record applications. Some services, like HealthScout (in New York City), HealthNotes (Portland, OR) and WellMed (Portland, OR), listed below, also employ writers. (But there are far more content providers than these 3 listed in the Jupiter report.)
Drug store chains, which sometimes provide health content from sources like Reuters or Vitamin Facts.
"Pure-play retailers," which sell health products, nutraceuticals and sometimes prescription drugs exclusively on-line, and all have on-line content, either in-house or syndicated. I have abstracted the Jupiter list below.
Fitness and weight-loss centers.
HMOs and managed care systems, which often provide their own content.
Over-the-counter drug advertisers. This was not a very active market. Whitehall Robbins and Schering-Plough spent a "paltry" amount, less than $600,000 each, on several product web sites in 1998, Jupiter concluded.
Direct-to-consumer prescription drug advertising . Schering-Plough spent more than any other on-line marketer, $2.4 million of its $203 million total advertising for Claritin (loratadine), which had $1 billion in sales.

Table: Health Information Sites

Source: Jupiter Communications: Health: 2Q99 Competitive Landscape Analysis 7/99 (Yes, the Media Metrix numbers are inconsistent) (My own comments are in parentheses.)

OnHealth
Media Metrix: 899,000
Public
Content Partners Massachusetts Medical Society, Scripps, Beth Israel.

Thrive Online
Media Metrix: 852,000
Content mostly created in-house, also Reuters, Medical Data Exchange

InteliHealth
Media Metrix: 760,000
Partnership between Aetna and Johns Hopkins; selling products directly

DrKoop.com
Media Metrix: 777,000
Public

Mayohealth.org
Media Metrix: 755,000
All content by Mayo Foundation

Mediconsult
Media Metrix: 663,000
Public
Ontario, Canada

Adam.com
Media Metrix: Fewer than 200,000
Public
Content proprietary plus Reuters, UCSF, Multum

The Health Network
Media Metrix: Fewer than 200,000
Part of Fox Entertainment

Medscape
Media Metrix: 486,000
Public
(CBS HealthWatch is the consumer site; they pay $450-700 for a 900-word story.)

Healtheon/WebMD
Media Metrix: 516,000
Public
(WebMD lists its content sources , although most of the news is now done by its own staff or contractors. They have long-term relationships with writers, they supply lots of work, and payment works out to a rumored $350 for a physician story, with another $150 for a consumer version, on tight deadlines. The quality is very high. Reporters come from physician publications like Medical Tribune and the New York Times, and WebMD is probably the best place on the web to find a professional-level news story the same day.) (For more background see The Industry Standard, 11 November 1999, "Healtheon-WebMD Greets Changed Market" .)

AmericasDoctor.com
Media Metrix: Fewer than 200,000
Public
Content from CenterWatch, AP, Clinical Reference Systems, Medical Advisory Systems

Health specialties on more general sites:

iVillage Network/Better Health
Media Metrix: 4,000,000 (iVillage Network)
Public

Healthy Ideas
Media Metrix: 1,900,000 (Women.com Network)
Relationship with Prevention Magazine

CondeNet/Phys
Media Metrix: 1,300,000 (CondeNet Network)
Content from Conde Nast publications

DiscoveryHealth.com
Media Metrix: 1,200,000 (Discovery Network)
(See a presentation about the parent Discovery Channel.)
Content includes InteliHealth, Johns Hopkins, NYT Online, Reuters, AP

Table: Content and Tool Syndicators

HealthScout
38 West 21st St.
New York, NY 10010
(212) 479-3396
General Manager, Robert Gordon
(See About HealthScout .) Staff: 43, including reporters from major newspapers. (The editorial advisory board includes Wallace Sampson, MD, editor of the evidence-based Scientific Review of Alternative Medicine.) (Has recently paid freelancers $100 for a 750-word story.)

HealthNotes
Portland, OR
"Health content syndicator; content covers health conditions, nutritional supplements, herbal and homeopathic remedies, diets and therapies, and drug interactions"
Staff: 30+

WellMed
Portland, OR
Health profiling tool, customized news feeds, electronic medical records
Staff: 47

MedicaLogic
Electronic medical record software used by physicians
Public

Table: Pure-Play Retailers

MotherNature.com
Media Metrix: 1,349,000

drugstore.com
Media Metrix: 980,000
Public

HealthShop
Media Metrix: 969,000

PlanetRx
Media Metrix: 560,000
Public

Rx.com

GreenTree

eNutrition

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